Lecture: organization of treatment and preventive care for the population of the Russian Federation plan. Treatment and preventive care for the population

Healthcare as a system of treatment-and-prophylactic, anti-epidemic, rehabilitation medical measures, institutions of state and municipal ownership has a sectoral structure, a set of activities of structures - elements of the system. It includes industries:

therapeutic and preventive (outpatient clinics, dispensaries, etc.);

medical care for women and children;

sanitary and anti-epidemic;

medical - pharmaceutical industry, pharmacies and enterprises;

medical education and medical science - higher and secondary medical and research institutions;

sanatorium and resort institutions;

pathoanatomical, forensic and forensic psychological examinations;

compulsory health insurance (CHI). These organizations (types of institutions) form the basis

Primary health care and social care

Primary health care (PHC) and related institutions are the area of ​​first contact of the population with health services. These include:

outpatient clinics;

antenatal clinics;

sanitary and epidemiological stations;

ambulance and emergency care institutions;

maternity care institutions.

WHO has developed the “Health for All by the Year 2000” strategy, which would enable every person and every family to lead a healthy, socially and economically productive lifestyle. The implementation of this strategy is possible through primary health care and social care in appropriate institutions.

In 1978, the largest international conference was held in Almaty, at which the concept of primary health care was developed and the corresponding resolution was adopted - the Alma-Ata Declaration.

The most numerous institutions in which primary health care and social care are provided are outpatient clinics; In them, primary health care is provided by local and shop doctors (therapists, pediatricians), general practitioners (family doctors), as well as paramedical workers in paramedic and paramedic-obstetric stations.

The primary health care system should provide only curative, but also preventive work, as well as the organization of medical care for the assigned population.

Currently, in our country, primary importance is given to outpatient clinics, which account for 80-90% of all visits. By 2005, primary health care in Russia

This strategy and related programs have been continued by WHO into the 21st century.

provided about 16,000 outpatient clinics, which employed about 60,000 doctors, including over 45,000 local therapists and 30,000 local pediatricians; There are still few general practitioners - a little over 4 thousand..

The number of surgical interventions performed in clinics increased in 1990-2005 by more than 20%, amounting to 6.0 million in 2005. The number of visits per resident per year (including ambulance and emergency medical care) decreased from 11.0 in 1985 to 9.0 in 2005

The functions of a general (family) practitioner are much broader than the responsibilities of a local therapist and pediatrician and include some of the services provided by medical specialists. The priority development of primary health care and the introduction of a general practitioner is associated with the improvement of medical care for the population of the Russian Federation. A consistent increase in the number of GPs is planned (up to 7.5 thousand in 2007).

General Practitioner Introduction Functions:

ensuring the volume and quality of outpatient medical and preventive care provided to the population;

increasing the availability of the most common services included in the structure of specialized care;

studying the conditions and lifestyle of family members.

General practitioners (family doctors) are required to carry out dynamic monitoring of all family members and carry out preventive measures in a timely manner.

Up to 95% of surveyed doctors and patients supported the advisability of treating all family members by the same doctor, considering the work of such a doctor to be more effective compared to the work of a local doctor. When working as a general practitioner (family doctor), the number of referrals for consultations with doctors of other specialties, the number of examinations is reduced, attention to the health of all family members is increased, and time is saved for patients and the doctor.

To improve the work of general practitioners (family doctors), it is useful to study the experience of such activities in countries where this is a traditional health service (France, Great Britain, Cuba, etc.)

Organization of outpatient care

Outpatient care is provided by outpatient clinics and clinics that are part of hospitals, independent city clinics, rural medical clinics, dispensaries, highly specialized clinics (dental, physiotherapy, etc.), antenatal clinics, health centers and medical and obstetric centers. There are more than 16,000 outpatient clinics in the country; the number of visits to doctors there annually exceeds 1.0 billion. On average, there are 9.0 visits to doctors per 1 city resident (2005). Almost 80% of all those who seek medical help begin and complete treatment in a clinic.

Among outpatient clinics, the leading ones are the clinic and outpatient clinic, which make up more than 75% of non-hospital institutions, and the number of medical visits in them is about 85%.

Clinic- this is a specialized health care facility that provides medical care to visiting patients, as well as patients at home, and carries out a set of therapeutic and preventive measures to treat and prevent diseases and their complications. The city population is mainly provided with assistance by the city clinic. If the clinic is intended exclusively or mainly to provide medical care to workers of industrial enterprises, construction organizations and transport enterprises, then it is considered a medical and sanitary unit (or the main division of a medical and sanitary unit).

Outpatient clinic differs from a clinic in the level of specialization and scope of activity. The outpatient clinic provides consultations in one specialty or a small number of specialties: therapy, surgery, obstetrics and gynecology, pediatrics, etc.

Polyclinics are distinguished by the organization of work (integrated with a hospital and unintegrated - independent), by territorial basis (urban and rural), by profile (general for serving adults and children and clinics serving only adults or only children, specialized: dental, physiotherapeutic , resort, etc.).

Are the activities of clinics regulated by the Order of the USSR Minister of Health? 1000 “On measures to improve the organization of work in outpatient clinics” (1981) with subsequent amendments.

Facility capacity and staffing levels are determined based on the population served and the expected number of visits. Based on the number of medical visits per shift from 1200 or more to 250, 5 groups of polyclinic institutions are distinguished, staffing is calculated, the organizational structure is determined, and financial authorities monitor the implementation of the so-called planned volume of work.

The main structural units of the city clinic:

management of the clinic (chief physician, his deputies);

registration desk with information desk;

treatment and preventive departments: therapeutic, shop therapeutic, surgical, traumatological, dental, dental, ophthalmological, otorhinolaryngological, neurological, physiotherapy departments (offices), rehabilitation and exercise therapy department; cardiology, rheumatology, endocrinology rooms, infectious diseases room, antenatal clinic; medical and paramedic health centers, dispensary department, emergency department, etc.;

auxiliary diagnostic units: X-ray department (office), laboratory, department (office) of functional diagnostics, endoscopy room, accounting and medical statistics office, administrative and economic part, etc.

By decision of the management, other units can be organized in the clinic: short-term inpatient departments (wards), so-called day hospitals, as well as health centers, a department of alternative methods of treatment based on paid medical services and self-supporting activities, etc.

The city clinic, organized in cities, workers' settlements and urban-type settlements, bases its work on local-territorial principle. Attached employees of industrial enterprises, construction organizations and enterprises

transport are serviced according to the workshop (production) principle. Doctors and nurses are assigned to each site and provide assistance to the population of the site. Therapists, pediatricians, obstetricians-gynecologists, phthisiatricians and, if possible, other specialists work according to the local principle.

The most widespread type of outpatient care is therapeutic, organized on a local basis. Medical therapeutic area is the most important link in the medical care system, and the local therapist is the leading figure in the district and in the public health system. The number of adult population in a therapeutic area currently averages 1,700, in a workshop area - 1,600 people (in a number of industries, depending on working conditions in workshop areas - up to 2,000 people and less than 1,000 people).

District doctor is not only a clinician, but also a healthcare organizer at the primary health care stage. A local doctor needs knowledge of the basics of public health and healthcare, clinical medicine, sociology and family psychology. The local doctor must be a researcher of the health status of the population of his area and the factors influencing it, must improve his activities, introduce new methods of diagnosis and treatment, elements of the scientific organization of work.

A good local doctor is essentially a general practitioner.

In accordance with the regulations “On the general practitioner of a local clinic (outpatient clinic),” the local general practitioner is obliged to provide:

timely qualified therapeutic assistance to the population of the site in the clinic (outpatient clinic) and at home;

emergency medical care for patients, regardless of their place of residence, in the event of direct contact in the event of acute conditions, injuries, poisonings;

timely hospitalization of therapeutic patients with mandatory preliminary examination during planned hospitalization;

consultation of patients, if necessary, together with the head of the therapeutic department, doctors of other specialties of the clinic (outpatient clinic) and other health care institutions;

the use of modern methods of prevention, diagnosis and treatment of patients, including complex therapy and rehabilitation treatment (medicines, diet therapy, physical therapy, massage, physiotherapy, etc.);

examination of temporary disability of patients in accordance with the current regulations on the examination of temporary disability;

organizing and conducting a set of measures for medical examination of the adult population of the site (identification, registration, dynamic observation, medical and health measures), analysis of the effectiveness and quality of medical examination;

organizing and conducting preventive vaccinations and deworming of the population of the site;

early detection, diagnosis and treatment of infectious diseases, immediate notification to the head of the therapeutic department and the doctor of the infectious diseases office about all cases of infectious diseases or patients suspected of infection, about food and occupational poisoning, about all cases of non-compliance with anti-epidemic requirements by infectious patients, referral to the appropriate department of the SES emergency notification of an infectious disease;

systematically improving the qualifications and level of medical knowledge of the district nurse;

active and systematic implementation of medical and educational work among the population of the site, the fight against bad habits.

The local therapist works according to a schedule approved by the head of the department, which provides for fixed hours for outpatient visits, home care, preventive and other work. The distribution of time for reception and assistance at home depends on the size and composition of the population of the site, on the current attendance, etc.

The work of a local therapist in a hospital outpatient department is based on a rotating system (work in the outpatient clinic, on the site and in the hospital).

To improve their qualifications, local doctors are sent to institutes (faculties) of postgraduate education, to advanced training and specialization courses at medical higher educational institutions, and research institutions at least once every 5 years.

Preventive work consists, first of all, in the widespread use by doctors of outpatient clinics, especially local therapists, dispensary method. This is an active method of dynamic monitoring of the health status of certain contingents (healthy and sick) of the population for the purpose of early detection of diseases, registration and comprehensive treatment of patients, carrying out measures to improve working and living conditions, to prevent the occurrence and spread of diseases, and the formation of a healthy lifestyle .

In modern conditions of developing specialization in medicine, a local doctor is more prepared for a “holistic” understanding of the patient than a “narrow” specialist, since he observes the patient in a social environment: at home, in the family, on weekdays and holidays, sees his life, often work, relationships, knows his budget, family atmosphere. In addition, the local doctor compares and synthesizes the opinions of specialists, and together with them draws up a treatment plan for patients in the district.

Thus, we have created the conditions for the development of the concept of a “family” doctor, who has knowledge not only of the pathology of internal organs, but also of a number of other specialties and is capable of providing primary health care.

Registry- a structural unit of the clinic where people make appointments with doctors. Registry employees may be persons with secondary education and trained by the institution to perform their duties. Predominantly persons with secondary medical education are appointed to the position of registry managers.

The registry can be centralized, when it is single for the institution, and decentralized, when there are several registries and they make appointments with pediatricians, dentists, obstetricians-gynecologists, etc. A number of clinics practice self-registration of patients for appointments with doctors. To do this, on special tables there are coupons for appointments with different doctors on different days of the week and at different times. The patient chooses an appointment time that is convenient for him and comes to the appointment with an outpatient card, which is kept at his home. The doctor can give the patient an appointment ticket at the appointment.

Specially designated registrars make appointments with doctors in workshop areas, draw up sick leave certificates issued by doctors, and register calls from doctors to patients at home. One of the registrars is assigned the functions of a help desk employee.

An outpatient medical record is a single document; it records the diseases for which the patient goes to the clinic, which helps the doctor correctly and timely diagnose and prescribe treatment. To make it easier for the doctor to get acquainted with the diseases the patient has suffered, diagnoses are recorded on the first page of the outpatient card - in the list of updated diagnoses.

Next to the registration desk, the names of the streets that make up the areas of the clinic's service area, the names of offices and departments, indicating the floor, room number, work schedule of each doctor, etc. are posted on stands in a prominent place.

Medical care at home- one of the main activities of the clinic. Medical care at home is provided around the clock: from 9 a.m. to 7 p.m. - by a local doctor, the rest of the time in emergency cases - by an ambulance and emergency doctor.

When a doctor is called to your home, the patient’s condition is clarified, and in emergency cases, the doctor on duty (in the absence or busyness of the local doctor) goes to the patient immediately. In emergency cases requiring hospitalization, an ambulance is called. Call data is recorded in a log. Subsequent visits by a doctor to a patient at home are called active if they are made on the initiative of the doctor, without calling the patient.

The doctor ensures that clinical diagnostic studies are carried out, the nurse performs therapeutic procedures, and consults the patient with doctors of other specialties.

In all cases in which hospitalization is indicated, patients are sent to a hospital inpatient unit. In the absence of indications for hospitalization or in case of organizational difficulties, the local doctor organizes care for the patient at home - hospital at home. For this purpose, members of the Red Cross Society - activists, sanitary commissioners and nurses - may be involved. In clinics combined with a hospital, it is possible to organize meals from the hospital kitchen and issue linen and patient care items for temporary use.

For a number of diseases, patients treated in outpatient clinics and at home are given prescriptions for free medications. A special order defines such groups of patients. The doctor's workload for home care is calculated in each institution based on the actual time spent. To provide care to patients at home, clinics supply doctors with special medical bags with a set of devices, tools and medicines. The same bags are provided to nurses at the sites. Nurses visit patients who are scheduled for medical procedures or who should be visited for clinical monitoring purposes.

Plays an important role in the activities of clinics head of the department. It is appointed for at least 9 medical positions in the therapeutic department and 8 in the surgical department. With a smaller number of positions, one of the specialists serves as the head of the department.

The functions of the head of the department include drawing up, together with the doctors of the department, a schedule and plan for treatment and preventive work, management and control over the organization of the treatment and diagnostic process, its quality and effectiveness, examination of temporary disability, etc. The head of the department performs this work, periodically participating in appointments with doctors , visiting patients at home when necessary. The head of the department becomes familiar with maintaining medical records; carries out, together with doctors, an examination of the temporary disability of patients, evaluates the quality of medical care provided to patients. Important functions of the head of the department are advanced training of medical personnel, holding conferences, classes on mastering modern diagnostic methods and mastering the technique of various medical procedures, systematic examination of the quality and effectiveness of the diagnostic and treatment work of doctors.

The clinics have the following operational and accounting documentation:

Outpatient medical record;

Statistical card for registering the final (refined) diagnosis;

Emergency notification of an infectious disease, food, acute, occupational poisoning, unusual reaction to vaccination;

Voucher for an appointment with a doctor;

Doctor's house call record book;

Work diary of a doctor at a polyclinic (outpatient clinic), dispensary, consultation;

Dispensary observation checklist;

List of persons subject to targeted medical examination;

Summary list of diseases subject to dispensary observation;

Certificate of incapacity for work;

Referral card for hospitalization;

Referral to consultation and auxiliary offices;

Medical death certificate;

Journal of infectious diseases;

Journal for recording the conclusions of the VKK;

Book of registration of certificates of incapacity for work;

Recipe (adults, children);

A prescription for a medicine containing a narcotic substance;

A prescription for a medicine is free, with payment of 50, 20% of the cost, etc.

With the introduction of health insurance, some clinics use a single outpatient card, in which visits, treatment and medical services are immediately registered. The latter are encrypted using the ICD.

As a structural unit in the clinic, they organize medical statistics rooms, directly subordinate to the chief physician or his deputy for medical work, for:

Organizations of statistical accounting;

Control over the maintenance of documentation and the reliability of the information contained in it;

Drawing up consolidated accounting documents;

Preparation of periodic and annual statistical reports;

Development of accounting and reporting statistical documents;

Participation in the analysis of the institution’s activities based on these developments;

Rational organization of storage of current year accounting documents.

The Medical Statistics Office works closely with all structural divisions of the clinic and doctors.

The most important document is the annual statistical report, which is submitted to a higher healthcare authority within the established time frame.

Heads of healthcare institutions are given the right to develop individual workload standards for doctors in outpatient clinics (units) depending on specific conditions (demographic composition of the population, disability, compactness of areas, availability of vehicles, epidemic situations, etc.). Heads of healthcare institutions are allowed, based on production needs, to strengthen individual structural units or introduce positions not provided for by staffing standards, at the expense of positions in other structural units within the limits of the number of positions and payroll established by the institution, while replacement of positions is allowed in any order .

Industry labor regulations are advisory; staffing standards (11.0 medical positions per 10,000 population) are used as a guide in determining the number of medical personnel positions.

As an example, we can cite the following calculations (they are different in different institutions, in different areas). The estimated time for an initial visit to a local therapist is 22 minutes, for a repeat visit - 16 minutes. The frequency of visits is 2.5. The average time spent on a diagnostic and treatment visit to a clinic is approximately 18 minutes. The norm of workload (service) - the amount of work performed per unit of time (60 minutes) for outpatient doctors (persons per hour) is 3. The planned function of a medical position is expressed in the number of visits to the doctor during the year and is rounded up to 5600 visits. The program of state guarantees of free medical care determined the “indicator of the volume of outpatient care” - the number of visits per 1000 people - 9000 visits, including under the basic compulsory medical insurance program - 8000.

The clinic's doctors work 5 days a week with two days off. Every day, out of a 6.5-hour working day, an average of 0.5 hours is spent on work not related to therapeutic, diagnostic and preventive activities (conferences, meetings, official conversations, necessary personal time, etc.). Thus, the calculation of the number of positions for outpatient doctors is based on the volume of work. The structure of medical positions is determined by the management of the clinic.

The number of middle and junior staff in outpatient clinics is determined depending on the number of medical personnel. The recommended ratio depends on the type of institution and is on average 1:2.2 for city clinics, and 1:(3.5-5.0) for outpatient departments of institutions located in cities and towns with a population of less than 25,000 people ) and depends on the nature of settlement.

Recently, a contract system for hiring employees has been adopted. Remuneration is made according to the tariff scale, taking into account the qualification characteristics (category), in some institutions - taking into account the volume and quality of work performed. The content of the work of employees, offices, and departments is determined by job descriptions.

Unfortunately, there is no single report card for equipping clinics (and hospitals). The institution is equipped depending on the material and technical capabilities and initiative of the management (employees).

The time and organization of work of employees is determined by the management of the clinic, taking into account labor legislation: the clinic must operate 5 days a week (the emergency department is open on Saturday and Sunday).

For 2006 and subsequent years, the national project “Health”, adopted on the initiative of the President of the Russian Federation V.V. Putin provides for significant additions to existing programs and plans in the field of health care, and primarily primary health care. The main directions of the national project “Health” include the development of primary medical care, preventive medical care, increasing the availability of high-tech (expensive) medical care and other important measures. Substantial

but the allocation for the project, especially for primary health care, has been increased. For example, over 68 billion rubles are allocated for development alone for 2 years (2006, 2007). It is planned to increase the number of GPs by 3 thousand, reduce the part-time ratio (to 1.4 and below), increase the level of qualifications of doctors, reduce the waiting time for diagnostic tests, the wear and tear period of diagnostic equipment, additionally equip healthcare facilities with medical equipment, ambulances (more 12 thousand for 2 years). Local general practitioners and pediatricians began to receive 10 thousand rubles in addition to their salaries, and junior nurses under these programs - 3 thousand rubles. per month. The wages of ambulance and emergency care workers have been raised and, in accordance with the plans, the wages of other doctors and medical personnel will be increased. Clinical examination and its financial support are being strengthened - from 2006 and in subsequent years.

Organization of inpatient medical care

Currently (2005) in the healthcare system of the Russian Federation there are about 8.0 thousand (7835) hospital institutions (in 1990 - 12.5 thousand), with 1672.1 thousand beds. The provision of hospital beds decreased from 130.5 per 10,000 population in 1990 to 121.5 in 1992 and 108.2 in 1999, to 95 in 2005.

The average length of stay for a patient in a hospital remained virtually unchanged: 16.6 days in 1990, 17.0 days in 1992 and

15.8 days in 1999, 13.7 in 2005, but the average number of days of bed occupancy increased from 289 to 327. The hospitalization rate decreased: in 1985 it was 24.4 per 100 population, in 1999 - 20.9, and in 2005 - 23.5.

The health crisis has certainly affected hospital facilities as well. This is manifested, first of all, in the fact that a significant part of the bed capacity does not meet the requirements of sanitary norms and rules, and the material and technical base does not allow the treatment and diagnostic process to be carried out in accordance with modern requirements. The bed capacity is in many cases underused and not used for its intended purpose. Bed occupancy in recent years has been significantly lower than the norm and averaged 290-307 days a year; 30-50% of patients did not require hospitalization and could have been examined and treated at the prehospital stage. At the same time, up to 70% of financial, material and technical resources are invested in the development of inpatient medical care.

The introduction of economic methods of industry management, the compulsory medical insurance system and the need to increase the competitiveness of medical institutions contribute to the structural restructuring of healthcare, including inpatient medical care. This reorganization should proceed along the following main directions in accordance with the concept of development of healthcare and medical science (1997), taking into account the intensity of the diagnostic and treatment process.

Organization of hospitals (departments) with high intensity of the diagnostic and treatment process. These are mainly hospitals that provide emergency intensive medical care. These healthcare facilities must be equipped with appropriate medical equipment, have a significantly higher supply of medical personnel, medicines, soft equipment, etc.

The number of beds in such hospitals is up to 20% of the total bed capacity, the average length of stay in them is short, necessary only for the relief of acute conditions; in the future, patients must be transferred to other medical institutions.

Hospitals (departments) focused on the treatment of planned medium-term patients, i.e. for rehabilitation treatment. Accordingly, standards of equipment, personnel and

Such hospitals have different types of support, different average lengths of stay for a patient in a bed, and different staff workloads. The approximate number of beds in hospital facilities of this type is up to 50% of the total bed capacity.

Hospitals (departments) for after-care and medical rehabilitation, mainly for patients with chronic diseases. The number of beds in them is up to 20% of the total bed capacity.

Medical and social hospitals (departments) - nursing hospitals, hospices. Health and social care authorities and agencies may refer patients to such facilities. Such institutions can account for up to 20% of total bed capacity.

At the same time, federal and regional centers for specialized medical care of various profiles will be maintained and developed, in which the latest medical technologies for treatment and diagnostics will be used.

A modern system of hospital care must be ensured by the development of specialization and the introduction of, as a rule, expensive new technologies.

Modern healthcare reform is aimed at intensifying inpatient medical care, reducing (by 20% or more) the number of underutilized beds, reducing the length of stay of patients in bed, transferring part of inpatient care to outpatient clinics, home hospitals and other non-stationary health care facilities (the so-called semi-hospitals or hospital replacements, the share of which reaches more than 15% of all previously provided services in day hospitals, i.e. regular hospitals).

Currently, the international standard defines the optimal size of a general hospital as 600-800 beds, and the acceptable minimum size as 300-400 beds, which makes it possible to deploy hospital beds in 5-7 main specialties and improves their management.

Leading hospital institution - city ​​Hospital- Health care facilities that provide qualified services to the population based on the achievements of modern medical science and technology.

Based on the type, volume and nature of the medical care provided and the organization of work, a city hospital can be:

by profile - multidisciplinary or specialized;

by organization - united or not united with the clinic;

by volume of activity - different categories (bed capacity).

The main task of the city hospital is to provide highly qualified medical and preventive care to the population.

An important section of activity is continuity in the examination and treatment of patients between the clinic and the hospital, which is achieved:

Mutual information between clinic and hospital doctors about the condition of patients referred for hospitalization and discharged from the hospital (sending an extract from the outpatient card to the hospital during hospitalization of a planned patient and an extract from the medical history to the clinic, etc.);

Actively involving hospital doctors in participating in medical examinations and analyzing its effectiveness;

Implementation by hospital specialists of activities to improve the qualifications of clinic doctors (joint clinical conferences, error analysis, consultations, etc.), participation in advanced training of doctors (courses, on-the-job training, etc.).

By profile, hospital institutions are dominated by multidisciplinary or general hospitals, which have departments for various medical specialties. Specialized hospitals, such as, for example, cardiorheumatology, infectious diseases, gastroenterology, pulmonology, dermatovenerology, maternity hospitals, ophthalmology, are usually located in large cities.

Both general and specialized hospitals can be clinical bases of medical schools, universities, academies, and research institutes. For example, on the basis of city hospitals? 15 and? 57 Moscow there are a number of clinical departments of the Russian State Medical University.

A number of specialized medical care centers have been created in the country as scientific, organizational, methodological, treatment and diagnostic associations in important clinical specialties. They are searching for new effective means and methods of prevention, diagnosis and treatment of relevant diseases, developing a rational organization of specialized medical care, and training highly qualified personnel. There are centers for oncology, surgery, cardiology, pulmonology, nephrology, gastroenterology, and maternal and child health.

In terms of work organization, the predominant health care institution is a united hospital, headed by a chief physician. He is responsible for all treatment and preventive, administrative, economic and financial activities of the institution. The chief physician of the united hospital has deputies for medical, outpatient and administrative work. The chief physician organizes and controls the correctness and timeliness of examination and treatment of patients, their care, dispensary services, the implementation of preventive and anti-epidemic measures in the area of ​​​​operation, advanced training of medical personnel, the correctness of maintaining medical histories, and the provision of the hospital with medical and household equipment. He systematically analyzes the hospital's performance indicators, approves the hospital's work plans and estimates, controls the correct use of materials and medicines, is responsible for the sanitary condition of the hospital, and for the selection and placement of personnel.

The deputy chief physician for medical affairs is responsible for the quality of all medical activities of the hospital; directly manages the treatment, preventive and sanitary and anti-epidemic work of the hospital; checks the effectiveness of treatment and preventive measures; analyzes each case of death in hospital and at home; ensures proper organization of therapeutic nutrition and exercise therapy; organizes consultations for patients.

The deputy chief physician for the clinic directly manages the work of the clinic and organizes outpatient care for the population; develops plans for treatment, preventive and anti-epidemic measures of the clinic and ensures their implementation; appoints a control and expert commission and manages its work; organizes dispensary observation of established populations and monitors its quality and effectiveness; systematically studies the morbidity rate of the population in the service area.

The deputy (assistant) chief physician for administrative and economic affairs manages all administrative and economic activities of the hospital, ensures the supply of household equipment and supplies, food, fuel, hot water, lighting, organizes meals for patients, heating, repairs, fire safety measures, linen economy, transport, etc.

Basic statistical accounting forms for hospitals:

Medical record of an inpatient (medical history);

Sheet for registering patients and beds;

Card of a person leaving the hospital;

Sick leave.

These and other accounting statistical forms are used in the preparation of the annual report.

To analyze the activity of a hospital, the average annual bed occupancy, bed turnover, average length of stay of a patient in a hospital, mortality, and the frequency of discrepancies between clinical and pathological diagnoses are calculated.

LECTURE “Organization of medical and preventive care for the population of the Russian Federation” LECTURE PLAN 1. 2. 3. 4. Types of medical and preventive care. Nomenclature and typical categories of healthcare institutions. Organization of outpatient care for the urban population. Organization of inpatient care for the urban population.

The healthcare system is a set of state and public measures of a socio-economic nature to organize medical care, prevent diseases and improve the level of health of the population.

State healthcare system Ministry of Health of the Russian Federation, Ministries of Health of the republics within the Russian Federation, health authorities of the autonomous region, autonomous okrugs, territories, regions, cities of Moscow and St. Petersburg, Russian Academy of Sciences, State Committee for Sanitary and Epidemiological Surveillance of the Russian Federation, medical and preventive and scientific research institutions , pharmaceutical enterprises and organizations, pharmacy institutions, sanitary and preventive institutions, forensic medical examination institutions, logistics services, enterprises producing medical devices and medical equipment.

Municipal health care system, municipal health authorities, medical and preventive and scientific research institutions,

Private health care system, treatment and prevention and pharmacy institutions, persons engaged in private medical practice and private pharmaceutical activities.

1. Types of medical and preventive care Medical and preventive care is a system of providing the population with all types of preventive and curative care. Treatment and preventive care is aimed at meeting the population's needs for all types of highly qualified medical care. Treatment and preventive care is a complex system in terms of the types of care provided and the types of institutions. There are three main types of treatment and preventive care:

TYPES OF TREATMENT AND PREVENTIVE CARE I Curative and preventive care Out-of-hospital Inpatient Sanatorium-resort Outpatient polyclinic (primary health care) care General care Ambulance and emergency medical care Specialized care On-site emergency and planned advisory care

II. According to the peculiarities of organizing assistance to certain social groups of the population: v urban and rural residents v workers of industrial enterprises v children v pregnant women III. v medical v pre-medical IV. v ends up in health care facilities and at home at the place of residence (territorial principle) v at the place of work (production principle)

2. Nomenclature and typical categories of healthcare institutions According to the Appendix to the Order of the Ministry of Health and Social Development of the Russian Federation No. 627 dated October 7, 2005 “On approval of the Unified nomenclature of state and municipal healthcare institutions” (as amended by Orders of the Ministry of Health and Social Development of the Russian Federation dated 10.02. 2007 No. 120, dated November 19, 2008 No. 653 n) medical care in the Russian Federation is provided by the following standard institutions: 1. Treatment and preventive institutions 2. Special type health care institutions 3. Health care institutions for supervision in the field of consumer rights protection and human well-being 4. Pharmacies

1. Medical and preventive institutions 1. 1. Hospital institutions 1. 1. 1. Hospitals, including: local district city, including children's city emergency medical care 1. 1. 2. Specialized hospitals, including: rehabilitation treatment, including children's gynecological infectious diseases, including children's narcological oncology ophthalmological psychoneurological, including children's psychiatric (inpatient) specialized psychiatric (inpatient) specialized observation tuberculosis, including children's resort 1. 1. 3. Hospitals of all types 1. 1. 4. medical and sanitary unit, including the central one 1. 1. 5. Nursing home (hospital) 1. 1. 6. Hospice 1. 1. 7. Leper colony type with intensive care

1. 2. Dispensaries: medical and physical education cardiological dermatovenerological mammological drug addiction oncological ophthalmological anti-tuberculosis psychoneurological endocrinological 1. 3. Outpatient clinics 1. 3. 1. Outpatient clinic 1. 3. 2. Clinics, including: city, in including children's central district dental, including children's consultative and diagnostic, including for children psychotherapeutic physiotherapeutic rehabilitation treatment

1. 4. Centers, including scientific and practical: rehabilitation therapy for internationalist soldiers; restorative medicine and rehabilitation, including for children; geriatric; diabetes; drug rehabilitation; medical, including district; occupational pathology; on the prevention and control of AIDS and infectious diseases; clinical diagnostic; speech pathology and neurorehabilitation; medical and social rehabilitation; general medical (family) practice; consultative and diagnostic, including for children; hearing rehabilitation; physical therapy and sports medicine; manual therapy; therapeutic and preventive nutrition; specialized types of medical care; psychophysiological diagnostics. diagnostic. medical and social examination and rehabilitation of disabled people

1. 5. Institutions and blood transfusion facilities 1. 5. 1. Emergency medical service station. 1. 5. 2. Blood transfusion station. 1. 5. 3. Blood center. emergency medical services 1. 6. Institutions for maternal and child health care 1. 6. 1. Perinatal center. 1. 6. 2. Maternity hospital. 1. 6. 3. Women's consultation. 1. 6. 4. Center for Family Planning and Reproduction. 1. 6. 5. Center for Adolescent Reproductive Health. 1. 6. 6. Children's home, including specialized ones. 1. 6. 7. Dairy kitchen. 1. 7. Sanatorium-resort institutions 1. 7. 1. Balneological hospital. 1. 7. 2. Mud bath. 1. 7. 3. Resort clinic. 1. 7. 4. Sanatorium, including for children, as well as for children with their parents. 1. 7. 5. Sanatorium-preventorium. 1. 7. 6. Year-round sanatorium health camp. help

2. Special type healthcare institutions 2. 1. Centers: - medical prevention; - disaster medicine (federal, regional, territorial); - medical mobilization reserves "Reserve" (republican, regional, regional, city); - licensing of medical and pharmaceutical activities (republican, regional, regional); - quality control and certification of medicines; - medical information and analytical; - information and methodological on examination, accounting and analysis of circulation of medical products; - medical inspection; - medical biophysical (federal). 2. 2. Bureau: - medical statistics; - pathoanatomical; - forensic medical examination; 2. 3. Control and analytical laboratory; 2. 4. Military medical commission, including the central one; 2. 5. Bacteriological laboratory for the diagnosis of tuberculosis.

3. Health care institutions for supervision in the field of consumer rights protection and human well-being 3. 1. Centers for hygiene and epidemiology; 3. 2. Centers for state sanitary and epidemiological surveillance; 3. 3. Anti-plague center (station); 3. 4. Disinfection center (station); 3. 5. Center for hygienic education of the population. 4. Pharmacy establishments 4. 1. Pharmacy. 4. 2. Pharmacy. 4. 3. Pharmacy kiosk. 4. 4. Pharmacy store.

Depending on the capacity of treatment and preventive institutions, their typical categories are established, which contributes to the rational planning of the network and staff of health care institutions. CATEGORIES polyclinics hospitals dispensaries number of doctors number of beds number of doctor visits per job shift

3. Organization of outpatient care for the adult population Outpatient care is the most widespread and generally accessible type of medical care. 80% of all those who seek medical help begin and complete their treatment in a clinic. Outpatient clinics are central to primary health care.

Currently, in the Russian Federation, the number of outpatient clinics in the Ministry of Health and Social Care system is more than 15.3 thousand. The number of visits to doctors there annually is about 1.5 billion. On average, one city resident has 9–10 visits to doctors per year.

Types of medical areas: Therapeutic Pediatric General practitioner Family doctor Complex therapeutic area

Recommended size of the attached population at medical sites: At a therapeutic site - 1,700 adults aged 18 years and older At a pediatric site - 800 children aged 0 - 17 years inclusive At a general practitioner's site - 1,500 adults aged 18 and over older In a family doctor’s area – 1,200 adults and children In a complex therapeutic area – 2,000 or more adults and children

Among medical institutions providing outpatient care to the urban population, polyclinics occupy the leading place. A polyclinic (from Latin polis - city, clinica - treatment) is a multidisciplinary treatment and preventive institution designed to provide medical care to the population at the pre-hospital stage.

Organizational structure of the city clinic 1. Management of the clinic 2. Registration 3. Treatment and prevention units - therapist's office - surgeon's office - otolaryngologist's office - ophthalmologist's office - neurologist's office 4. Prevention department: - pre-medical reception room - women's examination room - medical examination room - office health education and hygienic education of the population 5. Department of rehabilitation and rehabilitation treatment - physiotherapy department (office) - physical therapy room - mechanical therapy room - psychotherapy room - speech therapy room 6. Laboratory - diagnostic departments - x-ray room (department) - clinical and biochemical laboratory - office (department) of functional diagnostics - endoscopy room 7. Office of medical statistics 8. Administrative and economic part

The main objectives of the city clinic are: provision of qualified specialized medical care in the clinic and at home; organization and implementation of preventive measures aimed at reducing morbidity, disability and mortality; carrying out medical examination of the population; organizing and conducting events for sanitary and hygienic education of the population, promoting a healthy lifestyle.

Based on the general tasks of the clinic, the local doctor - therapist (general practitioner) with the local nurse solves their problems: 1. 2. 3. 4. 5. 6. 7. performs preventive work - organizes a set of measures for medical examination of chronic patients; provides qualified therapeutic assistance in the clinic and at home; provides emergency and emergency medical care to patients in the event of injuries, poisoning, acute conditions, regardless of their place of residence; conducts an examination of temporary and permanent disability; organizes preventive vaccinations, early detection of infectious diseases (anti-epidemic work); conducts and organizes rehabilitation treatment; carries out sanitary and educational work.

An important feature of outpatient care is the combination of therapeutic and preventive work. The expression of preventive work is widely used in the dispensary method. Medical examination is a method of active dynamic monitoring of the health status of certain contingents (healthy and sick) of the population with the aim of early detection of diseases, carrying out measures to improve their working and living conditions, restoring working capacity and extending the period of active life.

The main groups of dispensary observation: D I - healthy people who have no complaints, do not have a history of chronic diseases, in whom no changes in individual organs and systems were found during a medical examination, the results of diagnostic and treatment studies are without deviations from the norm. Dynamic monitoring is carried out in the form of annual preventive medical examinations. A general plan of medical, health-improving, preventive and social measures is being drawn up, aimed at improving working and living conditions, promoting a healthy lifestyle and sanitary and hygienic knowledge.

D II - practically healthy individuals with a history of chronic diseases that do not lead to dysfunction of the body and do not affect the ability to work and social activity. The purpose of dynamic observation in this dispensary group is to eliminate or reduce the influence of risk factors, increase the resistance and compensatory capabilities of the body.

D III – persons with a history of chronic diseases leading to severe morphological and functional disorders. Depending on the stage of the disease, this dispensary group is divided into: DIII 1 – persons with chronic diseases in the compensation stage; DIII 2 - persons with chronic diseases in the subcompensation stage; DIII 3 - persons with chronic diseases in the stage of decompensation. The purpose of dynamic observation is to prevent relapses, exacerbations and complications of existing diseases.

INDICATORS OF DISPANSERIZATION OF THE POPULATION 1. Completeness of coverage of the population with medical examinations Number of persons examined x 100 Number of persons subject to examination (Form 30) 2. Frequency of diseases first identified during medical examinations Number of diseases first identified during medical examinations X 1000 Number of persons examined (Final Act based on the results of periodic medical examination) 3. Completeness of coverage of the population with dispensary observation Number of persons registered with dispensary at the end of the reporting year X 1000 Average annual number of the attached population (Form 12 ***PBD) 4. ** Structure of patients registered with dispensary Number patients who are on dispan. registration for this disease at the end of the reporting year x 100 Total number of patients registered at the dispensary at the end of the reporting year (form 12) Note: ** indicators are calculated for individual nosological forms, age and sex groups *** personalized databases

5. Timely registration of patients with dispensary registration Number of patients taken under observation from among those diagnosed for the first time x 100 Number of diseases diagnosed for the first time in life in a given year (Form 12) 6. Percentage of transfer from one group of dispensary observation to another Number persons transferred to a lighter (severe) group x 100 Number of persons registered at the dispensary (Form 12 ***PBD) Note: ***personalized databases

QUALITATIVE INDICATORS FOR EVALUATING POLYCLINIC ACTIVITIES 1. Morbidity 1. 1. General morbidity 1. 2. Primary morbidity 1. 3. Morbidity with temporary disability of workers in enterprises served by medical units and industrial departments of polyclinics. 2. Primary access to disability for workers; 3. Frequency of detection of patients with advanced forms: malignant neoplasms, tuberculosis; 4. Frequency of deaths at home; 5. Complaints from the population.

INDICATORS OF MEDICAL ACTIVITY OF THE POLYCLINIC Indicators of the volume of outpatient care Indicators of staff workload Indicators of clinical examination of the population

INDICATORS OF VOLUME OF OUTPATIENT POLYCLINIC CARE 1. Number of visits per resident per year Number of visits to doctors, including preventive ones Average annual population (Form 30) 2. Proportion of visits made for diseases Number of visits made for diseases x 100 Total number of visits (form 30) 3. Share of visits by doctors at home Number of visits at home x 100 Total number of visits (form 30) 4. Share of preventive visits to the clinic Number of visits to the clinic for preventive purposes x 100 Number of all doctor visits to the clinic (form thirty)

STAFF LOAD INDICATORS 1. Actual average hourly workload of a doctor at a clinic appointment* Number of medical visits to a clinic x 100 Number of hours worked (Form 039/у-02) 2. *Planned function of a medical position Estimated workload of a specialist doctor per hour x planned number of workers hours per year (Municipal order of the institution) 3. Actual function of a medical position * Actual workload of a medical specialist per hour x number of hours worked per year (form 039/у-02) 4. Workload of a medical position (number of visits per medical position per year, month, hour of reception) Number of medical visits in the clinic Number of occupied medical positions (form 039/у-02) Note: * indicators are calculated for individual specialties

The main forms of primary medical records of outpatient clinics: Ø Medical record of an outpatient (form No. 025/у – 04) Ø Voucher for an appointment with a doctor (form No. 025 -4/у – 88) Ø Voucher of an outpatient (form No. 025 - 12/u – 04) Ø Control card for dispensary observation (form No. 030/u – 04) Ø Book of doctor’s notes at home (form No. 031/u) Ø Record of visits to outpatient clinics, at home (form No. 039/u - 02) Ø Work diary of a general practitioner (family doctor) (form No. 039/у - GP)

The main reporting forms for observation of outpatient clinics: Ø Information about the medical treatment institution (Form No. 30) Ø Information about the number of diseases registered in patients living in the service area of ​​the medical institution (Form No. 30) Ø Information about the activities of day hospitals of medical institutions ( form No. 14 - DS) Ø Information about the causes of temporary disability (form No. 16 - VN)

Advantages of outpatient care: 1. Variety of organizational forms (in rural areas - first aid stations, outpatient clinics, GP offices, in the city - clinics, centers, in enterprises - clinics, medical units, health centers). 2. Territorial – local principle in the organization of work. 3. Preventive work using the dispensary method. 4. Proximity to the population. 5. Planned and normative approach: a) 1 general practitioner per 1,700 adults aged 18 years and older; b) 5 patients at the clinic and 2 patients at home per hour - the workload norm; c) 5.9 positions of local therapist per 10,000 population aged 18 years and older.

Disadvantages in the work of the clinic: 1. Duplication of the activities of specialists in the clinic and hospital. 2. A sharp increase in the share of specialized care in the clinic (narrow specialists). 3. Reduced preventive focus in the work of the clinic and specialists. 4. Lack of continuity of clinics and hospitals. Only 30% of 100 who apply to Russian clinics begin and complete treatment with local general practitioners, and abroad – 80.0%. 5. Given the general underfunding of healthcare, clinics are financed using the residual method (30%). 6. Low quality of work of clinics: a) about 15.0% of patients are hospitalized without prior examination; b) late diagnosis, errors in diagnosis are not recorded in clinics: - myocardial infarction - in 20.4% of cases; - acute pneumonia – in 21.0% of cases; - diphtheria – in 60.0% of cases.

4. Organization of inpatient care for the urban population Inpatient (hospital) medical care is the most resource-intensive sector of healthcare. On average, 60–80% of all allocations allocated for health care are spent on the maintenance of inpatient institutions, versus 35–50% in economically developed countries.

Currently in the Russian Federation: Ø Ø Ø 6.5 thousand hospital institutions have been deployed. The total number of hospital beds is 1,373,400. The provision of beds for the population is 96.8 per 10,000 population. hospitalization rate – 22.3%. average annual bed occupancy is 318 days. The average length of stay of a patient in bed is 13.8 days.

A hospital is a medical and preventive institution designed to provide the population with qualified specialized inpatient care. Hospitals: 1. Depending on the number of beds, they can be of different categories: - district hospitals: from 25 to 100 beds - district hospitals: from 100 to 400 beds - regional hospitals from 300 to 800 beds 2. According to the organization of work: - combined with a clinic - not integrated with the clinic 3. By territorial basis: - rural - urban 4. By profile: - multidisciplinary - specialized

The main objectives of the city hospital are: providing highly qualified preventive care; medical-introduction into practice of modern methods of prevention, diagnosis and treatment of patients, taking into account the achievements of science and technology; development and improvement of organizational forms and methods of medical care.

INDICATORS FOR EVALUATING THE ACTIVITIES OF A HOSPITAL Indicators of the provision of population with inpatient care Indicators of bed capacity utilization Indicators of staff workload Indicators of the quality of inpatient care

Indicators of the provision of the population with inpatient care 1. Provision of the population with hospital beds Average annual number of beds (by departments and in the hospital as a whole) X 10,000 Average annual number of the population served 2. Level of hospitalization of the population Patients admitted to the hospital per year x 1000 Average annual number of the population served 3. Structure hospital bed capacity by department (bed) profiles Number of beds of a certain profile X 100 Total number of hospital beds 4. Structure of hospitalized patients by department (bed) profiles Number of patients of a certain profile X 100 Total number of hospitalized

Indicators of bed use 1. Average annual bed occupancy Number of bed days actually spent by all patients Average annual number of beds (form 30) 2. Average length of stay of a patient in a bed Number of bed days spent by all patients Number of people leaving the hospital (discharged + deceased) ( Form 30) 3. Bed turnover Number of people leaving the hospital (discharged + deaths) Average annual number of beds (Form 30)

Personnel workload indicators 1. Average number of beds per 1 doctor position 2. Average number of patients treated per 1 doctor position 3. Average number of diagnostic procedures per 1 doctor position 4. Average number of bed days per 1 doctor position

Indicators of the quality of inpatient care 1. Hospital mortality Number of deaths X 100 Number of people discharged from the hospital (discharged + deceased) (Form 30) 2. Indicator of discrepancy between clinical and pathological diagnoses Number of diagnoses confirmed during autopsy X 100 Total number of patients who died for this reason

3. Pre-daily mortality rate Number of deaths in the first 24 hours of hospital stay X 100 Total number of patients admitted to the hospital 4. Postoperative mortality rate Number of deaths after surgical interventions X 100 Total number of operated patients Note: * indicators are calculated for the hospital as a whole and for departments

The main forms of primary medical records of inpatient institutions Ø Medical record of an inpatient (form No. 003/u) Ø Register of admission of patients and refusals of hospitalization (form No. 001/u) Ø Sheet of daily records of the movement of patients and hospital beds (form No. 007 /у-02) Ø Journal of recording surgical interventions in the hospital (form No. 008/у) Ø Protocol (card 0 of the pathological examination (form No. 013/у) Ø Statistical card of those leaving the hospital (form No. 066/у - 02)

Main reporting forms for statistical monitoring of inpatient medical institutions Ø Information about the medical institution (Form No. 30) Ø Information about the activities of the hospital (Form No. 14) Ø Information about the implementation of the program of state guarantees for the provision of free medical care to citizens of the Russian Federation (Form No. 62)

The day hospital is intended to carry out preventive, diagnostic, therapeutic and rehabilitation measures for patients who do not require round-the-clock medical supervision, using modern medical technologies.

Goals of the day hospital: Ø improving the quality of medical care in outpatient and inpatient settings; Ø increasing the economic efficiency of medical institutions based on the introduction and widespread use of modern resource-saving medical technologies for prevention, diagnosis, treatment and rehabilitation.

Functions of a day hospital Ø Selection of adequate therapy for patients diagnosed with a disease for the first time in their life or for chronic patients with an exacerbation of the process, a change in the severity of the disease. Ø Conducting a comprehensive course of treatment using modern technologies for patients who do not require round-the-clock medical supervision. Ø Implementation of a rehabilitation and health complex of course treatment for sick and disabled people, pregnant women.

Ø Reducing the level of morbidity with temporary disability. Ø Carrying out an examination of the state of health, the degree of disability of citizens and deciding on the issue of referral for a medical and social examination. Ø Carrying out comprehensive preventive and health measures for people at risk of increased morbidity, including occupational ones. as well as long-term and frequent illnesses.

The structure of the day hospital is wards, equipped with the necessary equipment; treatment room; surgical room with small operating room; staff room; room for eating meals for patients (in hospitals)

The goals of the hospital at home are Ø improving the quality of provision of qualified and specialized care to patients while staying at home; ; Ø Development and improvement of new treatment methods aimed at the development of out-of-hospital care and resource-saving technologies.

Functions of a hospital at home Ø diagnosis and treatment of diseases; Ø follow-up treatment of patients after the stage of intensive treatment using modern means and methods of out-of-hospital medical care; Ø relationship and continuity with various treatment and preventive social security institutions.

Structure of hospital at home premises for medical personnel; room for storing mobile equipment, equipment, medicines, and patient care items.

Prevention is a term meaning a complex of various types of measures aimed at preventing any phenomenon and/or eliminating risk factors.

The specific subject content of the concept of prevention has many meanings used to designate different areas of policy, social, collective and individual activities and several types of medical activities. However, the specific objective content of this concept is always action - the ability to promote or hinder the implementation of one or another trend in public health that interests us.

Thus, the general content of the concept of “prevention” can be reduced to activities through which it is possible to achieve the preservation and improvement of individual, group or public health. We can say that this is a set of measures aimed at preventing people from developing diseases, their exacerbations, socio-psychological and personal maladjustment.

Disease prevention is a system of medical and non-medical measures aimed at preventing, reducing the risk of developing deviations in health and diseases, preventing or slowing their progression, and reducing their adverse consequences.

Medical prevention is a system of preventive measures implemented through the healthcare system.

Prevention is a system of government, social, hygienic and medical measures aimed at ensuring a high level of health and preventing diseases.

Preventive measures will only be effective if they are carried out AT ALL LEVELS: state, labor collective, family, individual.

The state level of prevention is ensured by measures to improve the material and cultural standard of living of the population, legislative measures regulating the protection of public health, the participation of all ministries and departments, public organizations in creating optimal living conditions from a health standpoint based on the full use of scientific and technological progress.

Preventive measures at the level of the workforce include measures to ensure sanitary and hygienic control of production conditions, hygiene of the home, trade and public catering, to create a rational regime of work, rest, a favorable psychological climate and relationships in the team, and sanitary and hygienic education.

Prevention in the family is inextricably linked with individual prevention and is a determining condition for the formation of a healthy lifestyle; it is designed to ensure a high hygienic level of housing, balanced nutrition, good rest, physical education and sports, and the creation of conditions that prevent the development of bad habits.

Medical prevention in relation to the population is defined as:

●individual - preventive measures carried out with individual individuals. Individual medical prevention - personal hygiene - scientific and practical medical activity for the study, development and implementation of hygienic knowledge, requirements and principles of maintaining and promoting health into everyday individual life. This concept is also used to determine the compliance of a person’s life with medical and hygienic standards and medical recommendations - conscious active hygienic behavior;

●group - preventive measures carried out with groups of people who have similar symptoms and risk factors (target groups);

●population (mass) - preventive measures covering large groups of the population (population) or the entire population as a whole. The population level of prevention, as a rule, is not limited to medical interventions - these are local prevention programs or mass campaigns aimed at promoting health and preventing disease.

However, the medical-ecological system emphasizes the conventionality of dividing prevention into socio-economic and medical measures and into public and individual. All its numerous components are interconnected by social relations and are revealed in society’s health policy.

Public medical prevention, preventive (preventive, social, public) medicine - scientific and practical medical activity to study the prevalence of diseases, disabilities, causes of mortality in society in order to substantiate socio-economic, legal, administrative, hygienic and other areas and measures of prevention, treatment events.

Reasons requiring increased prevention at the present stage:

1) the type of pathology changes: from epidemic (infection) to non-epidemic;

2) there is an unfavorable course of viral pathology;

3) unfavorable trends in the dynamics of demographic processes;

4) the physical and neuropsychic health of the population (especially children) is deteriorating;

5) the aggressiveness of the environment increases

In preventive medicine, a concept of the stages of prevention has been introduced, which is based on modern epidemiological views on the causation of human diseases. The subjects of application of preventive measures and influences are different stages of disease development, including various preclinical conditions, and the objects are individuals, groups of individuals, separate populations and the population as a whole.

In cases where preventive measures are aimed at eliminating the cause (root cause, etiological factor, etiology of the disease) and/or weakening the action of pathogenetic risk factors for the development of a disease that has not yet arisen (chain of epidemiological causes of the disease), we are talking about primary prevention. In modern epidemiology, primary prevention is divided into primordial prevention and primary specific prevention.

Primordial prevention is a set of measures aimed at preventing risk factors for diseases associated with unfavorable living conditions, the environment and work environment, and lifestyle.

Primary prevention is a set of medical and non-medical measures aimed at preventing the development of deviations in health and diseases, eliminating their causes, common to the entire population, its individual groups and individuals.

The goal of primary prevention is to reduce the frequency of new cases (incidence) of a disease by controlling its causes, epidemiological conditions, and risk factors.

Primary prevention includes:

●Conducting environmental and sanitary-hygienic screening and taking measures to reduce the influence of harmful factors on the human body (improving the quality of atmospheric air, drinking water, structure and quality of nutrition, working conditions, living and recreation, the level of psychosocial stress and other factors affecting the quality life).

●Formation of a healthy lifestyle, including:

Creation of a permanent information and propaganda system aimed at increasing the level of knowledge of all categories of the population about the impact of negative factors and the possibilities of reducing it;

Hygienic education;

Reducing the prevalence of smoking and consumption of tobacco products, reducing alcohol consumption, preventing the use of drugs and narcotic drugs;

Involving the population in physical education, tourism and sports, increasing the availability of these types of health improvement.

●Measures to prevent the development of somatic and mental illnesses and injuries, including those caused by work, accidents, disability and mortality from unnatural causes, road traffic injuries, etc.

●Implementation of medical screening in order to reduce the influence of risk factors and early detection and prevention of diseases of various target population groups through preventive medical examinations:

Preliminary - when applying for a job or entering an educational institution;

Upon registration and conscription for military service;

Periodic - for examination of admission to a profession associated with exposure to harmful and dangerous production factors, or with an increased danger to others;

Inspections of decreed contingents (catering workers, trade workers, child care facilities, etc.) in order to prevent the spread of a number of diseases.

●Carrying out immunoprophylaxis of various population groups.

●Medical examination of the population in order to identify the risks of developing chronic somatic diseases and the improvement of the health of individuals and populations under the influence of adverse factors, using medical and non-medical measures.

Basic principles of primary prevention:

1) continuity of preventive measures (throughout life, starting in the antenatal period);

2) differentiated nature of preventive measures;

3) mass prevention;

4) science of prevention;

5) complexity of preventive measures (participation in prevention of medical institutions, authorities, public organizations, the population).

Primary prevention, depending on the nature of the object, also provides two strategies: population and individual (for high-risk groups), which often complement each other.

With a population strategy, the goal of prevention is achieved by solving the problem of reducing the average risk of disease development (hypercholesterolemia or blood pressure levels, etc.) by carrying out activities that cover the entire population or a large part.

An individual strategy solves another problem - reducing high risk in individuals classified as “risk groups” based on certain epidemiological criteria (gender, age, exposure to a specific factor, etc.).

Secondary prevention is a set of medical, social, sanitary-hygienic, psychological and other measures aimed at early detection and prevention of exacerbations, complications and chronicity of diseases, limitations in life, causing maladjustment of patients in society, decreased ability to work, including disability and premature mortality.

Secondary prevention is applicable only to those diseases that can be identified and treated in the early period of development, which helps prevent the disease from progressing to a more dangerous stage. By early identification of patients based on screening tests (mammography, electrocardiogram, Pap smear, etc.) and their treatment, the main goal of secondary prevention is achieved - the prevention of undesirable disease outcomes (death, disability, chronicity, transition of cancer to the invasive stage).

Secondary prevention includes:

●Targeted sanitary and hygienic education, including individual and group counseling, training patients and their families in knowledge and skills related to a specific disease or group of diseases.

●Conducting dispensary medical examinations in order to assess the dynamics of health status, the development of diseases to determine and carry out appropriate health and treatment measures.

●Conducting courses of preventive treatment and targeted health improvement, including therapeutic nutrition, physical therapy, medical massage and other therapeutic and preventive methods of recovery, sanatorium and resort treatment.

●Carrying out medical and psychological adaptation to changes in the health situation, developing the correct perception and attitude towards the changed capabilities and needs of the body.

●Carrying out measures of a state, economic, medical and social nature aimed at reducing the level of influence of modifiable risk factors, preserving residual working capacity and the ability to adapt in the social environment, creating conditions for optimal support for the life of patients.

The effectiveness of secondary prevention is determined by a number of circumstances:

1. How often does the disease in the preclinical stage occur in the population?

2. Is the duration of the period between the appearance of the first signs and the development of severe disease known?

3.Whether the diagnostic test has high sensitivity and specificity for the disease and is simple, inexpensive, safe and acceptable.

4. Does clinical medicine have adequate medical means for diagnosing this disease, effective, safe and affordable treatment methods.

5. Is the necessary medical equipment available?

Tertiary prevention - rehabilitation (synonymous with restoration of health) - a set of medical, psychological, pedagogical, social measures aimed at eliminating or compensating for limitations in life, lost functions in order to restore social and professional status as fully as possible, prevent relapses and chronicity of the disease.

Targeted tertiary prevention is slowing down the development of complications in an already existing disease.

Its goal is to prevent physical impairment and disability, minimize suffering caused by loss of full health, and help patients adapt to incurable conditions. In clinical medicine, in many cases it is difficult to draw the line between tertiary prevention, treatment and rehabilitation.

Tertiary prevention includes:

●training patients and their family members in knowledge and skills related to a specific disease or group of diseases;

●conducting medical examinations of patients with chronic diseases and people with disabilities, including clinical medical examinations in order to assess the dynamics of health status and the course of diseases, carrying out permanent monitoring of them and carrying out adequate treatment and rehabilitation measures;

●carrying out medical and psychological adaptation to changes in the health situation, developing the correct perception and attitude towards the changed capabilities and needs of the body;

●carrying out state, economic, medical and social measures aimed at reducing the level of influence of modifiable risk factors;

●preservation of residual ability to work and the ability to adapt in the social environment;

●creating conditions for optimal support of the life of sick and disabled people (for example, production of medical nutrition, implementation of architectural and planning solutions, creation of appropriate conditions for people with disabilities, etc.).

Main directions of preventive activities

Personal prevention	Medical prevention	Public prevention
1.Leading a healthy lifestyle: ●rational and healthy nutrition; ●adequate physical activity; ●compliance with work and rest schedules; ●harmonious family and sexual relationships; ●mental hygiene; ●lack of bad habits. 2. Self-monitoring of health status: ●body weight for blood pressure; ●the condition of the skin and visible mucous membranes; ●for the condition of the mammary glands; ●for the menstrual cycle. 3. Compliance with hygiene requirements and standards. 4. Timely consultation with specialists in the field of health promotion and disease prevention.	1.Development of hygienic requirements for environmental conditions. 2. Implementation of environmental and social-hygienic monitoring, development of appropriate recommendations and their implementation within the scope of competence. 3.Conducting individual and group counseling aimed at developing a healthy lifestyle: ●information support; ●hygienic education; ●formation of effective motivation; ●providing assistance and professional assistance in the fight against tobacco smoking, increased alcohol consumption, and the use of drugs and narcotic drugs. 4.Improving the organization and improving the quality of all types of preventive medical examinations, creating motivation for health control. 5. Carrying out clinical examination of the population to identify the risks of developing chronic somatic diseases and improving the health of individuals and populations under the influence of unfavorable health factors using medical and non-medical measures. 6. Carrying out immunoprophylaxis. 7.Health improvement. II.Secondary prevention 2. Conducting targeted medical preventive examinations for early detection 3. Carrying out clinical examination of persons with an increased risk of morbidity, aimed at reducing the level of influence of modifiable risk factors, timely diagnosis of diseases and improvement of health. 4. Conducting courses of preventive treatment and targeted rehabilitation.	1.Development of public health promotion policy. 2. Creation of a favorable environment that determines the quality of life (improving the environmental situation, working conditions, living and recreation, etc.). 3.Increasing social activity. 4.Development of personal skills and knowledge. 5. Reorientation of health services (Ottawa Health Charter, 1986)
	III.Tertiary prevention 1.Targeted sanitary and hygienic education and counseling, training in specific knowledge and skills. 2. Carrying out clinical examination of patients with chronic diseases and disabled people, including medical examinations, observation, treatment and rehabilitation. 3. Carrying out medical and psychological adaptation. 4. Carrying out measures of a state, economic, medical and social nature to preserve health and residual working capacity, the ability to adapt to the social environment, create conditions for optimal support of the life of sick and disabled people

A medical preventive measure is an event or set of measures that has an independent complete meaning and a certain cost and is aimed at the prevention of diseases, their timely diagnosis and improvement.

Types of medical preventive measures:

●preventive counseling for individuals - health education;

●preventive consultation of population groups - health education;

●preventive medical examinations in order to identify early forms of diseases and risk factors and carry out recreational activities;

●immunization; vaccination;

●dispensary examination - dispensary observation and health improvement;

●preventive health measures - classes in various types of physical education, sanatorium-resort treatment, physiotherapeutic medical measures, massage, etc.

One of the most important problems facing practical healthcare to strengthen preventive activities, improve their quality, efficiency and effectiveness is the development of new and adaptation to modern requirements and operating conditions of modern organizational, information and preventive technologies.

Modern organizational, informational, educational and other preventive technologies used or recommended for use:

1.Identification of risk factors(RF) development of chronic non-communicable diseases. One of the most relevant modern preventive areas is the identification of basic and additional risk factors, informing patients about identified deviations and the possibility of their correction using modern preventive, health-improving and therapeutic technologies.

Forms and methods of work (screening technologies from the English screening - “selection, sorting”) - a strategy in healthcare, a population survey aimed at identifying diseases in clinically asymptomatic individuals in the population, as well as the risk of diseases.

The purpose of screening is the early detection of diseases, which allows for early treatment and reduced mortality. There are mass (universal) screening, which involves all persons from a certain category (for example, all children of the same age) and selective screening, used in risk groups (for example, screening family members in the event of a hereditary disease). Assessment and forecast of the total risk of CVD development. Assessing the total risk is necessary to determine the likelihood of developing cardiovascular events in the next 5-10 years.

2.Consultative and health assistance- a type of medical care that includes the provision of medical, information and educational services, issuing recommendations aimed at preventing diseases and promoting health, as well as consulting specialists involved in the management and treatment of the patient.

The goal of advisory and health care is to provide the maximum possible assistance to patients in reducing the impact of modulated risk factors, preventing diseases and their consequences through individual preventive counseling.

3. Diagnosis and prevention of emotional and behavioral disorders.

A fairly significant volume of chronic non-infectious diseases, their course and progression is associated with the presence of psychosomatic disorders. In this regard, many involve medical psychologists who work closely with attending physicians.

4. Information support.

Informatization is the basis that underlies the development, implementation and monitoring at all levels of theory and practice of activities to prevent diseases and promote the health of various population groups, taking into account existing health risks. The current situation indicates the need to systematize and streamline the information support system for preventive activities, determine ways to unify data banks on disease prevention and health promotion, priority areas in solving information support problems, as well as expand opportunities for access to the generated information base and increase the efficiency of its use. Information support is a systematized, comprehensive form of information on a specific area of ​​activity, adapted to the domestic and international information network.

Information resources are individual documents and arrays of documents in information systems: libraries, archives, funds, data banks, and other types of information systems.

Information technology is a set of methods, production and software-technological tools combined into a technological chain that ensures the collection, storage, processing, output and dissemination of information.

Information technologies are designed to reduce the labor intensity of the processes of using information resources.

The goal of data science is to create an information system that can more effectively facilitate the acquisition, use and dissemination of data in support of health for all. Considering that preventive activities are determined by the unconditional priority of the policy and practice of protecting and promoting public health, the formation of information support for preventive activities should become a priority task in the formation of state and industry information policies, and at the level of health care facilities - the basis for creating a unified information space for specialists and the provided population .

5.Hygienic training and education.

The tasks of health education, hygienic training and education of the population (both individuals and various groups and categories of citizens) must be implemented in one form or another by all departments and specialists of health care facilities and prevention departments.

The main goal of hygienic training and education is information for categories of the population about the impact of negative factors on health and the possibilities of reducing it, creating motivation to strengthen and maintain health, increasing personal and group responsibility for health, obtaining knowledge and skills that contribute to maintaining a healthy lifestyle,

6. Coordination of activities to conduct medical preventive examinations and medical examinations of the population.

The main goal of the occupational examination office is to optimize organizational forms for conducting medical examinations and medical examinations of the population in health care facilities. Coordination of activities in this direction of all interested departments and specialists of the clinic and the use of economically and clinically feasible methods to improve the efficiency and quality of this work.

7. Coordination of the activities of departments and specialists of health care facilities to implement targeted programs in terms of health promotion and disease prevention.

A preventive program (or a preventive fragment of a general program) is a systematic presentation of the main goals, objectives, and areas of activity for the prevention of morbidity, preservation and promotion of health. Prevention programs (or preventive fragments of the general program) include justification and a list of measures to implement the assigned tasks, terms and conditions of implementation, performers, resource requirements, expected results, as well as management, control and performance evaluation systems.

8.Monitoring of health and preventive activities.

It is proposed to include an office for monitoring health and preventive activities in the structure of the prevention department. Monitoring is a purposeful activity that includes permanent observation, analysis, assessment and forecast of the state of an object (process, phenomenon, system) or, in other words, an analytical tracking system.

Health monitoring involves observation and analysis of the health status of the assigned population and its individual target groups based on information provided by the statistics department (morbidity by appeal, including by individual classes and groups of diseases, gender, age, etc., morbidity based on the results of medical examinations, disability, mortality, etc.).

Monitoring the preventive activities of the departments of the prevention department and health care facilities includes analytical monitoring of the volume, quality and effectiveness of the provision of preventive and health-improving medical services both in the structure of the prevention department and in health care facilities as a whole, hygienic education and upbringing of the population.

9. Sociological research in the field of preventive activities. When solving specific problems of health promotion and disease prevention, the formation of a healthy lifestyle, the study of the processes occurring in this direction in society is becoming increasingly important, which can be achieved by conducting simple sociological research. Planning and carrying out effective preventive interventions involves studying the degree of readiness of certain groups of the population and individuals to learn and perceive hygienic knowledge and skills in maintaining a healthy lifestyle.

Sociological research in the healthcare system is a way of obtaining knowledge about the processes occurring in society related to attitudes towards one’s own and public health, the use of preventive, health-improving, therapeutic and rehabilitation interventions, assessing their availability, effectiveness and quality, based on obtaining information and identifying patterns based on theories, methods and procedures adopted in sociology

10.Intersectoral interaction or social partnership. When forming an integrated approach to solving problems of health promotion and disease prevention, healthcare authorities and institutions must take a leading position and initiate cooperation with all interested organizations and individuals. Such cooperation is currently interpreted as “social partnership”.

Epidemiological research should be an integral part of the health system when planning and implementing preventive intervention programs.

Objectives of the epidemiology of chronic non-communicable diseases:

1.Systematic monitoring of the levels of morbidity and mortality of the population.

2.Identification of trends, global patterns of disease spread.

3. Identification of territories, individual population groups with high and low morbidity.

4. Establishing the relationship between morbidity and specific factors of the external and internal environment.

5. Quantitative assessment of the role of individual factors and their complexes in the occurrence of diseases.

6. Forecasting morbidity and mortality, the degree of risk of disease.

7.Assessing the results and effectiveness of disease prevention measures.

8. Development of specific recommendations for improving prevention, early diagnosis, medical examination of the population and carrying out health-improving measures to transform the working and living conditions of people, change habits, customs, and lifestyles.

9.Preparation of necessary data for health care planning and financing.

According to modern concepts, epidemiological analysis is carried out in four stages:

First stage- analysis of the current situation, includes assessing the need and determining priorities for the prevention of CNDs. Only descriptive epidemiological studies can provide a true picture of the health system's need for specific interventions. For example, how can we determine the true need for interventions aimed at treating hypertension? According to official statistics, the incidence of hypertension is about 10% of the adult population of Russia, while according to epidemiological monitoring data, the true prevalence of hypertension is a fairly stable indicator and amounts to about 40% of the adult population. Accordingly, when carrying out any activities aimed at identifying hypertension, it is possible to predict an increase in the burden on healthcare in relation to the treatment of patients with hypertension. Needs assessment allows you to set priorities - i.e. the most significant public health problems at the moment, for the solution of which it is advisable to allocate resources. Priorities are determined based on a set of parameters assessed within the framework of epidemiological studies: the prevalence of phenomena, their social significance, the risk of complications, economic damage associated with a given disease and risk factor, etc.

Second phase- program development includes: formulating goals and objectives, creating a model of program functioning with predicting outcomes and developing a program evaluation plan. The goals and objectives of any health program should be the result of an assessment of needs and the selection of priorities based on the results of epidemiological studies. Comparison of data from epidemiological studies of the current situation and prospective studies performed earlier allows us to create a model of program functioning with clear time characteristics, resource allocation and forecast of program effectiveness. Based on the model of the program’s functioning, a program evaluation plan is constructed, the optimal option being epidemiological monitoring, which allows assessing the impact of interventions on the population as a whole, timely identifying the compliance of real changes with the planned ones, and making adjustments to the program. The evaluation of any program should include economic parameters, ranging from an accurate determination of the resources spent to an assessment of the economic effectiveness of the program/intervention using the currently recommended cost-utility methods, budget impact analysis, etc.

Third stage- implementation includes quality assessment, and here epidemiological monitoring, when including certain parameters (coverage of the target audience by a new intervention, etc.) is the optimal tool for monitoring the quality of implemented public health programs.

The final stage- includes analysis of processes and outcomes.

Monitoring plays a significant role in the implementation of preventive programs. Monitoring (from the Latin word “monitor” - warning) is a specially organized, systematic observation of the state of objects, phenomena or processes for the purpose of their assessment, control or development forecast. In other words, it is the systematic collection and processing of information that can and should be used to improve decision-making, as well as indirectly to inform the public or directly as a feedback tool for the purposes of project implementation, program evaluation or policy development. The results of epidemiological monitoring of CND risk factors, being combined into a single database, should help to correctly determine the priority of the domestic healthcare system as a whole.

Epidemiological monitoring allows you to evaluate short-term outcomes in real time and, based on short-term ones, predict long-term ones (for example, based on the dynamics of risk factors, predict a possible decrease in mortality in the long term in middle-aged and young people). With a permanent epidemiological monitoring system in place, it becomes possible to track the mid- and long-term results of public health prevention programs.

Russia created the concept of a unified preventive environment, which was approved by the entire international medical community and became the main achievement of the first global conference on a healthy lifestyle and the prevention of non-communicable diseases. The Russian concept is reflected in WHO resolutions and the political declaration of the UN General Assembly. The preventive environment presupposes, on the one hand, the creation of infrastructural, informational, educational, regulatory, tax and other conditions that allow the population to lead a healthy lifestyle, and on the other hand, motivating the population to maintain health and longevity

All services, ministries and departments should take part in the formation of a unified preventive environment, each of which should partly become healthcare. The competence of the Ministry of Education is the creation of educational and upbringing programs for the formation of a healthy lifestyle, which must be psychologically verified for different ages. The tasks of the Ministry of Communications, Press, Television and Radio include the development of psychologically verified programs for different social groups of the population, informational and motivational videos, reality shows, interactive sessions, computer “viruses” on popular sites - everything that shapes the fashion for physical and spiritual health. The Ministry of Agriculture ensures food safety and environmental friendliness. Ministry of Natural Resources - clean water and a healthy environment. The Ministry of Regional Development is developing new approaches to urban development and communications planning. Ministry of Labor - ensures healthy working conditions and a safe workplace. You can’t do without sanitary and epidemiological well-being. The competence of the ministries of economics and finance is to formulate priorities for financial support for all these programs. Along with government agencies, all civil society, non-governmental organizations, representatives of business and the private sector, and the family as the primary unit of society should be involved in the formation of a preventive environment.

In order to implement the provisions and documents on the formation of a healthy lifestyle and the prevention of CNDs among the population, the healthcare system of our country is actively creating a system of preventive institutions and units (CNCD prevention infrastructure), which provides for the involvement of all medical organizations in preventive work, specifying their functions and interactions (primary health care institutions, sanatorium-resort, inpatient medical institutions).

The infrastructure being created for the prevention of CNDs includes:

Republican (regional, regional) centers for medical prevention, which are independent legal entities (order of the Ministry of Health of Russia dated September 23, 2003 No. 455). Scientific and methodological management of the activities of the Centers for Medical Prevention (CPC) is carried out by the Federal State Budgetary Institution “State Research Center for Preventive Medicine” of the Ministry of Health of Russia;

City (district, interdistrict) centers of medical prevention. Organizational and methodological management of the activities of city (district) medical centers and examination of the quality of preventive services provided by them is carried out by a subjective (republican, regional, regional) medical center;

Health centers for adults, including those formed on the basis of central regional hospitals serving the rural population. The scientific and methodological management of the Central Health Center is carried out by the Federal Coordination and Methodological Center on the basis of the Federal State Budgetary Institution "State Research Center for Preventive Medicine" of the Russian Ministry of Health. Direct organizational and methodological management of the activities of the central health centers and examination of the quality of the preventive services they provide is carried out by the city (district) central medical center.

The health center is being created on the basis of state health care institutions of the constituent entities of the Russian Federation and health care institutions of municipalities, including health care institutions for children.

Doctors' offices that have undergone thematic improvement in promoting a healthy lifestyle and medical prevention;

Medical prevention room;

Testing room on a hardware and software complex;

Instrumental and laboratory examination rooms, physical therapy room (hall);

Health schools.

All patients are screened:

Opportunistic - initially there are no risk factors, weak or unknown, for example, the patient applied himself. It is assumed that opportunistic screening will also be carried out for persons who first sought medical help within the last five years,

Selective - initially there are strong risk factors.

The health center should assess the potential impact of risk factors on the patient's conditions:

●low- a preventive consultation is carried out, if desired, the patient is sent to a health school of the appropriate profile;

●average- additional screening is carried out, the patient is necessarily sent to a health school of the appropriate profile;

●high- the patient is sent for in-depth examination, treatment or rehabilitation to a specialized medical organization.

Conducting a comprehensive examination includes:

Height and weight measurement;

Ophthalmological examination;

Testing on a hardware and software complex for screening assessment of the level of psychophysiological and somatic health, functional and adaptive reserves of the body;

Computerized heart screening (express assessment of the state of the heart using ECG signals from the limbs);

Angiological screening with automatic measurement of systolic blood pressure and calculation of the brachial-ankle index;

Express analysis to determine total cholesterol and glucose in the blood;

Comprehensive detailed assessment of the functions of the respiratory system (computerized spirometer).

For residents of rural areas who wish to contact the Health Center of the executive power of a municipal entity in the field of healthcare, travel from the health care facility to the territorial health center located in the area of ​​responsibility can be organized at designated hours and days of the week. The health center for rural residents living in the area of ​​​​responsibility of the health center can regularly conduct on-site campaigns aimed at promoting actions to promote a healthy lifestyle.

For a citizen, including a child who has applied (referred) to the Health Center, a paramedical worker creates a registration form No. 025-TsZ/u “Health Center Card”, tests are carried out on the hardware and software complex, and an examination is carried out on the installed equipment.

Movement of the Health Center contingent

The results of the examinations are entered into the Card, after which the citizen, including the child, is sent to the doctor. To identify additional risk factors, it is recommended to conduct studies not included in the list of comprehensive examinations.

The doctor, based on the results of testing on the hardware and software complex and examination on the installed equipment, assesses the most likely risk factors, functional and adaptive reserves of the body, taking into account age-related characteristics, and a prognosis for the citizen, including the child (the child’s parents or other legal representatives). health, conducts a conversation on a healthy lifestyle, draws up an individual program for a healthy lifestyle.

If necessary, the doctor recommends dynamic observation at the Health Center with repeated studies in accordance with identified risk factors, or observation in the rooms of medical prevention and healthy child healthcare facilities, attendance at classes in the relevant health schools, physical therapy rooms and medical physical education clinics according to programs developed at the Health Center.

If during the examination at the Health Center a suspicion of any disease is revealed, the Center’s doctor recommends that the citizen, including a child, contact the appropriate medical specialist to determine further tactics for his observation and treatment.

Information about citizens who are suspected of having a disease and who need observation in a medical prevention office (in the office of a healthy child), with their consent, is transferred to the medical prevention office (in the office of a healthy child), a local therapist (precinct pediatrician) at the citizen’s place of residence, respectively.

At the end of the initial visit to the health center, which includes a comprehensive examination, registration form No. 002-TsZ/u “Healthy Lifestyle Card” is filled out for each citizen, approved by order of the Ministry of Health and Social Development of Russia dated August 19, 2009 No. 597n, which, at the request of the citizen, is handed over to him .

For each person contacting the health center, registration form No. 025-12/у “Outpatient Card” is filled out. Upon completion of the examination and examination by a doctor, the completed coupons are transferred to the appropriate department of the health care facility for further formation of registers of accounts for payment under the compulsory health insurance program in accordance with territorial programs of state guarantees for the provision of free medical care to citizens of the Russian Federation.

At the end of the reporting period (month, year), the Health Center draws up reporting form No. 68 “Information on the activities of the health center” (monthly, annual).

Regions are responsible for the organizational component, selection and repair of premises. The network of Health Centers is created with a population ratio of 1:200,000. In total, 502 Centers for adults and 211 Health Centers for children are open throughout the country.

Regarding the implementation of the proposed measures, the Health Center interacts with medical prevention rooms and healthy child rooms at health care institutions at the citizen’s place of residence.

Departments of medical prevention in polyclinics and general medical practice (family medicine) centers, as well as in a number of health centers. Organizational and methodological management of the activities of PMCs and examination of the quality of preventive services provided by them is carried out by the city (district) CMP;

Rules for organizing the activities of the department (office) of medical prevention

1. These rules establish the procedure for organizing the activities of the prevention department (office) (hereinafter referred to as the Department).

2. The department is organized in a medical organization (its structural unit) providing primary health care.

3. The prevention department includes the following structural divisions:

Anamnesis room;

Cabinet of functional (instrumental) research;

Healthy lifestyle promotion room;

Office for centralized recording of annual medical examinations;

Smoking cessation clinic.

4. When organizing the activities of the Department, it is recommended to provide for the possibility of conducting the necessary diagnostic studies directly in the Department.

5. The department is headed by a director who reports directly to the chief physician of the medical organization (the head of its structural unit) providing primary health care.

6.The main functions of the Department are:

Participation in the organization and conduct of medical examinations;

Participation in the organization and conduct of preventive medical examinations;

Early detection of diseases and persons with risk factors for developing diseases;

Control and recording of annual medical examination of the population;

Preparation and transmission of medical documentation to doctors for patients and persons at increased risk of diseases for additional medical examination, clinical observation and treatment and recreational activities;

Sanitary and hygienic education and promotion of a healthy lifestyle (fight against smoking, alcoholism, excess nutrition, physical inactivity, etc.).

In addition to the listed structures, psychological (psychotherapeutic) assistance offices take part in the implementation of preventive measures, including individual and group correction of behavioral risk factors for chronic NCDs. Organizational and methodological management of this area of ​​activity of psychological (psychotherapeutic) care offices and examination of the quality of preventive services provided by them is carried out by the city (district) CMP.

The highest collective body for the development of strategy and tactics, the construction and functioning of preventive structures, the formation of a healthy lifestyle among the population and the prevention of NCDs is the specialized commission of the Expert Council of the Russian Ministry of Health on Preventive Medicine, operating on a voluntary basis. The profile commission includes the main freelance specialists in preventive medicine of health authorities of all constituent entities of the Russian Federation, heads of subject (republican, regional, regional) medical centers, leading scientists and specialists, representatives of professional medical societies and associations in the field of preventive medicine.

The results of preventive health care are determined by its quality. The quality of preventive medical care is a set of qualitative and quantitative characteristics that confirm the compliance of the provision of preventive medical care to the population or an individual with the existing needs of the population for this care (medical - based on evidence-based medicine and psychosocial - based on the attitude, understanding and motivation of the population).

Quality criteria for preventive health care

Availability and accessibility of the required type of preventive health services. Criterion - list and completeness of preventive medical services of an institution (unit, specialist, etc.).

Adequacy of measures, technologies and resources used to achieve the goals of health promotion and prevention. The criterion is the compliance of preventive measures, services, technologies and resources used with the set goals of health promotion and prevention in the activities of a medical institution (half-department, specialists, etc.).

Continuity and continuity of the patient healing process in the healthcare system. The criterion is a model of preventive activities of a medical institution, ensuring interaction and coordination.

The effectiveness and strength of the impact of the applied preventive medical intervention on improving health indicators of groups of individuals and the population as a whole, based on scientific evidence-based research. The criterion is the introduction (application) of scientifically based preventive medical methods, approaches, technologies.

The effectiveness of preventive medical intervention in relation to improving health indicators of individual groups of people and the population as a whole in practical activities. The criterion is the dynamics of health indicators when applying effective prevention methods in practical conditions.

The effectiveness of the applied preventive medical intervention in relation to the selected criterion. The criterion is the compliance of the result of medical preventive care with the selected criterion of medical, social, and economic efficiency.

The ability to meet the needs of patients, the population and correspond to real implementation opportunities. The criterion is the compliance of the forms, methods, technologies, accessibility and other characteristics of preventive medical care with the needs, attitudes of patients and the population as a whole.

SAMPLE TEST TASKS

Please indicate one correct answer

1. The objects of primary prevention are:

a) convalescents of acute diseases

b) patients with chronic diseases

c) the entire population

2. The subject of preventive medicine is:

a) pathogenesis of diseases

b) symptoms of diseases

c) risks of disease

d) disability due to illness

3. The functions of primary medical prevention do not include:

a) providing a methodology for health-saving technologies

b) monitoring risk factors for non-communicable diseases

c) rehabilitation after an illness

SITUATIONAL TASK

A 52-year-old man has no complaints. Work is associated with psychological stress. Smokes up to 17 cigarettes a day. The mother suffers from coronary heart disease and type 2 diabetes mellitus, the father suffered a myocardial infarction at the age of 52 years.

Objectively: the condition is satisfactory. Height 174cm, body weight 96kg. The skin is clean and of normal color. Over the lungs, breathing is vesicular, there are no wheezes. Heart tones are clear, pure, rhythmic. Blood pressure - 120/75 mmHg, heart rate - 78 beats/minute. The abdomen is increased in volume due to subcutaneous fat, and is soft and painless on palpation. Liver along the edge of the costal arch. The effleurage symptom is negative on both sides. There is no peripheral edema. Stool and urine output are normal.

Survey results

Urinalysis: relative density - 1023, leukocytes 0-1, erythrocytes 0-1 in the field of view. Urine protein 100 mg/day.

Biochemical blood test: TC - 5.4 mmol/l.

EXERCISE

1. Identify risk factors for the development of cardiovascular diseases in the patient.

2. Patient management tactics.

List and content of the lecture course.

Health care organization.

VI semester

Topic 1.1. Fundamentals of organizing medical and preventive care to the population. Outpatient care, modern problems.

Treatment and preventive care as the main type of medical care. Organization of outpatient care for the population (principles, institutions, features). General medical practice (definition, reform). City clinic, role, tasks, structure, accounting and reporting documentation, activity analysis. Organization of the nursing process in an outpatient clinic.

Topic 1.5. Organization of emergency medical care for the population.

Regulatory and legal support for the organization of emergency medical care to the population. History of the service. Organization of activities of the hospital, ambulance station and substation. Activities of linear and specialized teams. Tasks and functions of paramedical personnel of the mobile team.

Topic 1.6. Inpatient and inpatient replacement care for the population.

Types of inpatient facilities. Hospital (functions, organizational structure, accounting and reporting documentation, activity analysis). Development of inpatient care in the context of health care reform. Hospital-substituting technologies (day hospital, hospital at home, etc.). Organization of the nursing process in a hospital setting.

Topic 1.9. Protection of motherhood and childhood. Organization of obstetric and gynecological care

The main stages of development of the maternal and child health care system, its objectives, main directions. Principles of the maternal and child health system. Organization of obstetric and gynecological care (principles of the institution). Maternity clinic, maternity hospital (tasks, organizational structure, accounting and reporting documentation, activity analysis). Risk factors for perinatal and maternal mortality. Ways to reform obstetric and gynecological care to the population (perinatal center). Activities of nursing staff.

Topic 1.12. Organization of medical care for children.

Regulatory and legal support for the organization of medical care for children in the Russian Federation. Organization of medical care for children (principles, institutions). Children's clinic (tasks, organizational structure, accounting and reporting documentation, activity analysis). Tasks and functions of nursing staff.

VIIsemester

Topic 2.1. World Health Organization (WHO). History of formation. WHO budget. Main activities. International cooperation in health care. WHO programs “Health for all by the year 2000” and “Health for all in the 21st century”.

Organization of healthcare in foreign countries. The international cooperation. International medical organizations, associations, societies. World Health Organization (history, financing, structure, main activities). Sections of activities related to nursing staff.

Topic 2.2. Healthcare management. Health authorities, tasks, functions.

Basic principles of healthcare management in the Russian Federation. Legislative basis of management. Structure and functions of the Ministry of Health and Social Development of the Russian Federation. Federal agencies and federal services. Features of healthcare management at the present stage.

Topic 2.3. Legislative framework for the activities of the Ministry of Health and Social Development and medical institutions. Nomenclature of medical institutions.

Regulatory and legal framework for the activities of the Ministry of Health and Social Development. Laws and by-laws regulating the activities of medical institutions. Nomenclature of medical institutions. Order of the Ministry of Health of the Russian Federation No. 000.

Topic 2.4. Organization of medical care for workers of industrial enterprises. MSCh, structure, tasks, content of work. Performance indicators of medical units.

Features and main forms of organizing medical care for workers and employees of industrial enterprises. Medical unit, health center (tasks, structure, functions, activity analysis). Tasks of a nurse of a shop general practitioner. Clinical observation of various groups of workers. Organizing and conducting medical examinations of workers. Prevention of industrial injuries and occupational diseases. Features of the organization of medical care at industrial enterprises of different forms of ownership.

Topic 2.6. State and prospects for the development of medical care for the rural population.

Features of the organization of medical care for the rural population (stages). Rural medical district (structure, functions). Local hospital. Outpatient clinic. Paramedic and midwife station. Tasks and functions of nursing staff. Central district hospital (tasks, structure, functions). Regional medical institutions (role, tasks, structure, functions). Ways to bring specialized medical care to the rural population.

Topic 2.8. Examination of disability. Medical and social examination.

Goals and objectives of the disability examination. Regulations on the examination of temporary disability in health care facilities. Rules for issuing and processing documents certifying temporary disability. Medical and social examination. Causes of disability. Disability groups.

Topic 2.10. Organization of the state sanitary and epidemiological service in the Russian Federation.

Law “On the sanitary and epidemiological welfare of the population.” Preventive and current sanitary supervision. Sanitary and epidemiological well-being of the population (basic concepts, definitions). Sanitary and hygienic monitoring. Contents of preventive and current sanitary supervision.

VIIIsemester

Topic 3.1. The state and prospects of healthcare reform in the Russian Federation.

Introduction of results-based budgeting (RBB) principles into domestic healthcare. Changing the ratio in the financing of outpatient and inpatient care. Development of hospital-replacing technologies. Introduction of nursing medical history, concepts of “nursing diagnosis”, etc.

Topic 3.3. Modernization of healthcare.

Register of medical workers. Health system passport. Passport of the region's healthcare system. The main sections of the program of activities for the modernization program of the Irkutsk region. Basic socio-economic indicators. Optimization of the healthcare infrastructure of the Irkutsk region to ensure procedures and standards of medical care. Improving the provision of medical care in the Irkutsk region based on compliance with standards and procedures for medical services. Introduction of modern information systems in healthcare of the Irkutsk region. Areas related to the activities of nursing staff.

Topic 3.5. Structure and functions of Rospotrebnadzor.

Structure, functions, tasks of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare. Contents of the activities of the Territorial Administration and the Federal State Health Institution. Sanitary and hygienic monitoring. Contents of preventive and current sanitary supervision.

Topic 3.10. Health care planning. Determining the population's needs for outpatient and inpatient care.

Planning in healthcare, principles of planning in domestic healthcare. Determining the population's needs for outpatient and inpatient care. Methodology for calculating indicators.

OBJECTIVE OF THE LESSON: to study the features of organizing medical and preventive care for the rural population of the Russian Federation. Study the structure and functions of medical institutions providing assistance to the rural population and know the basics of organizing medical care for adults and children in rural areas. To study the functional responsibilities of medical personnel of institutions providing medical and preventive care to rural residents. Master the methodology for analyzing the activities of health care facilities serving the rural population.

METHODS OF CONDUCTING THE CLASS: Students independently prepare for the practical lesson using the recommended literature and complete individual homework. The teacher checks the correctness of homework for 10 minutes and points out mistakes made, checks the level of preparation using testing and oral questioning. Then students independently calculate the performance indicators of the central regional hospital using the annual report. Analyze the data obtained and formulate a conclusion. At the end of the lesson, the teacher checks the students’ independent work.

CONTROL QUESTIONS:

1. What are the features of organizing medical care for the rural population?

2. What are the stages in providing medical care to rural residents?

3. Name the tasks, structure and functions of the rural medical district.

4. Which medical and preventive institution is the leading one at the level of the rural medical district?

5. What are the functional responsibilities of a general practitioner working in a rural district hospital?

6. What functions do feldsher-midwife stations perform in the structure of a rural medical district?

7. What are the tasks of rural medical institutions to protect maternal and child health?

8. Name the main tasks, structure and functions of the central district hospital (CRH).

9. What forms and methods of work do doctors at the Central District Hospital use to bring specialized medical care closer to rural residents?

10. What are the tasks, structure and main functions of the regional (regional) hospital?

11. What are the tasks and content of the work of the department of emergency and planned advisory care and the department of clinical expert and organizational and economic work of the regional hospital?

Medical care for the rural population is based on the same principles as for the urban population, but the peculiarities of life of the rural population (nature of settlement, low population density, specific conditions of the labor process, economic activities and everyday life, poor quality or lack of roads) require the creation of a special system organization of treatment and preventive care. The organization of medical care in rural areas, its volume and quality depend on the distance of medical institutions from the place of residence of patients, the staffing of healthcare facilities with qualified personnel and equipment, and the possibility of receiving specialized medical care. A feature of medical care for the rural population is the staged nature of medical care. There are three stages of providing medical care to rural residents:

1. Rural medical district - unites a rural district hospital, a medical outpatient clinic, paramedic and obstetric stations, paramedic stations, preschool institutions, paramedic health centers at enterprises, and a dispensary. At this stage, the rural population can receive qualified medical care. Qualified medical care is medical medical care provided to citizens for diseases that do not require specialized methods of diagnosis, treatment and the use of complex medical technologies.

2. District medical institutions - central district hospitals, district hospitals, district centers of state sanitary and epidemiological surveillance. At this stage, rural residents receive specialized medical care.

3. Republican (territorial, regional) medical institutions: Republican (territorial, regional) - hospitals, dispensaries, clinics, centers of state sanitary and epidemiological surveillance. At this stage, highly qualified and highly specialized medical care is provided.

Rural medical station (VU)

SVU is a complex of medical institutions that provide the population of a certain territory with qualified medical care, provided according to a unified plan under the leadership of the chief physician of the local hospital. The number of IEDs in an area is determined by population size and distance to the area hospital. The average population in one rural medical area ranges from 7 to 9 thousand inhabitants with an optimal radius of the area being 7-10 km. The territory of a rural medical district usually includes 3-4 settlements. The structure of institutions included in the rural medical district is determined depending on the location and size of settlements, service radius, economic condition of the area, and road conditions.

District hospitals are the leading medical institution in the rural medical area. Rural district hospitals (RPH) are joint institutions, the structure of which includes an inpatient and outpatient clinic. The capacity of a rural district hospital is determined by the number of hospital beds. SUB of the first category are designed for 75 - 100 beds, the second - for 50 - 75 beds, the third for 35 - 50 beds, the fourth for 25 - 35 beds. Currently, the basis for providing medical care to the rural population is rural district hospitals, mainly of categories 3 and 4. Depending on the capacity, local hospitals have a certain number of departments. The 1st category hospital has six departments: therapeutic, surgical, obstetric-gynecological, pediatric, infectious diseases, and anti-tuberculosis. In each subsequent category there is 1 less department. In a category 2 hospital there is no anti-tuberculosis department, in category 3 there is no anti-tuberculosis and pediatric department, in category 4 there are therapeutic, surgical and obstetrics-gynecology departments. The medical staff in a hospital is established based on the standard - one medical position for 20 - 25 beds, thus, in a fourth category hospital, 1 medical position is allocated to 3 departments. The medical staff for outpatient care is determined based on the recommended number of positions per 1000 rural residents (adults and children).

Local hospital staff

Currently, the process of consolidation of rural district hospitals is underway, mainly hospitals of 1 and 2 categories are being built. Hospitals of categories 3 and 4 will be turned into medical outpatient clinics or departments of the central district hospital. Hospitals of categories 1 and 2 are better equipped with equipment and doctors. The negative side of consolidation is the distance of medical care from the rural population.

The main tasks of the rural district hospital:

1.Provide the population of VU with qualified outpatient, inpatient and emergency medical care.

2. Carrying out measures to prevent and reduce morbidity and injury among various groups of the rural population.

3.Carrying out therapeutic and preventive measures to protect the health of mother and child.

4.Organizational and methodological management and control over the activities of the FAP and other institutions that are part of the VU.

5. Introduction into practice of modern methods of prevention, diagnosis and treatment.

Providing outpatient and inpatient care to therapeutic and infectious patients, assistance during childbirth, medical and preventive care for children, emergency surgical and trauma care are the direct responsibilities of doctors at a local hospital, regardless of its capacity. The SUB provides outpatient medical appointments in the main specialties (therapy, surgery, dentistry, etc.). In some cases (the absence of a doctor, his illness, vacation, a large number of calls), paramedics are also involved in outpatient appointments. Outpatient hours should be the most convenient for agricultural workers, and the outpatient work schedule is determined taking into account the seasonality of field work and the time of year. Home assistance must be trouble-free and timely, with all calls answered the same day. In the future, the doctor is obliged to provide systematic (active) visits to the patient at home. In accordance with accepted standards, the SUB doctor makes 5-6 home visits daily. On average, 40 minutes of working time are allocated for one visit. In recent years, the need for medical care at home has been increasing due to the increase in the proportion of elderly and senile people in the structure of the rural population, while the organization of care for the sick plays a special role.

The organization of ambulance and emergency medical care at a rural medical site is carried out by the staff of the local hospital on a 24-hour duty. The duty schedule for providing medical care at night is established by the chief physician of the SSU. Due to limited staffing, ambulance and emergency personnel on duty may be at home with the right to sleep and cannot leave home without the permission of the chief physician. If it is necessary to hospitalize a patient for emergency reasons, the patient is delivered to the hospital by the emergency medical service of the Central District Hospital or by sanitary vehicles of the local hospital, accompanied by a medical worker. If the patient is not transportable, a consultation is convened with the involvement of relevant specialists at the district and, if necessary, regional (regional, republican) levels.

Clinical examination occupies a large place in the activities of medical workers in rural medical districts. This type of work has some distinctive features in rural areas. The main person carrying out clinical examination of the rural population is the local doctor, but since a doctor can carry out full clinical examination only for a small group of sick people (60-70 people), paramedics from FAPs, as well as visiting teams of doctors from central districts, help him in carrying out medical examination hospitals.

The SUB has a clinical diagnostic laboratory, and the largest ones have an X-ray room.

A medical and obstetric station (FAP) is a medical and preventive institution that is part of a rural medical district and carries out, under the leadership of a local hospital (outpatient clinic), a complex of therapeutic, preventive and sanitary and anti-epidemic measures in a certain territory. It is the primary (pre-hospital) health care unit in rural areas. As a rule, FAPs are located in the most remote settlements from the local hospital, which brings medical care closer to the rural population. Serves part of the territory of the rural medical district, reporting on medical issues to the local hospital or outpatient clinic (when there are no such institutions in the area - the central district hospital). On the staff of the FAP: the head is a paramedic; midwife (visiting nurse) and nurse. FAP staff provides patients with pre-medical care (within the competence and rights of a paramedic and midwife) at outpatient appointments and at home, consults them with a doctor, and carries out medical orders. During the period of field work, FAP personnel, if necessary, provide assistance directly at the field camps.

A doctor at a local hospital (outpatient clinic), in accordance with a predetermined schedule of visits to the FAP, systematically monitors the quality and timeliness of medical care provided at the FAP, and also advises patients.

An important section of the FAP's activities is the provision of treatment and preventive care to women and children. The duties of a midwife include identifying pregnant women and registering them in the early stages of pregnancy, systematically monitoring pregnant women, and preparing them for the birth of a child. The midwife must promptly transfer women with pregnancy pathologies under the supervision of a local doctor or obstetrician-gynecologist of the Central District Hospital. The medical staff of the FAP systematically monitors healthy children under 1 year of age and provides patronage to children aged 1 to 3 years, provides medical care to sick children, and, if necessary, refers them to a doctor or calls a doctor to their home, and refers patients to hospitalization. The responsibilities of FAP workers include medical care for preschool institutions that do not have medical workers on staff.

FAP staff monitors the health status of the rural population, examines patients at the doctor’s direction to refer them for medical examination, compiles dispensary records, calls patients for routine examinations, examines the working conditions and life of persons registered with the dispensary, monitors the implementation of recommendations for their employment . FAP workers carry out sanitary and anti-epidemic work, in particular, identify infectious patients by conducting door-to-door visits. Before hospitalization of the patient, FAP employees ensure the implementation of anti-epidemic measures in the outbreak - ongoing disinfection, removal of persons who were in contact with the patient from work in food, children's and medical institutions, etc. Final disinfection is carried out by the local hospital or the corresponding sanitary and epidemiological surveillance center. The medical staff of the FAP also carries out preventive vaccinations.

FAP workers carry out sanitary and epidemiological supervision of the territory of populated areas, water supply, industrial premises, communal facilities, catering establishments, trade, schools and other children's institutions, as well as the storage and use of pesticides, etc.

FAP staff, under the guidance of a physician, takes part in the analysis of morbidity and injury and the development of an action plan to prevent them.

The FAP premises must consist of at least three examination rooms. A separate examination room is required to receive pregnant and postpartum women. The equipment of the paramedic-midwife station is intended to provide emergency pre-medical care, incl. emergency obstetric care. It includes devices, apparatus, sets of medicines, medical instruments, medical furniture and equipment, disinfection equipment, sanitary stretchers, items for sanitary education. Each FAP has patient care items: medical cups, eye baths, heating pads, etc.

The necessary medications are contained in the paramedic kit, as well as in the wall-mounted medicine cabinet. Equipping the FAP is carried out within the limits of the annual allocations allocated for these purposes. At the same time, funds from state, cooperative and other organizations are attracted. The list of medicines for emergency first aid is determined taking into account local conditions and approved by the chief physician of the central district or local hospital.

At the FAP, certificates are issued about the birth of the child, about vaccinations performed, as well as death certificates if the patient was monitored and treated.

The leading institution of the second stage is the central district hospital, which provides specialized medical care for its main types and organizational and methodological management of all medical institutions in the region. There is a SSES center in each regional center. There may be inter-district specialized centers, dispensaries, health centers, etc. The head of the health service is the chief physician of the district (or district medical association), who also heads the central district hospital. The sanitary and anti-epidemic service of the district is headed by the chief state sanitary doctor of the district, who is the chief physician of the State Sanitary Epidemiology Center. At the district level, district specialists are identified, whose responsibilities include medical, advisory and organizational work in their specialty.

Main tasks of the central district hospital

1. Providing highly qualified and specialized medical and preventive care to the population of the district and regional center.

2. Operational, organizational and methodological management of all healthcare institutions in the district, control over their activities.

3. Development and implementation of measures aimed at improving the quality of medical care for the population of the region, reducing morbidity, mortality, and improving health.

4. Providing advisory assistance to VCA specialists, improving their qualifications.

5. Providing ambulance and emergency assistance to residents of the area.

The leading structural unit of the Central District Hospital is a hospital with five main departments: therapeutic, surgical, pediatric, obstetric-gynecological, and infectious diseases. The profile and number of departments within the central district hospital depends on the capacity of the hospital. Central district hospitals of the first and second categories, designed for 300-350 or more beds, may also have specialized departments.

The clinic provides qualified and specialized care with consultations with specialist doctors in 10–12 specialties. Rural residents come to the clinic of the Central District Hospital on referral from medical institutions of rural medical districts for a functional examination, consultation and treatment by specialist doctors. To bring specialized care closer to rural residents, the central district hospital organizes teams of on-site medical and outpatient care. The visiting medical team works according to a plan and schedule approved in accordance with the established procedure by the chief physician of the central district hospital. The teams include a therapist, pediatrician, dentists, obstetrician-gynecologist, pediatric nurses, laboratory assistants and pharmacists. If necessary, specialist doctors - neurologists, ophthalmologists, allergists, etc. - can be included in the visiting teams. The visiting teams are provided with vehicles and equipped with the necessary portable equipment and equipment for examining and treating patients. The mobile team deployed at the FAP and SUB plays a significant role in the medical examination of the rural population.

An important structural unit of the Central District Hospital is the organizational and methodological office, the main task of which is to develop measures to improve medical care for the population of the region. The organizational and methodological office is headed by the deputy chief physician of the Central District Hospital for organizational work. Annually analyzing the activities of medical institutions, the organizational and methodological office identifies certain patterns and shifts in their work. The activities of medical and preventive institutions in the district are analyzed according to such indicators as the volume and quality of care provided in the clinic and at home, the workload of doctors of certain specialties, the use of bed capacity, the organization and quality of clinical examination, etc. The role of organizational and methodological rooms in the planning and organization of specialization and advanced training of doctors and paramedics is great. Carrying out management and control over the activities of medical and preventive institutions of the region, the Central District Hospital systematically sends teams of medical specialists to the localities, hears reports on the work of the chief doctors of local hospitals, outpatient clinics, heads of the first aid station, analyzes their work plans, statistical reports, medical histories of the deceased, and postmortem reports. autopsies and other documentation. A major role in this activity belongs to the main specialists of the region. In order to better provide the population of rural areas with specialized inpatient and outpatient care, inter-district specialized centers are organized in large central district hospitals, which also provide organizational, methodological and advisory assistance to health workers of medical institutions of the attached areas, are engaged in improving their qualifications, and developing specific measures to improve the relevant types of specialized medical care.

At the Central District Hospital, as at other hospitals, there are a medical council, a hospital council, a nursing council, as well as sections of scientific medical societies. The main criteria for the effectiveness of the activities of medical institutions in a rural area are: indicators of population morbidity (general, with temporary disability, children), primary disability, mortality, infant mortality; number of complaints from the population, etc.

The regional (regional, republican) hospital provides highly specialized inpatient and outpatient consultative care to the population of the region (krai, republic) and is a scientific, organizational, methodological and educational health care center.

Objectives of the regional (regional) hospital

Providing highly qualified and highly specialized consultative, diagnostic and therapeutic assistance to the population.

Providing on-site emergency and planned advisory medical care using air ambulance and ground transport.

Carrying out an examination of the quality of the diagnostic and treatment process in medical institutions of the region (region).

Introduction into the practice of medical institutions of the administrative territory of modern medical technologies, economic management methods and the principles of health insurance.

The main structural divisions of a regional (territorial) hospital: a consultative clinic, a large hospital with an emergency department, a diagnostic department (organized by functionally combining all diagnostic departments of the clinic and hospital), an organizational and methodological department, a department of clinical expert and organizational and economic work, an outreach department emergency and planned advisory assistance, pathology department, pharmacy. The department of emergency and planned advisory care is, as a rule, the basic medical unit of the regional center for disaster medicine. Has a fleet of cars for traveling to the countryside. Air missions are carried out on the basis of contracts with local airlines. Main functions: provides emergency and advisory assistance with travel to remote settlements and places of work of rural residents, ensures transportation of patients to medical institutions, sends specialists on calls from areas, in emergency cases ensures urgent delivery of various medications and means necessary to save lives sick.

Regional (territorial, republican) hospitals were created primarily to treat patients living in rural areas, where there was no specialized inpatient, and often outpatient, care. Currently, many of these hospitals, having concentrated the most trained medical staff and modern technical equipment, have become leading medical centers in the corresponding administrative territory. In this regard, regional hospitals provide medical care to both rural and urban populations, carry out organizational and methodological management of other medical and preventive institutions of the region (region), analyze the health status, morbidity of the population of their region, as well as the level and quality of medical care provided in German

The health status of rural residents and the organizational aspects of providing them with medical care are largely determined by the characteristics of life in rural areas. The standard of living of rural residents is low. Compared to the urban population, people living in rural areas have lower incomes, worse working and living conditions, and a lower general educational level. In rural areas, there is a high prevalence of bad habits - alcohol abuse and smoking. Every year the number of people living in rural areas is decreasing. There is an “aging” of the rural population of rural areas, the proportion of citizens over working age among rural residents reaches 30-33%. The mortality rate in rural areas is higher than in the city. The maximum differences in mortality rates between urban and rural residents relate to young ages. In the structure of mortality of rural residents, the share of unnatural and violent causes is noticeably higher. The health of the population is influenced by the specifics of agricultural work, the impact of various harmful factors: physical (dust, noise, vibration), chemical (pesticides, fertilizers), biological (tuberculosis, brucellosis), sharp climatic fluctuations. Providing quality drinking water remains a serious problem. Unfavorable working and living conditions and a high prevalence of alcohol abuse contribute to the increase in injuries. In 2005, injury rates in the agricultural sector were 1.7 times higher than the national average. The agricultural sector is second only to forestry and construction in terms of the number of fatal injuries.

The health status of the rural population is significantly worse than that of the urban population. This applies to both adults and children. Among rural residents, there is a high incidence of tuberculosis, intestinal infections, sexually transmitted diseases, mental and drug addiction disorders. The most serious problem of the rural population is drug addiction and, above all, alcoholism. The problem of alcoholism in rural areas has deep socio-economic roots. The real situation with the prevalence of this disease among rural residents is so unfavorable that it is necessary to take urgent comprehensive measures on the part of the state and society.

At the same time, the needs of the rural population for affordable and high-quality medical care are met to the least extent, and rural healthcare itself is actually in a critical situation. Considering that the rural population is 38.3 million people or 26.6% of the total population of the Russian Federation, the problem of accessibility and quality of medical care for rural residents is one of the most important for domestic healthcare.

Health care in rural areas traditionally lags behind urban development, which is due to social and economic differences between cities and rural areas. Disparities in rural health care have worsened significantly during the period of socio-economic transformation. In the conditions of decentralization of the health care system, the provision of medical care to citizens living in rural areas is carried out by the municipal health care unit, the resource provision of which was and remains clearly insufficient. The crisis in agriculture and changes in the forms of ownership of agricultural enterprises had a negative impact on the state of rural healthcare, since in the Soviet period the logistics and financial support of rural healthcare institutions largely depended on support from agricultural enterprises. The cost of operating medical institutions in rural areas and the complexity of tariff setting hinder the full inclusion of rural healthcare facilities in the compulsory medical insurance system.

The main problems of rural health care are the predominance in its structure of low-capacity health care facilities and staffing shortages, which, with insufficient funding and an extremely worn-out material and technical base of rural health care, makes it difficult to provide the rural population with medical care. The ongoing restructuring of rural health care is being carried out slowly and has not only its advantages, but also disadvantages, including the increasing distance from rural residents to receive medical care, which reduces its accessibility. The critical state of the material and technical base of rural healthcare facilities is clearly confirmed by the following data: the wear and tear of medical and technical equipment in rural healthcare facilities is 58%, the wear and tear of transport is 62%, about 90% of first aid stations and 70% of medical outpatient clinics do not have central heating, water supply and sewerage, in 25 % of FAPs do not have a telephone connection, only 0.1% of FAPs are provided with transport. More than half of rural healthcare facilities are in need of major repairs. The lack of modern medical equipment in rural institutions does not allow the introduction of new effective methods of diagnosing and treating patients, which entails negative medical, social and economic consequences. The work of ambulance services in rural areas is significantly complicated by an acute shortage of vehicles, fuels and lubricants, communications equipment, and personnel problems.

Access to specialized medical care for rural residents is decreasing. High-tech (expensive) types of medical care are also inaccessible to rural patients. A significant problem for village residents is the provision of medicines. Defects in the provision of primary health care, the virtual cessation of work on disease prevention, medical examination of the population lead to an increase in cases of diagnosis of serious diseases in late, advanced stages, which contributes to high disability and mortality among rural residents.

The supply of doctors and paramedics to the rural population compared to the urban population is 3.4 and 1.6 times less, respectively. In rural areas, the most promising is the development of general medical practice. The recruitment of qualified medical personnel and paramedical personnel is hampered by the low quality of life in rural areas, low wages, and insufficient social support. Since January 1, 2005, in accordance with the legislation of the Russian Federation, social support measures have been taken for medical workers of municipal health care organizations, which include rural health care facilities, but they are established by local governments.

In recent years, the federal target program “Social development of rural areas until 2010” has been implemented, which also provides funds for the development of primary health care in rural areas. However, financing of this Federal Target Program in past years was concentrated on activities in other sections (gasification, transport communications, culture, etc.). Rural health care is 80 percent financed from local budgets. In the context of the legislative delimitation of powers between levels of government, the powers of local government bodies currently include the organization of emergency medical care (with the exception of sanitary and aviation), primary health care in inpatient clinics and hospitals, medical care for women during pregnancy , during and after childbirth. In order to implement the provisions of the legislation, specialized medical institutions are transferred from the municipal level to the level of the constituent entity of the Russian Federation.

At the same time, when delineating powers in the healthcare sector, a number of unresolved problems emerged, including those directly related to the provision of medical care to the rural population. The vagueness of the wording in the legislation of the concept of “specialized medical care” causes ambiguous interpretations and, as a result, different organizational decisions are made at the local level. In large municipal institutions, specialized departments and offices find themselves in an uncertain legal situation, the feasibility of preserving which has been proven by many years of experience. The ongoing reform of local self-government, the creation of new municipalities, including rural ones, in a number of cases will require the reorganization and redistribution of forces and resources of the municipal health care system. There are fears that newly formed municipalities will strive to build their own closed healthcare system, which will lead to a violation of the principle of phasing the provision of medical care and irrational spending of already limited healthcare resources at the local level. The experience of recent years shows that without active support from the federal center and the constituent entities of the Russian Federation, the municipal health care unit is not able to ensure the availability and quality of medical care for citizens. In addition, achieving higher efficiency in the use of resources to provide primary health care requires a higher level of centralization of management and financing than a municipal entity. This has already been done with regard to specialized medical care within the framework of the division of powers.

The main provisions of priority projects in the field of healthcare are aimed at improving the quality of life of citizens, including those living in rural areas. In the field of healthcare (project “Health”) it is planned:

Development of primary health care, incl. disease prevention,

Medical examination of the population,

Equipping municipal healthcare institutions with diagnostic equipment,

Increasing wages for local therapists, local pediatricians, general practitioners, nurses,

Additional training for primary care physicians,

Immunization within the framework of the national calendar of preventive vaccinations,

Detection and treatment of people infected with immunodeficiency virus and hepatitis,

Introduction of new programs for medical examination of newborns,

Renewal of the emergency medical service vehicle fleet,

Increasing access to high-tech types of medical care for the population.

To solve these problems, it is planned to allocate significant funds from the federal budget starting from 2006. The implementation of the outlined tasks should directly affect rural healthcare. When implementing the priority national project "Health", it is recommended to ensure, as a matter of priority, the strengthening of rural healthcare, to create the necessary conditions for increasing the availability and quality of medical care for the rural population. Develop a set of measures aimed at strengthening and preserving the health of the rural population (clinical examination, on-site forms of providing specialized care, etc.). To attract young specialists with a modern level of knowledge to professional activities in primary health care in rural areas. Ensure timely and full financing of measures to develop a network of primary health care institutions, provided for by the Federal Target Program “Social Development of Rural Affairs until 2010”.

Lisitsyn Yu.P. Social hygiene (medicine) and healthcare organization. Kazan, 1999, p. 347 - 358.

Yuriev V.K., Kutsenko G.I. Public health and healthcare. St. Petersburg, 2002, p. 431 – 452.

Public health and healthcare. Ed. V.A. Minyaeva, N.I. Vishnyakova M. “MEDpress-inform”., 2002, p. 258 – 265.