Early detection of malignant neoplasms, treatment and dispensary monitoring of cancer patients is undoubtedly one of the most important factors in ensuring effective, high-quality treatment. Much of this depends upon coherence between structure and work organization of primary oncological service setting that monitors disease incidence and the administrative and structural organization of the medicalpreventive establishments (LPZ) of the region. Equally important is the sufficient number of doctors and nurses supplying the primary care setting.
The dynamic changes that took place in health service of Ukraine in general, and in Kyiv, in particular, prompted the city’s cancer service to find the most effective workplaces on local level. Based on the foregoing, the changes that were taking place over the last twenty-five years in the oncologists’ work organization of the primary setting become perfectly clear.
Until 1990 the dispensary unit united all oncologists of the city and was a structural subdivision of the Kyiv City Oncology Dispensary. The doctors of the department were subordinated to the chief physician of the dispensary. Such an organization of the oncologists’ work was somewhat one-sided and caused some difficulties in the implementation of the appropriate administrative measures in the area.
With the opening of the Kyiv City Oncology Center (KCCOC) in 1990, the dispensary was inactivated, and district oncologists were transferred to territorial medical associations (TMOs). District oncologists were appointed by the district administration and were subordinated to the heads of TMOs. At the same time, KCCOC carried out only organizational and methodological management, and the district oncologist, in his turn, faced difficulties in ensuring work sequence of TMO and KCCOC. The insufficient proportion of clinical practice in the oncologists’ work led to the loss of personnel potential.The positions of oncologists were occupied mainly by the retired employees and working associates.
Today, the cancer service of the city is working according to a new schedule. In accordance with Order No 145 of the Kyiv City Medical Center as of April 13. 01.2005 “On the Improvement of the Management System of the City Medical Center” a dispensary department, consisting of 10 district oncologists, was established in Kyiv City Oncology Hospital (KCOH). The same order regulates the double subordination of the district oncologist to the chief physician of the KCOH, the chief freelance oncologist of GUOZ and the head of the health department of the district state administration (UOZ RDA). At the same time, district oncologists hold consultations with patients and provide organizational and methodological guidance to the oncological services of the district in LPZ UOZ RDA; and they have the opportunity to directly carry out pre-examination and treatment of oncologic patients from their area in inpatient departments of Kyiv City Clinical Oncology Center (KCCOC).
The combination of organizational activity in the district and the clinical work at KCCOC made the position of district oncologist more attractive for physicians.As a result, during 16 years of work we managed to complete all positions of district oncologists with young specialists, who combined dispensary work with a clinical one, mastered all methods of special treatment for cancer patients.
During 16 years of the dispensary departments lifetime 12 oncologists were transferred to other departments of KCCOC on request due to their high professionalism and a qualified approach to the treatment of cancer patients.