Healthy medicine in a healthy body

The Ministry of Health of the Russian Federation proposes to allow medical rehabilitation of Russians at home using telemedicine. Distance classes, according to the department, will be useful for patients who live far from the medical facility and have restrictions on movement. Clinics will also benefit: in this case, the practice of visiting rehabilitation specialists to the patient is “not appropriate”. The Ministry of Health has been expanding the availability of rehabilitation assistance since 2022. The number of Russians in need of it, including NWO participants, is also growing.

The Ministry of Health has prepared a procedure for organizing medical rehabilitation at home, including the possibilities of telemedicine. If the medical organization has the appropriate license, but the state does not have a rehabilitation team, the clinic can attract an outside doctor and organize consultations using telemedicine technologies. In addition, distance learning may be useful if the patient lives in a remote location or has movement restrictions. The explanatory note clarifies that in most subjects of the Russian Federation with a long territory and difficulties in transport communication, it is “not advisable” to use an on-site rehabilitation service, since most of the specialists’ working time will be spent on the road, and besides, it is “extremely costly”.

Rehabilitation at home, including using telemedicine, will only be possible for non-severe patients with a score of 2 (mild) and 3 (moderate) points on the rehabilitation routing scale – after these services could already be provided in an outpatient setting . We are talking about patients in need of recovery after a stroke, heart attack, injury, surgery or due to chronic illness.

In the document, the Ministry of Health prescribed both understandable in the use of telemedicine (for example, physiotherapy exercises, tonometry, pulse oximetry, history taking), and procedures that are difficult to do without the personal presence of a doctor (palpation, therapeutic massage, examination of the functions of the nervous system). Patients will be provided with sports equipment (dumbbells, fitballs, Nordic walking sticks), as well as measuring devices (pulse oximeters, dynamometer), walkers and canes.

The Ministry of Health clarifies that “extensive positive experience” in the implementation of telerehabilitation was obtained both in Russia and in other countries during the COVID-19 pandemic. According to the agency, over the past three years in the Russian Federation, several thousand patients have undergone medical rehabilitation using telemedicine technologies. The process showed high efficiency for different categories of patients. The Ministry of Health believes that the only limitation in the widespread introduction of telerehabilitation is the possible lack of “sustainable Internet access”, a computer (laptop, tablet) for patients, as well as the difficulties that older people may encounter in mastering the technology.

“Over the past few years, we have repeatedly made proposals to expand the use of telemedicine, including in rehabilitation, as well as immersing telemedicine into the system of state guarantees,” commented Yury Zhulev, co-chairman of the All-Russian Union of Patients, on the initiative. In his opinion, there should be no difficulties with the use of remote services for rehabilitation, since relevant experience has already been accumulated in this area. For example, with patients with multiple sclerosis, doctors have previously done gymnastics remotely.

Alexander Komov, General Director of the Doctor Near Holding medical technology group, believes that providing the rehabilitation in question is not only an important task in the process of returning the patient to an active full life, but also an extremely urgent social problem. “Unfortunately, today many patients, leaving a hospital or a rehabilitation clinic, are left without the necessary support. Of course, telemedicine can solve this problem to a large extent. That is, it is not so much about replacing face-to-face visits, but about providing support to those patients who need it, but do not have access to it,” says Mr. Komov. He notes that in a number of private clinics and rehabilitation centers such support is already being implemented – patients remain in touch with the curator even after discharge, undergo regular monitoring of indicators and consultations.

The Ministry of Health is consistently expanding the availability of rehabilitation. In December, the department adopted new rules, according to which adult patients will be able to provide assistance in this profile not only in specialized centers, but also in physiotherapy exercises, massage and physiotherapy rooms. In addition, the ministry relaxed the requirements for equipping specialized medical rehabilitation departments and allowed staff to carry out procedures without taking additional advanced training courses.

Medical rehabilitation, as reported by Medvestnik, became the leader in the growth of budget expenditures in the healthcare sector: it was assumed that 10 billion rubles would be allocated for it in 2023, and 19.8 billion rubles were allocated. Of this amount, 10 billion rubles. will go to the transfer to the Federal Compulsory Medical Insurance Fund to pay for medical care, 8 billion rubles – to equip medical organizations, another 1.8 billion rubles. included in the salaries of medical staff. The draft program of state guarantees indicates that the standard for the profile “Medical Rehabilitation” includes “expenses for the provision of medical care to participants in a special military operation in Ukraine.” In December, the Minister of Labor of the Russian Federation Anton Kotyakov announced that the rehabilitation of all members of the SVO who, due to an injury, left the service, was transferred from the jurisdiction of the Ministry of Defense to civilian medical institutions. And in January, Vladimir Putin instructed the Ministry of Health, together with the defense department, to work out the possibility of connecting civilian hospitals to the provision of medical care and rehabilitation of the wounded during the SVO.

Natalya Kostarnova