Definition of the concept of therapeutic and preventive care (TCA), its types. Therapeutic and preventive care

THERAPEUTIC AND PREVENTIVE CARE in the USSR- the state system of providing the population with all types of medical care.

L.-p. p. is based on the principles of free, general accessibility and preventive orientation, district and continuity in work. L.'s system - the item. n., or, as it used to be called, "medical business", is one of the main functions of Soviet health care.

L.-p. in the USSR it is represented by a wide network of outpatient clinics, ambulance and emergency medical care stations, hospitals, dispensaries, sanatorium and resort institutions, maternal and child care institutions, blood transfusion stations and other institutions staffed and equipped with modern technical means that provide medical care both in institutions and at home. L.-p. the item is close to the population, it turns out both at the place of residence (territorial medical-professional, institutions) and at the place of work (MSCh) and is built according to the district principle (see Medical site, Rural medical site, Workshop medical site).

The material and technical base of L.-p. The settlement was actually created during the years of Soviet power. In 1913, in Russia there were 5.7 thousand medical and feldsher institutions providing outpatient care to the population, and 5.3 thousand hospital institutions with a fund of 207.6 thousand beds, or 13 beds per 10,000 inhabitants, dispersed over subordination in more than 12 departments. There was no BC in 35% of the country's cities. By 1979, the number of hospital beds increased by more than 15.4 times, the provision with them increased by 9.3 times, and the number of medical outpatient clinics increased by almost 6 times. By 1979, the country's bed fund reached 3 million 206 thousand, while the provision of the population with hospital care amounted to 122 beds per 10 thousand of the population. Also the number of the doctors giving to the population L. - the item has increased. etc. and other types of honey. security. Their number by 1979 reached 923 thousand, and by the end of the tenth five-year plan it will be 960 thousand and will approach the figure of 36 doctors per 10 thousand inhabitants; more than six million medical workers stand guard over the health of the people.

Growth of number of the institutions rendering L. - the item. population, and the number of hospital beds is shown in Table. 1.

The most characteristic feature of development L. - the item. items are: an increasing number of large diversified, technically equipped honey. institutions and the reduction of small ones; gradual differentiation of existing and newly created institutions; specialization of the intra-institutional structure, bed capacity, as well as medical personnel.

Instead of 3-4 types to lay down. institutions operating in the pre-revolutionary period have been created in the country and are providing L.-p. n. to the population of St. 50 types of specialized to lay down. institutions. The average capacity of regional BC for 1970-1976. increased from 549 to 736 beds, urban - from 166 to 197, central district - from 65 to 213 beds.

Order M3 of the USSR No. 1000 of October 23, 1978 put into effect the nomenclature to lay down. - prof. institutions.

The general direction of improvement to lay down. - prof., the help to the population in the USSR is its specialization and integration on the basis of large diversified to lay down. - prof. institutions combined with a polyclinic, as well as the creation of independent outpatient clinics (see Ambulatory, Hospital, Polyclinic). Volume to lay down. - the professional, the help rendered in the USSR by stationary establishments, in 1960-1975. presented in table. 2, specialization of the bed network - in table. 3.

An important feature of L.-p. The item is that instead of small out-patient clinics of pre-revolutionary Russia powerful policlinics (from 400 to 1600 visits in shift) with presence in their structure to 25 specialized diagnostic, research and to lay down received wide development. departments, offices (pre-medical appointments, examinations), clinical, biochemical, cytological, endoscopic laboratories, dispensary and methodological departments, etc. In the 70s. departments of rehabilitation treatment began to be created in polyclinics (see Polyclinic).

Development of a network of honey. institutions providing medical outpatient care, in 1960-1975. presented in table. 4.

In outpatient clinics, St. 50% of the population of cities and districts, of which 80 to 90% undergo a full course of treatment.

The volume of activity of outpatient clinics in the USSR for 1960-1975. is given in table. 5.

L.'s feature - the item. for the rural population is the phasing. At the first stage, medical care is rendered by a rural medical site (a collective farm maternity hospital, an outpatient clinic, a local b-tsey, and a pre-medical one - a feldsher-obstetric station, etc.). At the second stage, medical care is provided by district medical institutions (central district hospital, combined with a polyclinic, district hospital, dispensary), where patients receive specialized medical care for its main types, and at the third - regional (regional, republican ) b-tsey, dispensaries and city institutions, where all types of specialized medical care are provided to rural residents. In 1975, per 100 inhabitants. villages were hospitalized in district hospitals and hospitals located in cities, 22.5 people, and per 100 inhabitants. cities, this figure was 21.3, which is a major step in leveling the level and quality of L.-p. n. urban and rural population.

At industrial enterprises, in construction organizations and in transport, medical and sanitary units are created (see) as part of a hospital combined with a polyclinic, shop medical stations, health centers (see), sanatoriums (see), etc. They perform function to lay down. - the professional, the help to workers taking into account production conditions, and also actively participate in the decision of questions of improvement of working conditions and health protection.

L.-p. the item sick with cardiovascular, oncological, skin and venereal, psychoneurological diseases, tuberculosis and nek-ry others render dispensaries (see. Dispensary ).

The stomatologic help to the population (see. Stomatology, the organization of the stomatologic help) is carried out in stomatol, policlinics, dental offices and departments of BC. In the country by 1976 there were 23,550 stomatol, polyclinics, departments and offices and 6114 prosthodontic rooms.

Distinctive feature to lay down. - the prof. the help is prophylactic medical examination (see) and active monitoring of health of certain contingents of the population. In 1977, St. 35 million people At the same time, much attention is paid to periodic medical examinations of workers of individual shops and professions, preventive examinations of children, students drafted into the ranks of the Soviet Army, engaged in physical education and sports, etc. Mass targeted medical examinations of the population are widely carried out, aimed at early detection of diseases or patol, processes caused by various factors. In 1975, 106.9 million people underwent medical examinations. (see Medical examination).

The ambulance and emergency medical service is represented by a wide network of emergency and emergency medical aid stations (see Ambulance and emergency medical care). In large cities, specialized cardiological, traumatological, pediatric, toxicological, neurological, resuscitation, intensive care and other teams are created in their composition, as well as ambulance and emergency medical services combined with stations are organized. In 1975, more than 71 million sick and injured people received emergency medical care. Institutions of blood transfusion are represented by blood transfusion stations (see).

To system L.-p. The items also include institutions for the protection of motherhood and childhood: nurseries and nursery gardens (see Nursery, nursery garden); children's home (see Children's home); dairy kitchens (see Dairy cuisine); maternity hospitals (see); antenatal clinics (see), which are a structural unit of the maternity hospital; clinics or outpatient clinics. L.-p. children are provided by children's hospitals and clinics (see Children's Hospital, Children's Clinic). See also Health care, women's and children's health; Health protection of children and adolescents; Protection of motherhood and childhood.

The organization of rest and a dignity. - hens. treatment of the population plays an important role in system to lay down. - the professional, the help to the population. In 1975, there were 11,697 sanatoriums and recreation facilities in the country for 1,795,000 beds (see Healthcare, health resort care). The main type to lay down. institutions in the resorts is a sanatorium (see). Lech. procedures, as a rule, are carried out in balneological clinics (see Balneological clinic, Hydropathic), mud baths (see), etc. Patients who do not need a strict sanatorium regimen receive outpatient treatment in resort clinics.

In order to further develop the L.-p. to the population in the resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve public health" (1977), a comprehensive program is outlined, which provides for the improvement of primary health care (clinics, emergency and emergency medical care facilities, rural precinct BCs and outpatient clinics), development of the material and technical base of health care based on a rational combination of the construction of multidisciplinary and specialized medical facilities. institutions, expansion of a network of MSCH, strengthening of the central regional BC and other to lay down. - the professional, the institutions rendering medical aid to workers of the industrial enterprises and rural population. It is envisaged to improve the quality and culture of providing medical care to the population on the basis of widespread introduction in honey. practice of achievements of science and technology, best practices and scientific organization of labor (see Scientific organization of labor in health care), improvement of prof. training and ideological and political education.

By 1980, the USSR will have St. 60 thousand powerful specialized and well-equipped combined BCs with a bed fund of 3.5 million beds (13 beds per 1000 population), which ensures the complete completion of inpatient treatment of St. 60 million inhabitants, polyclinic and dispensary institutions for 2.5 billion visits per year (9-10 visits per inhabitant per year), which will ensure that the needs of the population in outpatient and polyclinic types of care are met.

NOMENCLATURE OF MEDICAL AND PREVENTIVE INSTITUTIONS

Hospital facilities

Hospital on water transport (central pool, pool, port, linear)

Hospital on railway transport (central, road, departmental, nodal, linear)

City Hospital

City emergency hospital

Hospital for disabled veterans of the Patriotic War

Children's hospital on railway transport

Children's city hospital Children's regional (regional, republican) hospital Children's district hospital Regional (regional, republican) hospital

District Hospital District Hospital District Hospital City Central Hospital District Central Hospital District Central Hospital

Specialized hospitals: children's infectious diseases hospital; Children's Orthopedic and Surgical Rehabilitation Hospital; children's psychiatric hospital; children's tuberculosis hospital; hospital for Infectious Disease; orthopedic-surgical hospital for rehabilitation treatment; otorhinolaryngological hospital; ophthalmological hospital; psycho-neurological hospital (for patients with chronic alcoholism); mental hospital; tuberculosis hospital; physiotherapy hospital;

Medical and preventive institutions of a special type

Leper colony

Dispensaries

Medical and physical education

Cardiology

Dermatovenerological

Narcological

Oncological

Antigoiter

Antituberculous

Neuropsychiatric

Trachomatous

Outpatient clinics

Ambulatory

Medical health center

City Polyclinic

Children's City Polyclinic

Children's Dental Clinic

Cosmetology clinic

Polyclinic on water transport (central basin, basin port, linear)

Polyclinic on railway transport (central, road, departmental, nodal, linear)

Dental clinic

Paramedic health center

Feldsher-obstetric health center

Physiotherapy clinic

Central district polyclinic

Emergency and emergency medical care and blood transfusion facilities

Blood transfusion station

Ambulance station

Institutions for the protection of motherhood and childhood

Nursery (Nursery-garden)

baby house

Kolkhoz maternity hospital

dairy kitchen

Maternity hospital

Sanatorium-resort institutions

Balneological clinic

Mud bath

Children's balneological clinic

Children's mud bath

Resort polyclinic

Children's sanatorium

Sanatorium

Sanatorium-dispensary

Specialized sanatorium pioneer camp all year round

tables

Table 1. GROWTH IN THE NUMBER OF MEDICAL INSTITUTIONS IN THE USSR PROVIDING THE POPULATION THERAPEUTIC AND PREVENTIVE CARE* AND THE NUMBER OF HOSPITAL BEDS (1940-1975; all departments)

Table 2. GROWTH IN THE VOLUME OF THERAPEUTIC AND PREVENTIVE CARE PROVIDED BY INSTITUTIONS IN 1960-1975* (in institutions of the M3 system of the USSR)

Indicators
Number of urban settlements and rural areas admitted to hospitals (thousands)
Including:
number of urban residents admitted to hospitals in urban settlements and rural areas (thousands)
on average per 100 inhabitants of urban settlements
number of rural residents admitted to hospitals in urban settlements and rural areas (thousands)
on average per 100 inhabitants of rural areas
number of rural residents hospitalized in urban hospitals (in % of the total number of hospitalized rural residents)
Average number of bed occupancy days per year (all beds):


Average number of days a patient stays in bed:

Table 3. GROWTH OF PROVISION OF THE POPULATION IN THE USSR WITH HOSPITAL BEDS FOR INDIVIDUAL SPECIALTIES in 1960-1975

Indicators
Number of beds for:
therapeutic patients (in thousands)

surgical patients (in thousands)

pregnant women and women in childbirth (in thousands)
per 10,000 people population
gynecological patients (in thousands)
per 10,000 people population
TB patients (thousands)
per 10,000 people population
infectious patients (in thousands)
per 10 00 0 people population
sick children (in thousands)
per 10,000 people population
nervous patients (in thousands)
per 10,000 people population

Table 4. DEVELOPMENT IN THE USSR OF THE NETWORK OF MEDICAL INSTITUTIONS PROVIDING MEDICAL OUTPATIENT CARE, 1960-1975

Indicators
Number of outpatient clinics - total*
Of these, polyclinic departments:
regional hospitals
city hospitals
district hospitals in rural areas
district hospitals
children's hospitals (non-infectious)
maternity hospitals*
dispensaries of all profiles *
other hospital institutions (including special ones)
Non-integrated outpatient clinics (including children's polyclinics, antenatal clinics)
Dental clinics (independent)
Medical health centers
Institutions of ambulance and emergency medical care
Departments of emergency and planned advisory care of regional (republican) hospitals
* In urban areas and rural areas. ** Some decrease is due to the enlargement of institutions.

Table 5. VOLUME OF ACTIVITY OF OUTPATIENT INSTITUTIONS IN THE USSR IN 1960-1975 (M3 systems of the USSR)

Indicators
Number of visits to medical treatment and prevention facilities (million):
to doctors on an outpatient basis
home doctors
Number of visits to feldsher facilities in rural areas (million):
to the nursing staff at an independent outpatient appointment
nurses at home
Average number of visits per inhabitant:
urban	No data
rural	No data
The number of persons who were under dispensary observation for diseases during the year:
adults and adolescents aged 15 and over (thousand people)	No data 1
per 100 0 people this age	No data
children under the age of 14 inclusive (thousand people)	No data
per 10 00 people this age	No data
* Incomplete data.

Bibliography: Zakharov F.G. Organization of medical care for industrial workers in Russia and the USSR, M., 1969; The national economy of the USSR for 60 years, p. 625, M., 1977; Fundamentals of the organization of hospital care in the USSR, ed. A. G. Safonova et al., M., 1976, bibliogr.; Guide to social hygiene and healthcare organization, ed. N. A. Vinogradova, vol. 2, p. 81, M., 1974; Serenko A. F., Ermakov V. V. and Petrakov B. D. Fundamentals of the organization of outpatient care to the population, M., 1976; 60 years of Soviet healthcare, chief. ed. B. V. Petrovsky, p. 7, 143, Moscow, 1977.

F. G. Zakharov.

The main principles of outpatient care are:

ü locality(certain territories are assigned to institutions, which in turn are divided into territorial sections.)

Plots are formed depending on the population.

A local doctor (therapist, pediatrician, obstetrician-gynecologist) and a local nurse are assigned to each site.

Therapeutic sites are formed at the rate of 1,700 residents aged 18 and over;

pediatric- at the rate of 800 children and adolescents under the age of 18;

obstetric and gynecological- per 6,000 adults or (if the population consists of more than 55% of women) at the rate of 3,300 women per site.

ü availability(provided by a wide network of outpatient clinics operating in Russia.)

Any resident of the country actually has no obstacles to contacting an outpatient clinic both at the place of residence and in the territory where he is currently located.

The availability of outpatient care is also ensured by its free of charge for the main types within the framework of the program of state guarantees for the provision of free medical care to citizens.

ü preventive focus(expressed primarily in the dispensary method of work of many institutions, which implies active dynamic monitoring of the health status of individual contingents of the population.)

The dispensary method is used in work with certain groups of healthy people (children, pregnant women, military personnel, athletes, etc.), as well as with patients subject to dispensary observation.

An important element of the preventive work of outpatient clinics is vaccination work. Preventive vaccinations for the children's population are carried out according to the appropriate vaccination schedule, for the adult population - according to indications and at will.

Outpatient clinics play a leading role in the sanitary and hygienic education of the population, the formation of a healthy lifestyle.

ü continuity and staging of treatment.(Outpatient care is the first stage of a single chain of treatment and prevention process: polyclinic - hospital - rehabilitation treatment facilities).

In addition, there may be several stages of treatment in the clinic itself. Usually the patient first turns to the local doctor. If necessary, the district doctor refers the patient to a doctor of a narrow specialty.

The positions of narrow specialists are provided for in most outpatient clinics.

If necessary, the patient can be referred to a consultative polyclinic, to a consultative and diagnostic center, to a dispensary according to the profile of the disease. Between all links of polyclinic care there should be continuity, which allows to exclude duplication of examinations and maintenance of medical records, ensure the complexity of treatment and diagnosis, and combine efforts in preventive work.

The local therapist should not only be a clinician, but also examine the state of health of the territory entrusted to him and the factors influencing him, and engage in prevention. The work schedule of the local therapist is 6 hours 30 minutes a day, of which 30 minutes are for activities not directly related to patient care. Every 3 years, at least 3 months, the doctor must work in a hospital. Professional development is carried out every 5 years. Admission rates are 5 people per hour, medical examinations - 7.5 people per hour, at home - 2 people per hour. 5.9 therapists are planned per 10,000 population. Nurses work on a paired principle (one sister performs medical appointments at home at 2 districts, and the other sits at appointments with 2 district doctors).

The main sections of the activity of the local therapist:

§ medical

§ preventive

§ sanitary and educational

§ anti-epidemic

§ maintenance of operational accounting documentation

VIEW MORE:

Main questions

1. Principles and organizational structure of medical and preventive care.

2. Primary health care (PHC), its importance in the health care system.

Polyclinic, its structure and tasks.

4. The district principle of the work of polyclinic institutions.

5. General practitioner, preparation, organization of work.

6. The concept of the organization of emergency (emergency) medical care.

7. Prevention - the main organizational principle of health care, forms, levels.

Department of prevention: structure, tasks, features of work.

9. Dispensary method, its content. Dispensaries, their types.

10. Indicators of the organization and effectiveness of clinical examination.

11. Organization of inpatient care. Stationary-replacing technologies.

12. Hospital, its structure and organization of work.

13. Basic medical documentation of the clinic and hospital.

Types and analysis of performance indicators of the polyclinic and hospital.

15. The concept of minimum social standards in health care.

Literature

Main

1. Lectures.

2. Social hygiene and healthcare organization /Ed. A.F. Serenko and V.V. Ermakov. - M .: Medicine, 1984. - S. 321 - 338.

A guide to practical exercises in social hygiene and healthcare organization / Ed. Yu.P. Lisitsyna, N.Ya. Hooves - M .: Medicine, 1984. - S. 159 - 229.

policy documents

On compulsory medical insurance of foreign citizens and stateless persons temporarily staying in the Republic of Belarus.

3. Decree of the Council of Ministers of the Republic of Belarus No. 963 of July 18, 2002 On state minimum social standards in the field of healthcare.

On the approval of the nomenclature of health care institutions.

5. Order of the Ministry of Health of the Republic of Belarus No. 104 of July 1, 2002 On approval of the nomenclature of medical and pharmaceutical specialties, the nomenclature of positions and the list of correspondence of medical and pharmaceutical specialties to positions.

Order of the Ministry of Health of the USSR No. 1000 of September 23, 1981 On measures to improve the organization of outpatient clinics.

7. Order of the Ministry of Health of the Republic of Belarus No. 242 of September 2, 1998 On a phased transition to the organization of primary health care on the principle of a general practitioner.

8. Order of the Health Department of the Grodno Regional Executive Committee No. 32 dated February 1, 2000 On improving the work of day hospitals.

Order of the Health Department of the Grodno Regional Executive Committee No. 144 dated March 31, 2000 On improving the work of hospitals at home.

11. Order of the Health Department of the Grodno Regional Executive Committee No. 313 dated July 22, 2002 On the medical examination of the adult population.

Order of the Ministry of Health of the Republic of Belarus No. 159 dated June 27, 1997 On the implementation of the program for the integrated prevention of non-communicable diseases (CINDI).

13. Order of the Ministry of Health of the Republic of Belarus No. 250 dated October 18, 2001 On improving the medical examination of citizens affected by the disaster at the Chernobyl nuclear power plant and equivalent categories of the population.

Order of the Ministry of Health of the Republic of Belarus No. 164 of August 31, 1992 On improving the organization of emergency and emergency medical care.

Order of the Ministry of Health of the Republic of Belarus No. 152 of May 13, 1999 On the state and measures to improve ambulance services.

Additional

Glushanko V.S. Public health and health care: A course of lectures for domestic students. - Vitebsk, 2001. - S. 85-101, 127-151.

2. The world health report 2000: Health systems: Better performance. - Geneva, 2000. - 232 p.

3. Lisitsyn Yu. P. Public health and health care: Textbook. - M., 2002.

- S. 314-332.

4. Lisitsyn Yu.P. Social hygiene and healthcare organization: Problematic lectures. - M.: Medicine, 1992. - S. 78-127.

5. Medic V. A., Yuriev V. K. A course of lectures on public health and health care. - Part 2.: Organization of medical care.

- M., Medicine, 2003. - S. 11-27, 290-304, 340-349,350-371.

6. Minyaev V. A. Polyclinic business. – M.: Medicine, 1987. – 319 p.

7. Minyaev V.A., Vishnyakov N.I., Yuriev V.K., Luchkevich V.

C. Social medicine and healthcare organization. - T. 2. - St. Petersburg, 1998. - S. 18-94, 212-223.

8. Public health and health care: A textbook for students / Ed. V.A. Minyaeva, N.I. Vishnyakova.

– M.: MEDpressinform, 2003. – P.175-247.

9. Guide to social hygiene and healthcare organization / Ed. Lisitsyna Yu.P. - V.2. - M.: Medicine, 1987. - S. 110-169, 205-258.

10. Social hygiene and health organization: Textbook / Ed. I.B. Zelenkevich, N.N. Piliptsevich. - Minsk: Higher School, 2000. S. 129 - 142, 145-156.

11. Inpatient medical care: Fundamentals of organization / Ed. A.G. Safonova, E.A.

Loginova - 2nd ed. – M.: Medicine, 1989. – 394 p.

Therapeutic f-t 5 k.

IX semester

ACTIVITY #4

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Target: Students must know the principles of organizing medical care for the population.

The health care system consists of the public and non-public health sectors.

The public health sector consists of state bodies in the field of health care, health care organizations based on the right of state ownership.

The non-state health sector consists of health care organizations based on private property rights, as well as individuals engaged in private medical practice and pharmaceutical activities.

The subjects of healthcare are healthcare organizations, as well as individuals engaged in private medical practice and pharmaceutical activities.

In the healthcare system, there are organizations: outpatient care; inpatient care; ambulance and air ambulance; disaster medicine; rehabilitation treatment and medical rehabilitation; palliative care and nursing care; blood services; forensic medicine and pathological anatomy; pharmaceutical activities; sanitary and epidemiological welfare of the population; scientific organizations; educational organizations; formation of a healthy lifestyle and healthy nutrition; HIV/AIDS prevention; national holdings.

Medical care is managed by the authorized body - the Ministry of Health, local government health authorities of the region, the city of republican significance and the capital.

The main types of medical care are:

pre-hospital medical care - medical care provided by medical workers with a secondary medical education for the prevention of diseases, as well as for diseases that do not require the use of methods of diagnosis, treatment and medical rehabilitation with the participation of a doctor.
qualified medical care - medical care provided by medical workers with higher medical education in case of diseases that do not require specialized methods of diagnosis, treatment and medical rehabilitation.
specialized medical care - medical care provided by specialized specialists for diseases that require special methods of diagnosis, treatment and medical rehabilitation.
highly specialized medical care - medical care provided by specialized specialists for diseases that require the use of the latest technologies for diagnosis, treatment and medical rehabilitation in medical organizations determined by the authorized body.
medical and social assistance - medical assistance provided by specialized specialists to citizens with socially significant diseases, the list of which is determined by the Government of the Republic of Kazakhstan.

Medical assistance can be provided in the following forms:

primary health care (PHC) - pre-medical or qualified medical care without round-the-clock medical supervision, including a range of affordable medical services provided at the level of the individual, family and society.

PHC is provided by district physicians, pediatricians, general practitioners, paramedics, obstetricians and nurses. The activities of organizations providing PHC are based on the territorial principle in order to ensure the availability of medical care to citizens at their place of residence and (or) attachment, taking into account the right of free choice of a medical organization.

consultative and diagnostic assistance - specialized or highly specialized medical care without round-the-clock medical supervision.
inpatient care is a form of providing qualified, specialized and highly specialized medical care with round-the-clock medical supervision.
hospital replacement care is a form of providing pre-medical, qualified, specialized and highly specialized medical care with medical supervision lasting from four to eight hours during the day.
emergency medical care - a form of medical care in the event of diseases and conditions that require emergency medical care to prevent significant harm to health or eliminate the threat to life.
air ambulance is a form of providing emergency medical care to the population when it is impossible to provide medical care due to the lack of medical equipment or specialists of appropriate qualifications in a medical organization at the location of the patient.
emergency medical care is a form of providing medical care by the disaster medicine service in natural and man-made emergencies.
rehabilitation treatment and medical rehabilitation are provided to citizens suffering from congenital and acquired diseases, as well as the consequences of acute, chronic diseases and injuries.
palliative care is provided under the guidance of a doctor to terminally ill patients in the terminal (final) stage of the disease in specialized structural units, independent medical organizations (hospices) or in the form of a hospital at home.
folk medicine (healing) - a set of empirical information accumulated by the people about healing agents, as well as medical and hygienic methods and skills and their practical application for maintaining health, preventing and treating diseases.

Health care entities are obliged to provide quality medical care in accordance with the license within the guaranteed volume of free medical care (GOBMP), which is provided to citizens of the Republic of Kazakhstan and oralmans at the expense of budgetary funds and includes preventive, diagnostic and therapeutic medical services that have the highest proven effectiveness, in in accordance with the list approved by the Government of the Republic of Kazakhstan.

The GBMP includes:

1) emergency medical care and air ambulance;

2) outpatient care, including: primary health care; consultative and diagnostic assistance in the direction of a specialist in primary health care and specialized specialists;

3) inpatient medical care in the direction of a specialist in primary health care or a medical organization within the planned number of cases of hospitalization (maximum volumes) determined by the authorized body, according to emergency indications - regardless of the availability of the referral;

4) hospital-replacing medical care in the direction of a specialist in primary health care or a medical organization;

5) rehabilitation treatment and medical rehabilitation;

6) palliative care and nursing care for the categories of the population established by the Government of the Republic of Kazakhstan.

Citizens are also entitled to additional paid medical services not included in the list of the State Comprehensive Medical Benefit, at the expense of their personal funds, as well as funds of enterprises, institutions, organizations and other sources not prohibited by the legislation of the Republic of Kazakhstan.

the country is implementing a plan to create a Unified National Health System (UNHS).

Illustrative material: 10 slides in the program ʼʼRower Pointʼʼ.

Literature:

1. The Constitution of the Republic of Kazakhstan.

3. Lisitsyn Yu.P.

Public health and health care: Textbook. - 2nd ed., revised. and additional - GEOTAR-Media, 2007. - 512 p.

4. On health care in the Republic of Kazakhstan: Basic legislative acts.

- Almaty: JURIST, 2004. - 182 p.

5. Sagindykova A.N. Constitutional and legal problems of protecting the health of citizens in the Republic of Kazakhstan. - Almaty, 1997. - 167 p.

Control questions:

1. List the medical care organizations.

2. Name the types of medical care.

3. Specify the main forms of medical workers.

4. Give a definition of ʼʼGOBMPʼʼ.

5. What is included in the list of GOBMP?

INTRODUCTION

The organization of healthy and preventive support for the population is provided both in the city and in the countryside. The organization of treatment and preventive care for the urban population consists of three stages:

Level 1 - primary health care (emergency care) is provided in an outpatient clinic, hospitals, emergency medical care, medical and maternity hospitals, medical centers;

Phase 2 - Medical care in hospitals - carried out in hospitals;

Phase 3 - rehabilitation treatment - in hospitals and outpatient facilities.

Primary health care is basic, accessible and free of charge for all types of health care provided by citizens, which includes: treatment of the most common diseases, as well as injuries, poisoning and other emergencies; medical prevention of serious diseases; Sanitary and hygienic education; who carry out other activities related to the provision of medical care to citizens at the place of residence (Fundamentals of the Law of the Russian Federation "On Health Care in the Field of Revision of Federal Law No. 122" dated August 22, 2004).

The provision of treatment and preventive care is built in accordance with certain principles:

1) the availability of free free medical care in accordance with the program of state guarantees.

The program defines the types, scope, procedures and conditions for the provision of free medical care to the population. The program of state guarantees is reviewed annually;

2) continuity of medical issues and prevention;

3) continuity of healthcare institutions;

4) advantage in the work of MP;

5) accuracy;

6) dispenser method.

The purpose of this work is to consider the issue of organizing medical care for the population in the Russian Federation and the Republic of Bashkortostan.

To achieve this goal, it is necessary to solve the following tasks:

review of the literature on the problem under study;
to study the basic principles of organizing healthcare for the population;
to study the main stages in the provision of primary health care to the rural population.

The summary contains an introduction, 2 sections, a conclusion, a list of references.

Principles of public health organization in the Russian Federation

1.1. Continuity of medical institutions

There is continuity between clinics, clinics and hospitals to organize quality medical care. Continuity is achieved through the exchange of information between doctors of medical and preventive institutions, joint clinical conferences, consultations - this allows improving the qualifications of medical personnel and reducing duplication of patient care2.

1) clinical contract with the hospital for hospitalization of patients;

2) epicrese release is transferred to the clinic;

3) Organization in the clinic of the department of rehabilitation therapy (after care)

4) Clinic doctors should work in the hospital one by one.

The benefit of providing medical care to those who work

Health care for workers is carried out in specialized institutions - medical and sanitary units (MCh), medical or paramedical medical institutions. MSCs can be open types - service workers companies, their relatives and the population of the neighboring territory.

At the moment there are all Moscow State University and closed types (only employees of this company). Medical centers and medical services work in accordance with the company's work schedule. Feldsher medical centers can be mobile.

The work of the trading service is first evaluated in the form No. 16 - according to the results of the analysis of the incidence for temporary disability.

An important part is the work of a commercial doctor with a long illness (1 illness 4 cases and 40 days of temporary disability per year).

The sales doctor prepares lists of those who are often ill for a long time. Treatment is carried out in consultation with a narrow specialist. The companies have sanatoriums-preventors.

Health units can act as:

2. Joint hospital.

II. Health care is also provided by a general network of medical and preventive institutions, especially in cases where companies do not have a health unit and a number of employees according to certain standards. (The vitamin plant is attached to the 1st clinic of the 5th clinic and cable device). The registry has a separate window for servicing employees.

The ecological principle is the connection of a specific contingent of the population with a local doctor.

Dispensation method

Clinical examination - active monitoring of the health status of certain groups of the population (healthy and sick), which are involved in the early detection of diseases, dynamic monitoring and complex treatment of cases, the implementation of measures to improve their working and living conditions, prevent the development and spread of diseases, working capacity and prolongation period of active life 3.

The following stages are distinguished in the organizational process of a clinical trial:

1. selection of contingents with active detection, their registration.

2. introduction of a complex of therapeutic and social and preventive measures, for example. introduction of appropriate clinical monitoring, evaluation of the results of the effectiveness of clinical examination.

The detection of people undergoing medical examination is usually carried out when patients see a doctor in a clinic or at home and as a result of various preventive examinations that detect the earliest stage of the disease.

Dynamic monitoring of group I (healthy) is carried out with annual preventive medical examinations. For this group of observational clinics, there is a general plan for therapeutic preventive and social measures, which includes measures to improve working and living conditions for health education and promotion of a healthy lifestyle.

Monitoring of dynamic group II is aimed at eliminating or reducing the impact of risk factors, increasing the body's resistance and compensatory abilities.

Currently, this method is used when working with a specific population of people:

- children under 18;
- pregnant women;
— students and full-time students;
- invalids of wars;
- athletes;
– Individual groups in accordance with the original GPG;
— Patients to be monitored.

Clinical respiratory days are designed to work with patients with dysfunction. The medical examination is carried out in two stages.

Level 1 indicators:

1. Completeness of the cover by medical examinations;

2. Condition subject to mandatory medical examination.

About 80% of the population is covered by the dispensary. In addition, an additional medical examination is being carried out within the framework of the national project "Health". According to the results of the medical examination, the GP GP district distributes citizens who have been clinically examined in 5 groups of health conditions:

I am "virtually healthy"

II - "with a high degree of risk for the development of a disease requiring preventive measures,

III - "the need for additional examination and treatment on an outpatient basis"

IV - "the need for observation and treatment in a hospital setting"

V - "they need high-tech types of healthcare."

Citizens listed:

to group I - you do not need to control hospitals, they conduct a preventive conversation in a healthy lifestyle;

vII. group - this AAP has a preventive program in place;

for group III - additional examinations and, if necessary, outpatient treatment;

Group IV - additional examinations and, if necessary, treatment in a hospital;

for group V - to send to the Commission a public health authority of the Russian Federation at the choice of those who need high-tech healthcare.

The Preventive Health Examination Standard includes an expert review of:

fluoroscopy, mammography (in women over 40) or breast ultrasound, ECG (electrocardiogram), OAM (urinalysis), KLA (CBC), total cholesterol and lipid profile, sugar, tumor markers (40 years and older)

2 experts: district doctor or general practitioner, obstetrician, gynecologist (female population), urologist (for men), neurologist, surgeon, ophthalmologist, endocrinologist.

As an additional medical examination: no new cases of disease in the subsequent stages, including cancer, tuberculosis, severe diabetes, stroke, heart attack and other diseases leading to long-term and permanent disability (three months after completion of the medical examination) 4.

The principle of specialization in health care

Specialized rescue team

Narrow specialized clinic,

in multipurpose hospitals.

in outpatient clinics.

Dispensers are specialized medical and preventive institutions for the active identification, treatment, rehabilitation and prevention of patients.

All dispensaries of national importance are financed from the budget of the Republic of Belarus

Kinds: cardiology, medical-sports, skin-venous, etc. Dispensers include clinic and hospital. An important part of the work is advisory assistance to the general network of health care and prevention institutions.

The quality of medical care in specialized hospitals is higher than in a general hospital. For example, a cardio dispenser is a cardiac department in a hospital or a therapeutic department.

However, this is an expensive form of medical care.

2. Organization of treatment and prevention for the rural population

It is built on the same organizational principles as the urban population. The main ones are districts and dispensaries. Differences in the organization of healthcare are determined by a number of factors: low population density of rural residents; distance of residents from district centers; poor provision of communications; the specificity of working and living conditions is the seasonal nature of agricultural work.

Contact with animals, chemical fertilizers, etc.

Health characteristics:

step by step;
Up to 40% of the volume of medical care is provided by average health professionals (beds for paramedical midwives);
large radius radius;
lower availability of material, technical and human resources (medical and diagnostic equipment, doctors, beds);
primary health care for people engaged in agricultural activities.

And the level of providing medical care to the rural population is the Rural Medical Group (RME).

It turned out that qualified first aid and medical care. The location radius is 5-7 (up to 20) km. As part of work in rural medical institutions: district hospital (SUB), rural clinics (CBA), FAPs, kindergartens, other medical centers in outpatient companies.

From 6 to 8 specialties: treatment, pediatrics, dentistry, surgery, obstetrics and gynecology. A medical station in a rural area, located in the area of the central hospital, is considered imputed, and its population directly refers to it.

In a complex therapeutic area - 2000 or more adults and children.

Phase II - qualified specialized healthcare in district hospitals, as part of the central regional hospital, central regional pharmacy, hospital district, medical centers between districts (10-20 specialties).

Pages: 123next →

Topic 4. ORGANIZATION OF MEDICAL PREVENTIVE CARE TO CIVIL SOCIETY.

target: Familiarize students with the health care system for the urban population. Consider the structure, tasks of urban medical institutions and conduct an analysis.

Learning objectives:

It is necessary to complete the master records and operational documentation of organizations for treatment and prevention.
Calculate and evaluate the work of the city and the clinic independently.
Independently calculate and analyze hospital performance

The main questions of the topic:

What is the treatment and preventive maintenance of the urban population?

The main indicators of the clinic?

6. What institutions provide medical care to urban residents?

presentations;
work in small groups;
solving situational problems;
oral and written interviews.

Medik V.A., Yuriev V.K. Lectures on public health and public health. Part 2. Organization of health care. - Moscow: Medicine, 2003. - 456 pages.

4. Minyaev V.A., Vishnyakov I.N. Public health and health: a textbook for students of medicine. University. - M.: "MEDRESS-INFORM", 2006 - 528 pages.

5. Yuryev V.K., Kutsenko G.I. Public health and healthcare - St. Petersburg: Petropolis.

- 2000. - 910 p.

1. Give the types of treatment and prevention for the urban population.

2. Structure and organization of the city polyclinic.

3. The role of outpatient clinics in the organization of treatment and prevention of the urban population.

4. What is the essence of the municipal principle of organizing outpatient care and what are the dimensions

5. Key signs of the polyclinic?

What institutions provide medical care to urban residents?

7. What are the main departments and activities of the local therapist?

8. The structure of the city hospital.

9. Organization of work and tasks of the city hospital.

10. State standards of the staff of the clinic, hospital

Topic 5.

ORGANIZATION OF PREVENTED MEDICAL ASSISTANCE FOR THE RURAL POPULATION.

target: Familiarize students with the health care system for the rural population.

Review the structure, functions of rural medical institutions and perform the analysis.

Learning objectives:

It is necessary to fill in the basic accounting and operational documentation of rural medical and preventive institutions.
Independently calculate and evaluate the performance of the district clinic.
Independently calculate and analyze performance indicators of district and regional hospitals.

The main questions of the topic:

What medical institutions provide assistance to rural residents?

2. What are the main characteristics of the healthcare organization for the rural population?

3. What medical institutions are part of the rural medical station?

4. Give a general description of the rural medical station?

What are the main tasks of a rural hospital?

6. Felischer - place of birth, its main tasks.

7. Central regional hospital, its structure and tasks?

8. What are the standards of central regional hospitals?

Structure and tasks of the regional hospital.

10. Indicators of organizational and methodological work of the regional hospital.

Teaching and learning methods:

presentations;
work in small groups;
solving situational problems;
oral and written interviews.

1. Akanov A.A., Kurakbaev K.K., Chen A.N., Akhmetov U.I. Organization of healthcare in Kazakhstan. — Astana, Almaty, 2006.

2. Public health and activities of health care institutions (statistical material) Almaty, 2007.

3. Medic V.A., Yuriev V.K. Lectures on public health and public health. Part 2. Organization of health care.

- Moscow: Medicine, 2003. - 456 p.

4. Minyaev V.A., Vishnyakov I.N. Public health and health: a textbook for students of medicine.

University. - M.: "MEDRESS-INFORM", 2006 - 528 pages.

5. Yuryev V.K., Kutsenko G.I. Public health and healthcare - St. Petersburg: Petropolis. - 2000. - 910 p.

Supervision: (questions, tests, tasks, etc.)

1. The role of outpatient and polyclinic institutions in the organization of treatment and prevention of the urban population.

What is the essence of the municipal principle of organizing polyclinic care and what are the dimensions of therapeutic facilities?

What is the organizational structure and tasks of the city police?

4. What are the main parts of the work and activities of the district therapist. What are the tasks of the polyclinic and district therapists for preventive medical examination of the population?

5. What is the importance of hospital care in the field of public health?

6. List the main hospitals providing hospital care.

7. Specify the main therapeutic and diagnostic departments of the hospital.

What institutions provide health care to rural residents? What health facilities are part of the rural medical station?

9. Central regional hospital, its structure and main tasks.

10. Regional hospital, structure and main functions.

Topic 6.

FIELD ACTIVITY ANALYSIS.

target: To acquaint students with the content, forms and methods of work of city police officers and hospitals.

Learning objectives:

Analyze the annual report of the Central Regional Hospital
Analyze the annual report of the regional hospital.

The main questions of the topic:

What is the procedure for preparing an annual report on a health and preventive facility?

4. How is the employment rate calculated (doctors, middle and lower staff)?

How do you calculate the physician workload indicator?

Teaching and learning methods:

presentations;
work in small groups;
solving situational problems;
oral and written interviews.

Akanov A.A., Kurakbaev K.K., Chen A.N., Akhmetov U.I. Organization of healthcare in Kazakhstan. - Astana, Almaty, 2006 - 232 pages.

2. Public health and activities of health care institutions (statistical material) Almaty, 2007.

3. Medic V.A., Yuriev V.K. Lectures on public health and public health. Part 2. Organization of health care. - Moscow: Medicine, 2003. - 456 pages.

fourth

Minyaev V.A., Vishnyakov I.N. Public health and health: a textbook for students of medicine. University. - M.: "MEDRESS-INFORM", 2006 - 528 pages.

5. Yuryev V.K., Kutsenko G.I. Public health and healthcare - St. Petersburg: Petropolis. — 2000.

Supervision: (questions, tests, tasks, etc.)

1. What is the procedure for preparing an annual report on a health and preventive facility?

2. What is the main part of the annual report of the United City Hospital?

3. What is the value of the annual report for analyzing the activities of the POL?

fourth

How is the employment rate calculated (doctors, middle and lower staff)?

5. How is the physician's burden calculated?

6. What is the procedure for calculating the placenta index and baseline standards?

7. What factors determine the average length of a patient's stay in bed?

8. What indicators are typical for the activities of hospitals?

9. How is the in-hospital mortality rate calculated and what is its average size?

10. What indicators indicate the composition of patients in the hospital, the time and results of treatment?

This chapter discusses the issues of organizing medical care for the population of the Russian Federation, depending on the conditions for its provision: these are outpatient, inpatient (hospital), emergency medical care, as well as its specialized types - dental and rehabilitation medical care, including sanatorium-and-spa treatment. The features of the organization of medical care for certain groups of the population are also described: the rural population, women, children, as well as employees of large enterprises.

11.1. Medical care in an outpatient setting

The most widespread type of medical care - PHC - (see also Chapter 9.3) is provided mainly in outpatient settings; at the same time, specialized medical care can be provided in specialized dispensaries.

In an outpatient setting, medical care is provided in cases where round-the-clock monitoring of patients, their isolation or the use of intensive treatment methods are not required.

Outpatient clinics include:

medical and obstetric stations,

medical dispensaries,

polyclinics,

dispensaries,

women's consultations,

health centers,

general medical practices, etc.

In 2008, there were 15.6 thousand outpatient clinics (APU) in the Russian Federation, and the number of visits to doctors in them annually amounted to more than 1.0 billion. 9.3 doctor visits to polyclinics per year.

The organization of the activities of the APU is based on four fundamental principles:

precinct, those. assigning a separate territory (site) to the polyclinic.

Continuity and phasing in treatment; the polyclinic is the first stage in the technological process of treating a patient (polyclinic - hospital - rehabilitation treatment). Patients usually go to the hospital only on the referral of a doctor, and from the hospital information about the treatment carried out is transmitted to the site.

preventive focus, which is implemented through a set of measures aimed at preventing diseases; among them: clinical examination (early detection of diseases and dynamic monitoring), health schools, preventive vaccinations, etc.

Availability; ideally, outpatient care should be freely available to the population of the Russian Federation at any time. However, in practice, due to underfunding of medical care and a shortage of doctors, this principle is not always implemented.

Polyclinic- This is a specialized health care facility, which provides medical care to patients who come to the reception, as well as patients at home; a complex of therapeutic and preventive measures for the treatment and prevention of diseases and their complications is carried out. The urban population is mainly assisted by the city polyclinic. If the polyclinic is intended exclusively or mainly for the provision of medical care to employees of industrial enterprises, construction organizations and transport enterprises, then it is considered medical unit- MSCh (or the main subdivision of the MSCh).

Ambulatory differs from the polyclinic in the level of specialization and scope of activities. The outpatient clinic conducts appointments in one specialty or a small number of them: internal medicine, surgery, obstetrics, gynecology and pediatrics.

Polyclinics distinguish organization of work:

combined with hospital

not united - independent;

on a territorial basis :

urban

rural;

by profile:

common for serving adults and children

polyclinics serving only the adult or only the children's population;

specialized - dental, physiotherapy, resort, etc.

The activities of polyclinics are regulated by Order No. 1000 of the Minister of Health of the USSR "On measures to improve the organization of the work of outpatient clinics" (1981), with subsequent changes made to it, and Order No. 633 of October 13, 2005 of the Ministry of Health and Social Development of the Russian Federation "On the organization of medical care".

The capacity of the institution and the number of staff are determined based on the size of the population served and the expected number of visits. The capacity of the clinic is judged by the number of medical visits per shift- from 250 to 1200 and more.

City Polyclinic, organized in cities, workers' settlements and urban-type settlements, builds its work on the local-territorial principle. Attached workers of industrial enterprises, construction organizations and transport enterprises are served by workshop(production) principle. Doctors and nurses are attached to each site, who provide assistance to the population of the site. Physicians, pediatricians, obstetricians-gynecologists, phthisiatricians and, if possible, other specialists build their work according to the district principle.

The most widespread type of primary health care is therapeutic care, organized according to the district principle. Medical therapeutic area- the most important link in the system of providing medical care, and the district therapist is the leading figure in the area and in the system of public health protection. The adult population of the therapeutic site currently averages 1,700 people aged 18 and over.

District doctor

The district doctor is not only a clinician, but also a healthcare organizer at the PHC stage. He needs to know the basics of public health and healthcare, clinical medicine, sociology and family psychology; he must be guided by the state of health of his wards at the site and the factors affecting him, improve his activities, introduce new methods of diagnosis and treatment, elements of the scientific organization of labor.

A good district doctor is essentially a general practitioner (GP).

In accordance with the regulation "On the general practitioner of the local polyclinic (outpatient clinic)" and the order of the Ministry of Health and Social Development No. 282 of April 19, 2007 "On approval of the criteria for evaluating the effectiveness of the district general practitioner" The primary care physician must ensure:

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

emergency medical assistance to patients regardless of their place of residence in case of direct treatment in the event of acute conditions, injuries, poisoning;

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 polyclinic (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 (drugs, diet therapy, exercise therapy, massage, physiotherapy, etc.);

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

organization and implementation of a set of measures for the medical examination of the adult population of the site (identification, registration, dynamic observation, medical and recreational activities), analysis of the effectiveness and quality of medical examination;

organization and conduct of 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 cabinet 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 SES department emergency notification of an infectious disease;

systematic improvement of their qualifications and the level of medical knowledge of the district nurse;

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

The district therapist works according to the schedule approved by the head of the department, which provides for fixed hours for outpatient reception of patients, 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 prevailing attendance, etc.

The work of the local therapist of the outpatient department of the hospital is built according to the alternation system (work in the clinic, on the site).

To improve the skills of district doctors, they are sent to institutes (faculties) of postgraduate education, to advanced courses and specializations at higher medical educational institutions, research institutions at least once every 5 years.

Polyclinic structure

The main structural divisions of the city polyclinic:

polyclinic management (chief doctor, his deputies);

reception desk with information desk;

medical and preventive units:

therapeutic,

surgical,

traumatological,

dental,

ophthalmic,

otorhinolaryngological,

neurological,

physiotherapy departments (offices),

department of rehabilitation and exercise therapy (LFK);

cardiological, rheumatological, endocrinological rooms, infectious diseases room, female consultation;

medical and feldsher 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 in the clinic, other units can be organized:

hospital-replacing short-term departments (wards) - the so-called day hospitals, and

health centers,

department of non-traditional methods of treatment based on paid medical services and self-supporting activities, etc.

Registry- a structural subdivision of the polyclinic, in which they make appointments with doctors. Registry employees can be persons with secondary education and trained by the institution to perform their duties. Persons with a secondary medical education are appointed to the position of head of the registry.

The registry can be centralized (single for the institution) and decentralized (in separate registries, they make an appointment with pediatricians, dentists, obstetricians-gynecologists, etc.). In a number of polyclinics, self-registration of patients for appointments with doctors is practiced. To do this, there are coupons for appointments with different doctors on different days of the week and at different times on special tables. The patient chooses a convenient time for the visit. Since 2011, it is planned to introduce electronic (or Internet) systems for recording patients for doctor's appointments.

Outpatient medical record- a single document, it registers diseases, about which the patient goes to the clinic. For a faster familiarization of the doctor with the diseases suffered by the patient, the diagnoses are recorded on the first page of the outpatient card - in the list of clarified diagnoses.

Near the reception desk, in a conspicuous place, information stands are equipped, where they indicate the names of the streets that are part of the sections of the polyclinic service area, the names of offices and departments, indicating the floor, room number, work schedule of each doctor, etc.

Home health care

Home health care is one of the main activities of the polyclinic. Medical care at home is provided around the clock: from 9 am to 7 pm - by a local doctor, the rest of the time in urgent cases - by an ambulance and emergency doctor.

When making a call to the doctor at home, the patient's condition is ascertained, and in emergency cases, the doctor on duty (if the district doctor is absent or busy) goes to the patient immediately. In emergencies requiring hospitalization, an ambulance is called. The call data is logged. Subsequent visits by the doctor to the patient at home are called active if they are made on the initiative of the doctor, without calling the patient.

Head of the polyclinic department

Plays an important role in the activities of polyclinics department head. He is appointed for at least 9 medical positions in the therapeutic and 8 in the surgical department. With a smaller number of positions, one of the specialists performs the functions of 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 a plan for treatment and preventive work,

management and control over the organization of the diagnostic and treatment process, its quality and efficiency,

examination of temporary disability, etc.

The head of the department performs this work, periodically participating in the reception, which is carried out by the doctors of the polyclinic; visiting patients at home when necessary. The head of the department gets acquainted with the maintenance of medical records; conducts, 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 medical and diagnostic work of doctors.

Statistical reporting in the clinic

The clinics have the following operational accounting documentation:

outpatient medical record;

statistical coupon for registration of the final (refined) diagnosis;

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

a ticket to see a doctor;

doctor's house call record book;

diary of work of a doctor in a polyclinic (outpatient clinic), dispensary, consultation;

control card of dispensary observation;

a list of persons subject to a targeted medical examination;

summary list of diseases subject to dispensary observation;

certificate of incapacity for work;

hospitalization slip;

referral for consultation and support rooms;

medical certificate of death;

journal for recording the conclusions of the VKK;

sick leave registration book;

prescription (adult, child);

a prescription for a drug containing narcotic substances;

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

With the introduction of health insurance, some clinics are using a single coupon for an outpatient, in which the visit, treatment and medical services are recorded at once.

On the rights of a structural unit in the polyclinic are organized medical statistics offices, reporting directly to the chief physician or his deputy for medical work, for:

organization of statistical accounting;

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

compilation of consolidated accounting documents;

compiling a periodic and annual statistical report;

development of accounting and reporting statistical documents;

participation in the analysis of the activities of the institution on the basis of these developments;

rational organization of storage of accounting documents of the current year.

The Cabinet of Medical Statistics works in close contact with all structural divisions of the polyclinic and doctors.

The most important document annual statistical report, which is provided to a higher health management body within the established time limits.

Regulation of the work of staff in the clinic

Industry regulations on labor today are advisory, and staffing standards are used as a guide in determining the number of positions of medical personnel. Today, the heads of healthcare institutions have been given the right to develop individual workload standards for doctors in outpatient clinics (divisions) depending on specific conditions (demographic composition of the population, disability, compactness of areas, provision of vehicles, epidemiological situations, etc.). Heads of healthcare institutions are also allowed, based on operational needs, to strengthen individual structural units or introduce positions that are not provided for by staff standards at the expense of positions in other structural units within the limits of the number of posts and payroll established for the institution. We present calculation examples number of positions in the clinic. Planning the number of positions of doctors in outpatient facilities is recommended to be carried out using the following methodology:

where B is the number of medical positions;

P - the approved standard of visits per inhabitant per year;

H is the population;

Ф - function of a medical position (planned number of visits per one medical position per year).

In 2009, the approved rate of visits per inhabitant per year was 9.18. If we calculate the number of medical positions of district general practitioners, then the standard of visits for him will be about 2.13 per 1 inhabitant. The number of these visits (P) consists of primary and repeated visits for diseases (including home visits), as well as visits for preventive purposes and dispensary observation.

The function of a medical position (F) is calculated by the formula:

A is the number of working days in a year;

B is the number of working hours per day;

C is the load rate per unit of time (hour) for a doctor of a certain specialty.

For example, the number of working days per year (A) for a therapist in a polyclinic with a 6-day working week, taking into account weekends and vacations, averages about 273 days. The number of working hours per day (B) with a 6-day working week is about 6 hours per day (excluding time not spent on medical and preventive work). The load rate (C) averages 3-4 patients per hour (i.e. 17 minutes per patient). Based on the data presented, the planned function of the medical position (F) of a general practitioner in a polyclinic will be about 5,700 visits per year.

Thus, to serve a site of 10 thousand people, about 4 positions of district general practitioners will be required, and given the fact that doctors need to be replaced during vacations, in some cases, this standard is increased by the heads of the institution to 5-5.5 positions.

The number of middle and junior staff in APU depends on the number of medical staff. The recommended ratio, taking into account the type of institution, on average for urban polyclinics is 1: 2.2, and for institutions located in towns and cities with a population of less than 25,000 people, 1: 3.5-5.0 and depends on the nature of settlement .

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

Unfortunately, there is no single table of equipment for polyclinics (and hospitals). The institution is equipped depending on the material and technical capabilities and the initiative of the management (staff). In 2010, the Ministry of Health and Social Development of the Russian Federation began to prepare procedures for the provision of medical care, which will provide recommended standards for staffing and equipment of the Ministry of Defense.

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

Specialized dispensaries and centers

Specialized dispensaries are designed to implement a set of preventive measures for patients suffering from socially significant diseases, their active detection at an early stage, as well as treatment and rehabilitation. Dispensaries are divided into:

medical and physical culture;

cardiological;

oncological;

dermatovenerological;

anti-tuberculosis, etc.

They serve both adults and children. The structure of the dispensary, as a rule, includes a polyclinic and a small hospital.

Currently, to provide specialized medical care in large cities, consultative and diagnostic centers (CDCs) are being created, which are equipped with modern diagnostic equipment (computer and magnetic resonance tomographs, special laboratory equipment, etc.) and consultative and diagnostic departments (CDDs) of large hospitals. .

Health care as a system of treatment and prevention, anti-epidemic, rehabilitation medical measures, institutions of state and municipal property has a sectoral structure, the totality of the activities of structures - elements of the system. It includes industries:

treatment and prophylactic (ambulatory polyclinic hospitals, 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-resort institutions;

pathoanatomical, forensic and forensic psychological examinations;

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

Primary medical and social assistance

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

outpatient clinics;

women's consultations;

sanitary and epidemiological stations;

ambulance and emergency care facilities;

maternity institutions.

WHO has developed a strategy "Health for all by the year 2000", which would enable every person, every family to lead a healthy, socially and economically productive life. The implementation of this strategy is possible through primary medical and social assistance in the institutions corresponding to it.

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

The most numerous institutions in which primary medical and social assistance is provided are outpatient clinics; in them, PHC is provided by district and shop doctors (general practitioners, pediatricians), general practitioners (family doctors), as well as paramedical workers in feldsher and feldsher-obstetric stations.

The PHC system should provide not only curative, but also preventive work, as well as the organization of medical care for the attached population.

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

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

provided about 16,000 outpatient clinics employing about 60,000 doctors, including over 45,000 district therapists and 30,000 district pediatricians; so far there are few general practitioners - a little more than 4 thousand ..

The number of surgical interventions performed in polyclinics increased in 1990-2005 by more than 20%, amounting to 6.0 million in 2005. The number of visits per 1 inhabitant per year (including emergency and emergency medical care) decreased from 11.0 in 1985 to 9.0 in 2005

The functions of a general (family) practice doctor are much broader than the duties of a local therapist, pediatrician and include part of the services provided by specialist doctors. The priority development of PHC 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 frequent services included in the structure of specialized care;

study of the conditions and lifestyle of family members.

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

Up to 95% of the doctors and patients surveyed spoke in favor of treating all family members with the same doctor, considering the activity of such a doctor to be more effective than the work of a district doctor. The work of a general practitioner (family doctor) reduces the number of referrals for consultations to doctors of other specialties, the number of examinations, increases attention to the health of all family members, saves time 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 polyclinics that are part of hospitals, independent city polyclinics, rural medical outpatient clinics, dispensaries, highly specialized polyclinics (dental, physiotherapy, etc.), women's consultations, health centers and feldsher-obstetric stations. There are more than 16,000 outpatient clinics in the country, the number of visits to doctors in them annually is more than 1.0 billion. On average, there are 9.0 visits to doctors per 1 city dweller (2005). Almost 80% of all those who seek medical help start and end treatment in a polyclinic.

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

Polyclinic- This is a specialized health care facility, which provides medical care to incoming patients, as well as patients at home, a complex of therapeutic and preventive measures for the treatment and prevention of diseases and their complications is carried out. The urban population is mainly assisted by the city polyclinic. If the polyclinic is intended exclusively or mainly for the provision of medical care to employees of industrial enterprises, construction organizations and transport enterprises, then it is considered a medical unit (or the main unit of the medical unit).

Ambulatory differs from the polyclinic in the level of specialization and scope of activities. The outpatient clinic conducts admission in one specialty or a small number of specialties: therapy, surgery, obstetrics and gynecology, pediatrics, etc.

Polyclinics are distinguished by the organization of work (combined with a hospital and non-integrated - independent), by territorial basis (urban and rural), by profile (general for serving the adult and child population and polyclinics serving only the adult or only the children's population, specialized: dental, physiotherapy , resorts, etc.).

The activities of polyclinics are regulated by the Order of the Minister of Health of the USSR? 1000 "On measures to improve the organization of work of outpatient clinics" (1981) with subsequent changes.

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

The main structural divisions of the city polyclinic:

polyclinic management (chief doctor, his deputies);

reception desk with information desk;

medical and preventive units: therapeutic, workshop therapeutic, surgical, traumatological, dental, denture, ophthalmological, otorhinolaryngological, neurological, physiotherapy departments (offices), department of rehabilitation and exercise therapy; cardiological, rheumatological, endocrinological rooms, infectious diseases room, female consultation; medical and feldsher health centers, dispensary department, ambulance and emergency department, etc.;

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

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

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

transport are serviced according to the workshop (production) principle. Doctors and nurses are attached to each site, who provide assistance to the population of the site. Physicians, pediatricians, obstetricians-gynecologists, phthisiatricians and, if possible, other specialists build their work according to the district principle.

The most massive type of outpatient care is therapeutic, organized according to the district principle. Medical therapeutic area- the most important link in the system of providing medical care, and the district therapist is the leading figure in the area and in the system of public health protection. The number of adult population of the therapeutic area currently averages 1700, shop - 1600 people (in a number of industries, depending on working conditions for shop areas - up to 2000 people and less than 1000 people).

District doctor- is not only a clinician, it is a healthcare organizer at the PHC stage. The district doctor needs knowledge of the basics of public health and healthcare, clinical medicine, sociology and family psychology. The district doctor should be a researcher of the health status of the population of his area and the factors influencing it, he should improve his activities, introduce new methods of diagnosis and treatment, elements of the scientific organization of labor.

A good district doctor is essentially a general practitioner.

In accordance with the regulation "On the general practitioner of the local polyclinic (outpatient clinic)", the local therapist is obliged to ensure: