Stages of primary health care. Organization of medical care for the population of the Russian Federation

GENERAL PROVISIONS

PHC is the basis of the delivery system medical care, including measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle and sanitary and hygienic education of the population.

Primary pre-medical health care is provided by paramedics, obstetricians and others. medical workers with secondary medical education. Primary medical care is provided by general practitioners, including district physicians, pediatricians, including district physicians, and GPs [general (family) practitioners]. Primary specialized health care is provided by medical specialists, including medical specialists of medical organizations providing specialized medical care, including high medical care.

PHC is provided in outpatient settings and day hospital conditions. In the last decade, the volume of primary health care has been growing. In 2011, PHC provided on an outpatient basis accounted for 1,175.2 million visits worth 288.6 billion rubles; in day hospitals - 60 million patient days for the amount of 20.6 billion rubles.

The main medical institutions providing PHC are listed below:

Polyclinics (adults, children's, dental);

Women's consultations;

Centers for general medical (family) practice;

Dispensaries.

KEY PRINCIPLES FOR PRIMARY HEALTH CARE

PHC is the most massive type of medical care, which is received by about 80% of all patients who apply to organizations

healthcare. The organization of activities of institutions providing PHC is based on 4 fundamental principles(Fig. 5.1).

Precinct

Most of the institutions providing primary health care work according to the district principle: certain territories are assigned to them, which, in turn, are divided into territorial sections. Plots are formed depending on the population. Each of them is assigned a local doctor (therapist, pediatrician) and a nurse. When forming sites to ensure equal working conditions for doctors, one should take into account not only the population, but also the length, type of development, distance from the clinic, transport accessibility, etc.

Availability

The implementation of this principle is ensured by a wide network of outpatient clinics operating on the territory of the Russian Federation. In 2011, more than 13,000 outpatient clinics operated in Russia, providing medical care to more than 50 million people. Any resident of the country should not have obstacles to contacting an institution providing PHC, both at the place of residence and in the territory where they are currently located. Availability and free of charge PHC to the population is ensured by the SGBP free provision medical assistance to citizens.

Continuity and stages of treatment

PHC is the first stage of a unified technological process of providing medical care "polyclinic - hospital - institutions rehabilitation treatment". As a rule, the patient first turns to the local doctor of the clinic. If necessary, he can be sent to a consultative and diagnostic center (CDC). dispensary (oncological, anti-tuberculosis, neuropsychiatric, etc.), hospital, medical and social rehabilitation. There should be continuity between these links in the provision of medical care, which makes it possible to exclude duplication of diagnostic studies, maintaining medical records, thereby ensuring the complexity of prevention, diagnosis, treatment and rehabilitation of patients. One of the directions in achieving this goal is the introduction of an electronic medical record (electronic patient passport).

Preventive focus

Institutions providing PHC are called upon to play a leading role in the formation of a healthy lifestyle as a set of measures that allows maintaining and strengthening the health of the population, and improving the quality of life.

The priority activity of these institutions is dispensary work. Clinical examination- direction in the activities of medical institutions, including a set of measures to promote a healthy lifestyle, prevention and early diagnosis of diseases, effective treatment patients and their dynamic observation.

In the preventive activities of institutions providing primary health care, primary, secondary and tertiary prevention are distinguished.

The dispensary method is primarily used in working with certain groups. healthy people(children, pregnant women, athletes, military personnel, etc.), as well as with patients subject to dispensary observation. In the process of medical examination, these contingents are registered in order to early detection diseases, complex treatment, carrying out measures to improve working and living conditions, restore working capacity and extend the period of active life.

important direction preventive work institutions providing primary health care - vaccination work. Preventive vaccinations for children are carried out according to the appropriate calendar, for adults - at will and indications.

Further development of PHC should be aimed at solving the following tasks:

Ensuring the availability of this type of medical care for all groups of the population living in any regions of the country;

Full satisfaction of the needs of the population in qualified medical and preventive and medical and social assistance;

Strengthening the preventive orientation in the activities of institutions providing PHC;

Improving the efficiency of the work of institutions providing PHC, improving management;

Improving the culture and quality of medical and social care.

CITY POLYCLINIC FOR ADULTS

The city polyclinic for adults is a healthcare institution that provides PHC to the population aged 18 years and older. Polyclinics are organized as part of hospital institutions (regional, regional, republican, district, central district hospital, medical unit). In addition, they can be independent institutions.

The main tasks of the clinic:

Providing medical care to the population directly in the clinic and at home;

Organization and conduct of the complex among the attached population preventive measures aimed at reducing morbidity, disability and mortality;

Clinical examination of the population, especially those with increased risk diseases of cardio-vascular system, oncological and other socially significant diseases;

Organization and implementation of measures for sanitary and hygienic education of the population, the formation of a healthy lifestyle.

An approximate organizational structure of a city polyclinic for adults is shown in fig. 5.2.

The polyclinic is headed by main enemy, who manages the activities of the institution and is responsible for the quality and culture of medical and preventive care, as well as organizational, administrative, economic and financial activities. He develops a work plan for the institution and organizes its implementation.

The chief physician selects medical and administrative personnel, is responsible for their work, rewards well-working proactive employees and brings violators to disciplinary responsibility labor discipline; carries out the placement of personnel, organizes the advanced training of doctors and paramedical personnel, prepares a reserve of heads of departments, establishes the work schedule of the institution, approves work schedules for personnel, etc.

The chief physician manages loans, controls the correct execution of the budget and ensures the economical and rational use of funds, safety material assets, correct compilation and timely submission of statistical, medical and financial reports to the relevant authorities, timely consideration of complaints and applications from the population, and also takes the necessary measures on them.

Among the most qualified and organizational doctors chief physician appoints his first deputy - deputy for medical work, who, during the absence of the chief physician, performs his duties. He is actually responsible for all preventive and treatment-diagnostic activities of the institution. The chief physician also has other deputies: for clinical and expert work, for the administrative and economic part.

Heads of departments also bear their share of responsibility for the quality of preventive and treatment-diagnostic work in the polyclinic, the observance of medical ethics by the staff. They directly supervise the preventive and treatment-diagnostic work of doctors, control it, consult patients with diagnostically complex forms of diseases, control the validity of issuing certificates of temporary disability by doctors; arrange timely hospitalization

patients who need inpatient treatment are provided with measures to improve the skills of doctors and paramedical personnel. Treatment of patients in need of hospitalization, but left for any reason at home, is also carried out under the constant supervision of the head of the department.

The first acquaintance of the patient with the clinic begins with the reception, which organizes the reception of patients and their care at home. It performs the following tasks:

Keeps an appointment with doctors by direct contact and by phone;

Regulates the intensity of the flow of patients in order to ensure a uniform workload at the reception, the distribution of patients by type of assistance provided;

Carries out timely selection of medical documentation and its delivery to doctors' offices, proper maintenance and storage of file cabinets.

In the practice of primary health care, three main methods are used to organize the appointment of patients for an appointment with a doctor: a coupon system, self-recording and a combined method.

Currently, a project " Electronic registry". It provides for a significant increase in the efficiency of registering the population for an appointment with a doctor and a system for monitoring the availability of medical care in a region, a locality or a single medical institution.

"Electronic registry" gives the patient the opportunity to make an appointment with a doctor in the following ways: by a single phone number; through the Internet; through an information kiosk located in the lobby of the polyclinic; through the clinic's receptionist.

"Electronic registry" provides for the availability of a single toll-free phone number for all municipal polyclinics. Having typed it, the patient enters the call center, where specially trained operators make an appointment with the necessary specialist within a minute. In addition to the call center, you can make an appointment with a doctor through a specialized Internet portal with easy navigation. If the doctor is unavailable for some reason, the patient is offered alternative options: either to make an appointment with a specialist in another medical institution, or to stand in line. The information resources of the call center allow the operator to offer the patient the fastest and most convenient option for making an appointment. On the Internet portal, options are offered automatically.

"Electronic Registry" not only increases the efficiency of making patients' appointments with doctors, but also serves as an effective management tool for the heads of health authorities and outpatient clinics. The created information base allows for a short time to generate the necessary reports, as well as manage the flow of patients to outpatient clinics online.

You can call a doctor at home in person or by phone. Received calls are entered in the "Doctor's house call record book" (form 031 / y), which indicates not only the patient's last name, first name, patronymic and address, but also the main complaints. These books are both for each therapeutic area, and for each of the doctors of narrow specialties.

In order for patients to receive the necessary information in the lobby of the polyclinic, it is advisable to organize a detailed “silent reference” with the work schedule of doctors of all specialties, the numbers of their offices, medical sites with streets and houses included in them, rules for preparing for research

(fluoroscopy, radiography, blood tests), etc. "Silent reference" should contain, in addition, information about the time and place of reception of the population by the chief physician and his deputies; addresses of on-duty polyclinics and hospitals of the district (city) that provide emergency specialized assistance to the population on Sundays, etc.

The optimal form of work of the registry using electronic (paperless) information storage technologies. For these purposes, it is necessary to create a local computer network on the scale of the entire clinic with terminals in all medical offices and diagnostic and treatment units.

In the immediate vicinity of the reception desk, there should be a pre-medical appointment, which is organized in the clinic to regulate the flow of visitors and perform functions that do not require medical competence. The most experienced nurses are selected to work in it.

The main figure of the urban polyclinic for adults is the local therapist, who provides qualified therapeutic assistance to the population living in the assigned area in the polyclinic and at home. Therapeutic sites are formed at the rate of 1,700 residents aged 18 years and older per site. In his work, the local therapist is directly subordinate to the head of the therapeutic department.

The work of the local therapist is carried out according to the schedule approved by the head of the department or the head physician of the polyclinic, which should provide for fixed hours for outpatient appointments, time for home care, time for preventive and other work. Distribute the time of admission to the clinic and home care, depending on the size and composition of the population of the site, attendance and other factors.

An important role in the organization of PHC for the population is played by doctors of narrow specialties (cardiologist, endocrinologist, neuropathologist, urologist, ophthalmologist, etc.), who in their work directly report to the head of the department or deputy chief physician for medical work.

WOMEN'S CONSULTATION

A antenatal clinic is organized as an independent healthcare facility of a municipal district (urban district) or a structural unit of a healthcare facility (city or central district hospital) to provide outpatient obstetric and gynecological care to women.

The management of the antenatal clinic, organized as an independent health care facility of a municipal district (city district), is carried out by the chief physician, who is appointed to and dismissed by the head of the health management body of the municipality. The management of the antenatal clinic in the structure of the health care facility is carried out by the head of the department, who is appointed to the position by the head of the institution.

structure and staffing medical and other personnel of the antenatal clinic is approved by the head of the health facility, depending on the amount of work performed.

The main goal of the antenatal clinic is to provide qualified outpatient obstetric and gynecological care to the female population outside of pregnancy, during pregnancy and in the postpartum period.

The main tasks of the antenatal clinic:

Preparing women for pregnancy and childbirth, providing obstetric care during pregnancy and in the postpartum period;

Provision of PHC to women with gynecological diseases;

Provision of family planning counseling and services, prevention of abortion and sexually transmitted diseases, introduction modern methods contraception;

Provision of obstetric and gynecological care in a specialized reception, day hospital;

Providing social and legal assistance in accordance with the law;

Submission to the regional branch of the Social Insurance Fund of the Russian Federation of reports-applications for obtaining birth certificates;

Carrying out activities to improve knowledge, sanitary culture of the population in the field of protection reproductive health and etc.

The approximate organizational structure of the antenatal clinic is shown in fig. 5.3.

In large antenatal clinics, day hospitals can be organized for examination, treatment of gynecological patients and minor gynecological operations and manipulations.

The work of the antenatal clinic is organized taking into account the maximum availability of obstetric and gynecological care for the female population. Emergency obstetric and gynecological care is provided by specialized departments of hospitals or maternity hospitals. Help at home for pregnant women, puerperas and gynecological patients is provided by the attending or duty doctor of the antenatal clinic. Help at home is carried out on the day of the call. After visiting the woman, the doctor makes an appropriate entry in the primary medical documentation. Therapeutic and diagnostic manipulations at home according to the doctor's prescription are performed by paramedical personnel.

A woman is given the right to choose an obstetrician-gynecologist at her request. In order to optimize continuity, it is recommended that the woman be observed outside of pregnancy, during pregnancy and after childbirth by the same doctor. The main tasks of an obstetrician-gynecologist are: dispensary observation of gynecological patients, pregnant women and puerperas, providing them with emergency medical care if necessary and referral to specialized hospitals.

Preparation for childbirth and motherhood in the antenatal clinic is carried out both individually and in groups. The most promising and effective form of training is family preparation for the birth of a child, aimed at involving family members in active participation in prenatal preparation. The presence of the father of the child during childbirth and the postpartum period contributes to a change in the lifestyle of the pregnant woman and her family, focuses on the birth of the desired child.

Along with the family form of preparation for childbearing, the use of traditional methods psychophysical preparation of pregnant women for childbirth, as well as teaching them the rules of personal hygiene, preparation for future childbirth and child care in the “Schools of Motherhood” organized in antenatal clinics. At the same time, demonstration materials, visual aids, technical means and items of child care are used.

On January 1, 2006, within the framework of the national project "Health", the implementation of the "Birth Certificate" program began, aimed at solving the problem of maintaining and strengthening the health of mother and child, improving the quality and accessibility of medical care for women during pregnancy and childbirth, and creating conditions for childbirth healthy children.

A birth certificate is issued at the antenatal clinic at the place of residence at a gestational age of 30 weeks (in case multiple pregnancy- 28 weeks) and more. A prerequisite is registration and continuous observation in this antenatal clinic for at least 12 weeks. The certificate is issued for a woman, not for a child, so even in the case of multiple pregnancy, it is only one. A woman who during pregnancy was observed in the antenatal clinic at paid basis or entered into an agreement with the maternity hospital for the provision paid services, a birth certificate cannot be issued. In the absence of registration at the place of residence (“propiska”), a woman can register with the antenatal clinic of that locality where he actually lives. When issuing a certificate, a note is made in it about the reason for the lack of registration. A woman also has the opportunity to choose a maternity hospital in any city of her choice. The certificate is issued regardless of whether the woman is an adult or not, she works or does not work.

As a result of the introduction of certificates, the volume of additional funding for the obstetrics service in 2011 amounted to more than 17.3 billion rubles, which were distributed as follows: 32% was sent to antenatal clinics, maternity- 63%, children's polyclinics - 5% of these funds. The funds received by these health care institutions under the Birth Certificate program were used to increase wages personnel providing medical care to women during pregnancy and childbirth, dispensary observation of a child of the 1st year of life, as well as for the purchase of medicines and products medical purpose, medical equipment, tools, soft inventory, and in stationary institutions - extra food pregnant and lactating mothers.

The introduction of birth certificates was one of the factors in reducing infant, perinatal and maternal mortality rates.

Of particular social importance is the work on family planning, which is carried out by the women's clinic.

Family planning- making a conscious decision on the number of children and the timing of their birth, the ability to regulate childbearing in accordance with the specific situation in the family, and, consequently, the possibility of having only desired children from parents who are ready for this. Granting women the right to reproductive health care, including family planning, is a fundamental condition for their full life and gender equality. The realization of this right is possible only with the development of family planning services, expansion and

introduction of special programs (“Safe motherhood”, etc.), improvement of the system of sexual and hygienic education, provision of contraceptives to the population (primarily young people).

They regulate childbearing in three ways: contraception, abortion and sterilization.

WHO notes that one of the components of reproductive health is that men and women have the right to receive the necessary information and access to safe, effective, affordable and acceptable methods of birth control of their own choice. Family planning is carried out by obstetrician-gynecologists and midwives with special training. A specialized room (reception) of family planning is equipped with audio and video equipment for demonstrating contraceptives, visual aids, printed information materials for the population on family planning and abortion prevention.

Working with young people who are at risk for developing unwanted pregnancy and STIs can be managed by allocating special hours at specialized appointments in family planning offices.

Unfortunately, abortion remains one of the main methods of birth control in Russia. In 2011, 1124.9 thousand abortions were performed, which is 26.9 cases per 1000 women of childbearing age. If in the late 1980s the share of the USSR accounted for a third of all abortions in the world, then since the beginning of the 1990s. thanks to the development of family planning services, their frequency is gradually decreasing (Fig. 5.4). Nevertheless, even now abortion accounts for more than 40% of the causes of secondary infertility.

In accordance with the current legislation, every woman has the right to independently decide on the issue of motherhood. Artificial termination of pregnancy is carried out at the request of a woman with a gestational age of up to 12 weeks. according to social indications - up to 22 weeks, and if available medical indications and the consent of the woman - regardless of the gestational age.

The issue of termination of pregnancy for social reasons is decided by a commission consisting of an obstetrician-gynecologist, the head of the institution (department) and a lawyer, if there is an opinion on the gestational age established by the obstetrician-gynecologist, relevant legal documents (certificate of the death of the husband, divorce, etc.) confirming social testimony, and a written statement from the woman. If there are social indications, take

The exchange is issued with a conclusion certified by the signatures of the members of the commission and the seal of the institution.

Artificial termination of pregnancy for medical reasons is carried out with the consent of the woman, regardless of the gestational age. Medical indications are established by a commission consisting of an obstetrician-gynecologist, a doctor of the specialty to which the disease (condition) of the pregnant woman belongs, and the head of the healthcare institution (department). If there are medical indications, a pregnant woman is issued a conclusion with a complete clinical diagnosis, certified by the signatures of these specialists and the seal of the institution.

In order to protect women's health, reduce the number of abortions and deaths from them, surgical sterilization of women (and men) is allowed in the Russian Federation. It is carried out at the request of the patient in the presence of appropriate indications. There is a large list of medical and social indications and contraindications for surgical sterilization, which cannot be regarded as the best way to prevent pregnancy.

CENTER FOR GENERAL MEDICAL (FAMILY) PRACTICE

Centers for general medical (family) practice(TSOVP) take an active part in providing PHC to the population. In 2011, more than 3,500 TSPs operated in Russia.

TsOVP is organized on the territory of municipal districts and urban districts. The GP site is formed at the rate of 1500 people of the adult population (aged 18 years and older), the family doctor site - 1200 people of the adult and child population.

As the experience accumulated over the past decade shows, the involvement of general medical (family) practice centers in the provision of PHC leads to a significant improvement in the quality and accessibility of medical care, strengthening preventive work, and strengthening family health.

The organization of TsOVP will eventually replace the existing network of outpatient clinics in rural areas, polyclinics - in cities, and improve the provision of PHC to the population.

established in last years practice shows that the activities of the TCEP are focused on providing medical care to the population in the following main specialties: therapy, obstetrics and gynecology, surgery, dentistry, ophthalmology, otorhinolaryngology, gerontology, etc. An approximate organizational structure of the TCEP is shown in fig. 5.5.

The position of GP (family doctor) is assigned to specialists with higher medical education in the specialty "General Medicine" or "Pediatrics", who have completed clinical residency in the specialty "General Medical Practice (Family Medicine)" or who have undergone retraining and received a certificate of a specialist in this specialty. The duties of the VP include:

Conducting outpatient reception, visiting patients at home, providing emergency care;

Carrying out a complex of preventive, therapeutic, diagnostic and rehabilitation measures aimed at early diagnosis diseases, treatment and dynamic observation of patients;

Conducting an examination of temporary disability;

Organization of medical, social and household assistance together with authorities social protection and mercy services for the lonely, the elderly, the disabled, the chronically ill;

Carrying out sanitary and educational work on hygienic education of the population, promotion of a healthy lifestyle, family planning;

Maintaining approved forms of accounting and reporting documentation.

The GP (family doctor), as a rule, performs the function of the head of the PTC.

DAY HOSPITALS

Day hospitals- one of effective forms provision of PHC to the population. They are organized for the examination and treatment of patients with acute diseases and exacerbations of chronic diseases or pathology of pregnancy that do not require a round-the-clock inpatient regimen, as well as for the rehabilitation of patients after inpatient treatment. The experience of organizing day hospitals in outpatient clinics in Moscow, St. Petersburg and Yekaterinburg showed their greatest effectiveness in the treatment of the following pathological conditions: AH stage I-II, coronary artery disease with angina pectoris without rhythm disturbance, exacerbation of chronic bronchitis and bronchial asthma(without hormonal dependence), radiculitis, pain syndromes on the basis of osteochondrosis, peptic ulcer of the stomach and duodenum (uncomplicated), chronic gastritis, obliterating atherosclerosis of the lower extremities, extragenital diseases of pregnant women, etc.

The selection and referral of patients for examination and treatment in a day hospital in an outpatient clinic is carried out by local general practitioners, pediatricians and other specialists. If the course of the disease worsens, the patient who is in the day hospital should be immediately transferred to the appropriate specialized department of the hospital.

The capacity of day hospitals and the required number of positions of medical personnel are determined individually in each specific case by the head of the outpatient clinic in agreement with the head of the health management body.

Expenses for the purchase of medicines and dressings are established in accordance with the calculation standards in force in this institution.

The day hospital uses in its work the treatment and diagnostic services as part of the polyclinic, on the basis of which it is organized. Nutrition of patients in day hospitals in outpatient clinics is organized in relation to local conditions and at the expense of the patient himself.

Stations at home organize in cases where the patient's condition and home (social, material) conditions allow organizing medical

help and care at home. The purpose of organizing hospitals at home is the treatment of acute forms of diseases (which do not require intensive inpatient monitoring). aftercare and rehabilitation of chronically ill patients, medical and social assistance to the elderly, observation and treatment at home for people who have undergone uncomplicated surgical interventions, and etc.

Hospitals at home can be organized as part of polyclinics, polyclinic departments hospitals, dispensaries. They have proven themselves in pediatrics and geriatrics.

The organization of hospitals at home involves the daily observation of the patient by a doctor, laboratory diagnostic examinations, drug therapy(intravenous, intramuscular injections), various procedures (banks, mustard plasters, etc.). If necessary, the complex of treatment of patients also includes physiotherapeutic procedures, massage, physiotherapy exercises, etc. More complex diagnostic examinations (phonocardiogram, echocardiogram, fluoroscopy, etc.) are carried out if clinical indications in the clinic, where patients are delivered by ambulance. If necessary, patients in a hospital at home are provided with advisory assistance by doctors of narrow specialties.

The management of the hospital at home is carried out by the head of the relevant department, who in his activities reports to the chief doctor of the hospital and his deputy in the polyclinic. The selection of patients for treatment is carried out by the head of the department together with the doctor of the hospital at home on the proposal of local doctors or doctors of other specialties.

Hospitals at home can be centralized and decentralized. The centralized form of work provides for the allocation of a separate general practitioner and 1-2 nurses. At the same time, it should be noted that the nurse of the hospital at home takes biological materials for tests, performs procedures and injections 1-2 times a day. Additional injections to patients are carried out by the district nurse of the polyclinic. With this form of work, the hospital at home serves 12 14 patients per day. With a centralized form of organization, transport support is necessary.

It is most expedient to organize the work of a hospital at home in a decentralized form with the participation of a district doctor and a polyclinic nurse. At the same time, a visiting procedural nurse (or two) is allocated to help district nurses to perform procedures for patients: injections, sampling of biological media for analysis. District doctors and nurses serve 2-3 patients at once in nearby areas. The field of service of the exit procedural nurse can include up to 20 thousand of the population, for which it is provided with vehicles.

Thus, the organization of hospitals at home takes into account the specifics of the patients served (children, the elderly, chronically ill) as much as possible. In addition to achieving a specific medical and economic effect, treatment in hospitals at home is of great socio-psychological significance, as it allows medical care to be provided in familiar conditions and is not associated with a violation of the patient's microsocial environment. This treatment in terms of medical and social effectiveness in some cases is not inferior to treatment in a round-the-clock hospital, but at the same time it is 3-5 times cheaper.

1. Public health and healthcare as a science and area of practice. Main goals. Object, subject of study. Methods.
2. History of healthcare development. Modern health care systems, their characteristics.
3. State policy in the field of public health protection (Law of the Republic of Belarus "on healthcare"). Organizational principles of the public health system.
4. Nomenclature of healthcare organizations
6. Insurance and private forms of healthcare.
7. Medical ethics and deontology. Concept definition. Modern problems of medical ethics and deontology, characteristics. Hippocratic oath, doctor's oath of the Republic of Belarus, Code of Medical Ethics.
10. Statistics. Concept definition. Types of statistics. Statistical data accounting system.
11. Groups of indicators for assessing the health status of the population.
15. Unit of observation. Definition, characteristics of accounting features
26. Dynamic series, their types.
27. Indicators of the dynamic series, calculation, application in medical practice.
28. Variation series, its elements, types, construction rules.
29. Average values, types, methods of calculation. Application in the work of a doctor.
30. Indicators characterizing the diversity of a trait in the studied population.
31. Representativeness of the trait. Assessment of the reliability of differences in relative and average values. The concept of Student's "t" criteria.
33. Graphic displays in statistics. Types of diagrams, rules for their construction and design.
34. Demography as a science, definition, content. The value of demographic data for health care.
35. Health of the population, factors affecting the health of the population. Health formula. Indicators characterizing public health. Scheme of analysis.
36. Leading medical and social problems of the population. Problems of the size and composition of the population, mortality, fertility. Take from 37,40,43
37. Population statics, research methodology. Population censuses. Types of age structures of the population. Population size and composition, health implications
38. Dynamics of the population, its types.
39. Mechanical movement of the population. Study methodology. Characteristics of migration processes, their impact on population health indicators.
40. Fertility as a medical and social problem. Methods of study, indicators. Birth rates according to WHO. Modern trends in the Republic of Belarus and in the world.
42. Reproduction of the population, types of reproduction. Indicators, methods of calculation.
43. Mortality as a medical and social problem. Methods of study, indicators. Levels of general mortality according to WHO. Modern tendencies. The main causes of death of the population.
44. Infant mortality as a medical and social problem. Factors determining its level. Methodology for calculating indicators, evaluation criteria for WHO.
45. Perinatal mortality. Methodology for calculating indicators. Causes of perinatal mortality.
46. Maternal mortality. Methodology for calculating the indicator. The level and causes of maternal mortality in the Republic of Belarus and the world.
52. Medico-social aspects of the neuropsychic health of the population. Organization of psycho-neurological care.
60. Methods for studying morbidity. 61. Methods for studying the incidence of the population, their comparative characteristics.
Methodology for studying general and primary morbidity
Indicators of general and primary morbidity.
63. The study of the incidence of the population according to special records (infectious and major non-epidemic diseases, hospitalized morbidity). Indicators, accounting and reporting documents.
The main indicators of "hospitalized" morbidity:
The main indicators for the analysis of the incidence of wut.
65. The study of morbidity according to preventive examinations of the population, types of preventive examinations, the procedure for conducting. health groups. The concept of "pathological affection".
66. Morbidity according to causes of death. Methods of study, indicators. Medical certificate of death.
The main indicators of morbidity according to the causes of death:
67. Prediction of morbidity rates.
68. Disability as a medical and social problem. Definition of the concept, indicators.
Trends in disability in the Republic of Belarus.
69. Lethality. Method of calculation and analysis of lethality. Significance for the practice of the doctor and healthcare organizations.
70. Methods of standardization, their scientific and practical purpose. Methods for calculating and analyzing standardized indicators.
72. Criteria for determining disability. The degree of expression of persistent violations of body functions. Indicators characterizing disability.
73. Prevention, definition, principles, contemporary problems. Types, levels, directions of prevention.
76. Primary health care, definition of the concept, role and place in the system of medical care for the population. Main functions.
78. Organization of medical care provided to the population on an outpatient basis. The main organizations: a medical outpatient clinic, a city polyclinic. Structure, tasks, directions of activity.
79. Nomenclature of hospital organizations. Organization of medical care in a hospital setting of healthcare organizations. Indicators of provision with inpatient care.
80. Types, forms and conditions for the provision of medical care. Organization of specialized medical care, their tasks.
81. Main directions for improving inpatient and specialized care.
82. Women's and children's health. Control. Medical organizations.
83. Modern problems of women's health. Organization of obstetric and gynecological care.
84. Organization of medical and preventive care for the children's population. Leading child health issues.
85. Organization of health protection of the rural population, the basic principles of providing medical care to rural residents. stages of organization.
Stage II - territorial medical association (TMO).
Stage III - the regional hospital and medical institutions of the region.
86. City polyclinic, structure, tasks, management. Key performance indicators of the polyclinic.
Key performance indicators of the polyclinic.
87. Precinct-territorial principle of organization of outpatient care to the population. Types of plots.
88. Territorial therapeutic area. Regulations. The content of the work of the local general practitioner.
89. Cabinet of infectious diseases of the polyclinic. Sections and methods of work of a doctor in the office of infectious diseases.
90. Preventive work of the clinic. Department of prevention of the polyclinic. Organization of preventive examinations.
91. Dispensary method in the work of the clinic, its elements. Control card of dispensary observation, information reflected in it.
1st stage. Accounting, examination of the population and selection of contingents for dispensary registration.
2nd stage. Dynamic monitoring of the state of health of those undergoing medical examinations and carrying out preventive and therapeutic measures.
3rd stage. Annual analysis of the state of dispensary work in the hospital, evaluation of its effectiveness and development of measures to improve it (see Question 51).
96.Department of medical rehabilitation of the polyclinic. Structure, tasks. The order of referral to the department of medical rehabilitation.
97. Children's polyclinic, structure, tasks, sections of work.
98. Peculiarities of providing medical care to children on an outpatient basis
99. The main sections of the work of the local pediatrician. The content of medical and preventive work. Communication in work with other medical and preventive organizations. Documentation.
100. The content of the preventive work of the local pediatrician. Organization of nursing care for newborns.
101. Comprehensive assessment of the health status of children. Medical examinations. health groups. Clinical examination of healthy and sick children
Section 1. Information about the subdivisions, facilities of the medical and preventive organization.
Section 2. States of the medical and preventive organization at the end of the reporting year.
Section 3. The work of doctors in polyclinics (outpatient clinics), dispensaries, consultations.
Section 4. Preventive medical examinations and the work of dental (dental) and surgical rooms of a medical organization.
Section 5. Work of medical auxiliary departments (offices).
Section 6. Work of diagnostic departments.
Section I. Activity of women's consultation.
Section II. Obstetrics in a hospital
Section III. maternal mortality
Section IV. Information about births
145. Medico-social expertise, definition, content, basic concepts.
146. Legislative documents regulating the procedure for conducting a medical and social examination.
147. Types of mrek. The composition of regional, district, inter-district, city and specialized MRECs. Organization of work, rights and obligations. The procedure for sending to the mrek and inspecting citizens.
PHC - health care, necessary and accessible both for each person individually and for the entire population as a whole, and provided on an acceptable basis for him, with his active participation and at costs corresponding to the capabilities of the population and the state.
It is aimed at solving the main problems of public health protection.
The PSM is an integral part of the country's EA, being the core of this system and a component of socio-social and economic development.
Taking into account economic conditions, social values, geographical features, culture, PHC in different countries may have specific features, but regardless of this, it includes the following general functions:
a) assistance rational nutrition and an adequate supply of safe water;
b) basic sanitary and hygienic measures;
c) maternal and child health, including family planning;
d) vaccination against major infectious diseases;
e) prevention and control of local epidemic diseases;
f) health education of the population (hygienic education and upbringing);
g) treatment of common diseases and injuries.
It is necessary to support and interconnect PHC with other parts of the HC in the following areas:
a) staff training;
b) management and control of the CA;
c) organization of material and technical supply;
d) informing
e) financing;
f) organizing a referral system
g) accessibility medical care
Availability types:
The purpose of PHC is to provide the entire population with the necessary types of medical care.
PHC is one of the criteria for the rational use of the entire health care system.
Composition of forces (services) included in the structure of PHC medical units:
1. FAP: about 2.5 thousand in Belarus
3. Rural district hospitals
1. district network of polyclinics
2. women's consultations
3. ambulance stations
3. TsGiE: 146 in Belarus
4. disinfection stations
5. sanitary checkpoints
Types of medical care in terms of volume and quality:
1. First aid - is provided at the scene in the order of self-help and mutual assistance with the help of improvised means.
2. First pre-medical (paramedic) assistance (FAP)
3. First medical assistance(SVA, SUB)
5. Qualified medical care - for its provision it is necessary to have a specialist, equipment, conditions for the implementation of assistance
6. Specialized medical care
The quality of care: district (qualified  specialized assistance), region and republic (qualified and all types of specialized care).
PHC is the area of first contact between the population and health services and is linked to other health departments.
Types of medical care at the point of delivery: outpatient and inpatient.
Basic principles of primary health care:
a) preventive orientation - the organization of a wide range of social and preventive measures aimed at maintaining the health of the population served, studying and, if possible, making adjustments to their working and living conditions.
b) accessibility - is ensured by bringing the doctor's place of work closer to the place of residence of the population served, providing it with reliable telephone (paging) communication, vehicles, allowing the attached population to provide primary medical care at any time of the day.
c) continuity - in his professional activity, the doctor is not limited to the framework of a single or private episode of the disease, but is engaged in the protection of human health over significant periods of his life.
d) universality - a doctor provides medical care to patients regardless of their age, gender, religion, social, financial or official status.
e) complexity - the doctor carries out not only medical care and rehabilitation, but also disease prevention and health promotion for the populations served.
f) coordination - if necessary, the doctor makes decisions on referring the patient to the appropriate specialist, organizes all types of qualified medical care and has the right to participate in consultations of his patients with specialists in various fields. The doctor informs the population about the available health services, types of assistance and services provided, new promising methods of treatment and prevention of diseases, actively defends the interests of patients in their contacts with other representatives of medical care.
g) confidentiality - the doctor and all medical workers are obliged to keep not only medical secrets, but also any other information from the life of patients, which is especially important in the conditions of their compact residence, and the population served must be completely confident in the confidentiality of their appeals (except in cases where provided by the current legislation of the Republic of Belarus).
The PHC representative is general doctor- a specialist with a higher basic medical education in the specialty "General Medicine", who has completed additional professional training focused on primary health care, and is admitted to medical activities in the manner prescribed by the legislation of the Republic of Belarus.
Medical organizations of primary health care- see question 34.

Primary Health Care- a set of medical-social and sanitary-hygienic measures carried out at the primary level of contact individuals, families and populations with health services.

As defined by the International Conference on Primary Health Care health care(Alma-Ata, 1978), P. m.-s. p. is the first level of contact of the population with the national health care system; it is as close as possible to the place of residence and work of people and represents the first stage of the continuous process of protecting their health.

Primary health care includes outpatient, emergency, emergency and general medical care (see para. Treatment and preventive care ). Its organization in our country has peculiarities. In cities, this assistance is provided by territorial polyclinics for adults and children's polyclinics (see. children's Hospital , Polyclinic ), medical units (see Medical unit ), women's consultations (see Women's consultation ), medical and feldsher health centers (see. health center ). In rural areas, medical institutions are the first link in the system of this assistance. rural medical area : district hospital, dispensary , feldsher-obstetric stations (see. Feldsher-obstetric station ), health centers, medical dispensaries. For residents of the district center, the main institution providing P. m.-s. n., is the polyclinic of the central district hospital (see. Hospital ).

Emergency assistance to the population of cities is provided by points (departments) of medical help at home ; residents of rural areas - paramedical and obstetrical stations, doctors of outpatient clinics and district hospitals.

Territorial accessibility P. m.-s. The item is provided with rational placement of medical institutions taking into account the developed and perspective systems of resettlement of the population, and also a number of other factors.

In P.'s implementation of m.-with. the item of the greatest role of doctors of ambulatory and polyclinic establishments. The therapist (district doctor) provides timely qualified therapeutic assistance to the population of the site in the clinic (outpatient clinic) and at home; organizing and conducting a set of events for clinical examination population of the site: coordination of activities with medical specialists from outpatient clinics, sanitary and social activists. The main tasks of the general practitioner of the local shop medical station are to provide workers and employees with qualified therapeutic assistance, participate in preventive measures to prevent and reduce morbidity with temporary disability, occupational diseases and injuries, and improve sanitary and hygienic working conditions.

In our country, the training of general practitioners is carried out with a focus on the transition to the provision of medical care on the principle of a "family doctor". With the introduction of new forms of work of doctors, the ratio of P.'s volumes of m.-s. and specialized care should change in the direction of increasing the volume of the first, which will be associated with the expansion of therapeutic measures carried out in the conditions of primary health care institutions.

In the work of the medical staff of institutions providing P. m.-s. , the leading role belongs to prevention . In this regard, the functions should be reviewed and the scope of preventive activities of doctors should be expanded (see. Doctor ), paramedics, midwives and nurses (see Nursing staff ).

Further development of P. m.-with. p. should be aimed at solving the following tasks: ensuring the availability of this type of medical care for all groups of the population living in any regions of the country; full satisfaction of the needs of the population in qualified medical treatment-and-prophylactic and medical and social assistance; reorientation of activity of establishments of P. of m. which has an individual therapeutic focus on medical and social prevention; increase of efficiency of work of establishments of P. of m. n., improving the management of P. m.-s. P.; improving the culture and quality of medical and social care.

For the full functioning of the service P. m.-s. n. needed following conditions: priority allocation of material, human and financial resources for its development; development and implementation of a system of special training for doctors, secondary medical and social workers for work in P.'s establishments of m. P.; providing the effective measures promoting increase of prestige of service P. of m. - page. n. and its individual employees, strengthening confidence among the general population.

Important in P.'s organization of m.-with. n. is the active involvement of the population itself in it. Representatives of the population should participate in assessing the existing situation in their areas, in the distribution of resources, in the organization and implementation of health protection programs. The population can provide financial support and their labor. This may manifest itself in various forms: public assistance to the elderly, the disabled, socially vulnerable groups of the population, the organization of self-help and mutual support groups, nursing services, etc. Control and coordination of the work of public and voluntary organizations should be carried out by health workers of primary health care institutions.

An important condition for the successful implementation of target installations P. m.-s. n. is the interaction of health care with other social and economic sectors, whose activities are aimed at solving major social problems in society, creating conditions for the protection and improvement of public health.

Bibliographer.: The universal right to health and its implementation in various countries of the world, ed. D.D. Benediktova, M., 1981; Gadzhiev R.S. Rural medical site, M., 1988; Health for all goals. Copenhagen, WHO, 1985.

Primary Health Care I

a set of medical-social and sanitary-hygienic measures carried out at the primary level of contact of individuals, families and population groups with health services.

According to the definition given at the International Conference on Primary Health Care (Alma-Ata, 1978), P. m.-s. p. is the first level of contact of the population with the national health care system; it is as close as possible to the place of residence and work of people and represents the first stage of the continuous process of protecting their health.

Primary health care includes outpatient, emergency, emergency, and general medical care (see Treatment and Preventive Care). Its in our country has features. In cities, this assistance is provided by territorial polyclinics for adults and children's polyclinics (see Children's polyclinic, Polyclinic), medical units (see. Medical and sanitary part), antenatal clinics (see. Women's consultation), medical and feldsher health centers (see. Health center). In rural areas, the first link in the system of this assistance is the medical and prophylactic institutions of the rural medical district (Rural medical district): district, Ambulatory, feldsher-obstetric stations (see. Feldsher-obstetric station), health centers, medical dispensaries. For residents of the district center, the main institution providing P. m.-s. n., is the central district hospital (see Hospital).

Emergency assistance to the population of cities is provided by points (departments) of medical care at home (Home Help); residents of rural areas - paramedical and obstetrical stations, doctors of outpatient clinics and district hospitals.

For the provision of emergency medical care (Ambulance) in the cities, a wide network of relevant stations (substations) has been created; in rural administrative regions ambulance stations or ambulance departments at central district hospitals have been organized.

A special place in the system P. m.-s. n. occupies field assistance provided by visiting medical teams, as well as mobile vehicles and medical complexes (Mobile vehicles and medical complexes). Field services are usually formed on the basis of central district, regional, regional, republican and large city hospitals.

The implementation of sanitary-hygienic and anti-epidemic measures is entrusted to the sanitary-epidemiological service (Sanitary-epidemiological service) with the direct participation of doctors and paramedical workers of territorial and industrial medical sites (see Medical site).

For the full functioning of the service P. m.-s. n. the following conditions are necessary: priority material, human and financial resources for its development; development and implementation of a system of special training for doctors, paramedical and social workers for work in P.'s institutions m.-s. P.; providing the effective measures promoting increase of prestige of service P. of m. - page. n. and its individual employees, strengthening confidence among the general population.

Important in P.'s organization of m.-with. n. is the active involvement of the population itself in it. Representatives of the population should participate in assessing the existing situation in their areas, in the distribution of resources, in the organization and implementation of health protection programs. can provide financial support and their own work. This can manifest itself in various forms: public assistance to the elderly, the disabled, socially vulnerable groups of the population, the organization of self-help and mutual support groups, nursing services, etc. Control and coordination of the work of public and voluntary organizations should be carried out by health workers of primary health care institutions.

Bibliographer.: The universal right to and its implementation in various countries of the world, ed. D.D. Benediktova, M., 1981; Gadzhiev R.S. , M., 1988; Health for all goals. Copenhagen, WHO, 1985.

II Primary health care

a set of treatment-and-prophylactic and sanitary-hygienic measures carried out at the first (primary) level of contact between the population and health services.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

Lecture 10

Introduction.

– Provision of treatment;

– Rehabilitation

Organization of the work of the children's clinic.

Children's polyclinic - a medical and preventive institution, which is a structural unit of the United Children's Hospital or an independent medical institution that provides out-of-hospital care to children from birth to 18 years (17 years 11 months 29 days inclusive).

The principles and procedures of a children's polyclinic are in many respects similar to those in polyclinics for adults, but there are also some peculiarities that are characteristic only for this institution.

Children's polyclinic in the area of its activity provides:

a) organization and implementation of a complex of preventive measures among the child population by:

Providing dynamic medical supervision for healthy children;

holding preventive examinations and medical examination of children;

holding preventive vaccinations;

Conducting lectures, talks, conferences for parents, classes at the school for mothers, etc.;

b) treatment and preventive care for children at home and in a polyclinic, sending children for treatment to hospitals, hospitals, for rehabilitation treatment in a sanatorium, their selection in specialized kindergartens, kindergartens, children's recreation and rehabilitation facilities, etc .;

c) medical and preventive work in children's educational institutions;

d) anti-epidemic measures (together with the centers of the State Sanitary and Epidemiological Supervision);

e) legal protection of children.

The mode of operation of the polyclinic should be built taking into account the trouble-free provision of the population with medical care during working and non-working hours. Work on the site must be organized, alternating receptions in the morning and evening hours.

Structure children's polyclinic is in accordance with the tasks assigned to it and includes ( exemplary scheme):

Filter with a separate entrance and insulators with boxes;

Registry;

Departments of pediatric and highly specialized care;

Department of organization of medical care for children and adolescents in educational institutions of the Children's School of Education;

Department (office) of medical and social assistance;

Department (office) of rehabilitation treatment;

Department of medical and diagnostic care;

Clinical expert commission;

Administrative and economic part and other support services.

AT modern conditions in the cities, mainly large children's clinics for 600-800 visits per shift are organized and built, which have all the conditions for organizing medical and preventive work: the necessary set of premises for specialized rooms, gyms for physical therapy, a swimming pool, water and mud baths, rooms for light - and electrotherapy, mobile physiotherapy rooms for educational institutions, etc.

There are 12.5 positions of district pediatricians for every 10,000 children. The main task the district pediatrician is to carry out preventive measures aimed at ensuring the harmonious physical and neuropsychic development of children living on the territory of the district, at reducing morbidity and mortality by providing timely and highly qualified medical care.

The district pediatrician works under the guidance of the head of the department according to a plan drawn up on the basis of an analysis of the health status of the child population. He has the right to issue certificates of incapacity for work in accordance with the current instructions, to give orders to his subordinate middle and junior medical workers.

There are several main sections of the work of the district pediatrician: preventive, curative, anti-epidemic, work on the formation of a healthy lifestyle, communication with other medical institutions, organization of the work of a nurse, work with medical records.

Medical work.

The medical work of the local pediatrician includes:

Home care for children with acute illnesses and exacerbations chronic pathology until complete clinical recovery;

Reception in the children's polyclinic of convalescents after acute diseases that do not pose a danger to others;

Organization of hospitalization according to indications.

Active detection of patients with chronic forms diseases on early stages, their registration, timely treatment and rehabilitation;

Carrying out complex etiopathogenetic treatment of diseases using means of rehabilitation treatment (physiotherapy methods, physiotherapy exercises, hydrotherapy, etc.); .

Implementation of continuity in the treatment of sick children with childhood educational institutions, hospitals, sanatoriums;

Examination of temporary disability of working adolescents and parents of sick children.

The organization of the reception of children in the clinic should provide them with qualified medical care as soon as possible. The work schedule of district doctors and doctors by specialty is drawn up in such a way that mothers with children can be seen by their district doctor during the week in the morning, afternoon and evening (sliding schedule).

A feature of the work of the children's polyclinic is that all sick children with acute diseases are observed by the local doctor at home. The clinic accepts mostly healthy children, as well as those suffering from chronic diseases, repeated patients with infectious diseases without acute events and convalescents.

Home care is provided by doctors during non-clinic hours. For daytime and evening appointments starting after 2 pm, home care is provided before the appointment.

The district doctor is obliged to visit a sick child on the day of the call, actively (without a call) to visit sick children at home until complete recovery or hospitalization. The frequency and intervals of visits are regulated depending on the nature, severity of the disease, the age of the child.

In the treatment of children, especially young children, its timely start is of exceptional importance. District pediatricians, when making a call to a sick child, must have a set of necessary medicines with them and, if necessary, provide assistance to the patient at home immediately after the diagnosis is made, even when the child is sent to the hospital. If necessary, the doctor must provide the child with medicines at one time.

The district nurse fulfills the doctor's prescriptions for the treatment of a sick child at home, monitors the implementation by parents of medical recommendations on treatment, nutrition, regimen and care for a sick child. At the request of the attending physician, the children's polyclinic provides the sick child with the necessary laboratory, functional studies and consultations of doctors of narrow specialties at home. The head of the department of the children's polyclinic oversees the organization of treatment of sick children at home, and, if necessary, provides advisory assistance.

The local doctor, if necessary, organizes the hospitalization of the child and continues to monitor his health after discharge from the hospital. If it is impossible to hospitalize a child (refusal of parents, lack of a place in a hospital, quarantine, etc.), a hospital is organized at home. At the same time, the child is provided with the whole range of necessary therapeutic and diagnostic measures, laboratory examinations in accordance with the severity and nature of the disease, the post of a nurse or her regular visits several times a day. At night, the child is assisted by an emergency or ambulance pediatrician. The local doctor visits the patient daily until complete recovery; in addition, the child without fail must be reviewed by the head of the department.

If a chronic pathology is detected, the patient should be registered with a dispensary either with a local pediatrician or with a doctor of the appropriate profile. Every child registered must be carefully monitored and active treatment. The content of dispensary work is reflected in individual plans dispensary observation, which are developed by doctors specifically for each patient.

At the end of the year, doctors make up for each registered patient milestone epicrisis, which assesses the state of health and the effectiveness of therapeutic and preventive measures. The criteria for evaluating the results of the ongoing medical examination are recovery, improvement, state without change, deterioration.

If the child is not removed from the dispensary, then at the same time a plan of treatment and preventive measures for the next year is drawn up. After completing the epicrises for all children taken under dispensary observation, the district pediatrician analyzes the prophylactic examination for individual nosological groups over the past year, draws up a report and submits it to the head of the department, which compiles a summary report on the results of dispensary work for the past year. After analyzing the work done, measures are planned to improve the quality of dispensary care for children.

An important element The work of the district pediatrician should be considered an examination of the temporary disability of a family member due to the child's illness. When issuing certificates of incapacity for work, the district doctor is guided by the current instructions.

Gynecological care

Active detection of gynecological patients. Identification of gynecological patients is carried out at the reception of women who have applied for a consultation or referred by other specialists; when examining women at home (on call); when conducting preventive examinations in consultations, at enterprises, institutions, examination rooms of polyclinics, etc.

Preventive gynecological examinations subject to women living in the area of activity of the consultation, working in industrial enterprises and institutions located in the area of activity of the consultation. Each woman should be examined by an obstetrician-gynecologist once a year using cytological and colposcopic examination methods.

Organization and conduct of examination and treatment of women with gynecological diseases. Treatment of gynecological patients is carried out mainly in the antenatal clinic, but can also be organized at home (as prescribed by a doctor), at health centers, dispensaries, and also in polyclinics. In the antenatal clinic, a small operating room and a room for temporary stay of patients after operations can be organized. On an outpatient basis, individual small gynecological operations and manipulation. In some cases, medical care for a gynecological patient can be provided at home.

If necessary, a woman can be referred for a consultation with specialists from other health facilities. In large, well-equipped antenatal clinics, specialized appointments can be organized: in gynecological endocrinology, infertility, miscarriage, etc.

Timely hospitalization of women in need of inpatient treatment. A patient assigned for inpatient treatment is given a referral for hospitalization. The midwife of the site checks the fact of the patient's admission to the hospital. In the card of an outpatient, a record is made of the referral to the hospital and the actual hospitalization of the woman. After the patient is discharged from the hospital, aftercare can be carried out in the antenatal clinic. Information from the hospital is transferred to the outpatient card, and the extract remains with the woman herself.

Examination of disability in gynecological diseases. Examination of temporary and permanent disability in gynecological diseases is carried out on a general basis.

Dispensary observation of gynecological patients builds on general principles clinical examination.

Family planning and abortion prevention

The main objectives of the women's family planning clinic are to prevent unwanted pregnancy through the widespread introduction of modern means and methods of contraception, improve the technology and quality of abortion, and combat infertility.

The obstetrician-gynecologist should provide advice, individual selection and training in the use of contraceptives by women who wish to abstain from pregnancy. During the consultation, it is desirable to have an exhibition-showcase of contraceptives, to organize their sale.

In accordance with the current legislation, every woman has the right to independently decide on the issue of motherhood. Artificial termination of pregnancy is carried out at the request of a woman with a gestational age of up to 12 weeks, according to social indications - up to 22 weeks, and if there are medical indications and the woman's consent - regardless of the gestational age.

To obtain a referral for an artificial termination of pregnancy, a woman goes to an obstetrician-gynecologist of the antenatal clinic, polyclinic (outpatient clinic), family doctor, in rural areas - to the obstetrician-gynecologist of the district hospital or to the doctor of the district hospital. Before referring to an abortion, it is necessary to explain the danger and harm for a woman of this operation.

An obstetrician-gynecologist, when a woman applies for a referral for artificial termination of pregnancy, performs an examination to determine the gestational age and establish the absence of medical contraindications to the operation. Before referral for termination of pregnancy is carried out necessary examination women, and in case of termination of pregnancy in late dates- a complete clinical examination, regulated for abdominal surgery. With absence medical contraindications for the abortion operation, the woman is issued a referral to a medical institution indicating the duration of pregnancy, the results of the examination, the conclusion of the commission on the termination of pregnancy for specific medical (diagnosis) or social indications.

Consent to medical intervention in relation to persons under 15 years of age, and citizens recognized in the manner prescribed by law as incapacitated, they are given by their legal representatives.

It is allowed to carry out artificial termination of pregnancy on an outpatient basis:

AT early dates pregnancy with delayed menstruation up to 20 days (mini-abortion);

With a gestation period of up to 12 weeks. - in day hospitals organized on the basis of specialized research institutes, clinical, multidisciplinary city and regional (territorial, republican, district) hospitals.

Artificial termination of pregnancy up to 12 weeks. in women with a burdened obstetric history, in the presence of extragenital and allergic diseases(conditions), as well as in the later stages of pregnancy, is performed only in a hospital.

Artificial abortion in the second trimester of pregnancy should be performed in a multidisciplinary, well-equipped hospital. Hospitalization of pregnant women is carried out in the presence of a referral to a hospital, the conclusion of the commission and the results of the examination. The operation must be carried out with the obligatory effective pain relief. The length of stay in the hospital after surgery is determined by the attending physician individually, depending on the state of health of the woman.

After a vacuum aspiration operation in an outpatient facility and termination of pregnancy up to 12 weeks. in the conditions of a day hospital, made without complications, the patients should be under the supervision of medical personnel for at least 4 hours.

After artificial termination of pregnancy in outpatient and stationary conditions every woman should receive the necessary information about the regime, possible complications and recommendations for the prevention of unwanted pregnancies.

In connection with the operation of artificial termination of pregnancy, working women are issued a certificate of incapacity for work. Artificial termination of pregnancy is carried out within the framework of the program of state guarantees for the provision of free medical care to citizens of the Russian Federation in institutions that have received a license for this type of activity, by doctors with special training. After termination of pregnancy, a woman is recommended to visit a antenatal clinic (clinic, outpatient clinic) to carry out the necessary rehabilitation measures and individual selection of a contraceptive method.

The issue of termination of pregnancy for social reasons is decided by a commission consisting of an obstetrician-gynecologist, the head of an institution (department), a lawyer on a written application / woman, if there is an opinion on the gestational age established by the obstetrician-gynecologist, and relevant legal documents (death certificate husband, divorce, etc.), confirming social indications. If there are social indications, the pregnant woman is issued a conclusion certified by the signatures of the members of the commission and the seal of the institution.

Artificial termination of pregnancy for medical reasons is carried out with the consent of the woman, regardless of the gestational age. Medical indications for termination of pregnancy are established by a commission consisting of an obstetrician-gynecologist, a doctor of the specialty to which the disease (condition) of the pregnant woman belongs, and the head of the healthcare institution (department). If there are medical indications, a pregnant woman is issued a conclusion with a complete clinical diagnosis, certified by the signatures of these specialists and the seal of the institution.

Lecture 10

Organization of primary health care to the population.

Introduction.

Primary health care (PHC) is the primary element of a multi-level public health structure that brings medical care as close as possible to the place of residence and is built on the principle "from the periphery to the center". The experience of Zemstvo and Soviet medicine in organizing PHC was approved by WHO and taken as a basis for developing the concept of PHC for all countries, which was reflected in the WHO Alma-Ata Declaration (1978).

PHC should meet the basic health needs of the population:

– Preservation and promotion of health;

– Provision of treatment;

– Rehabilitation

In Russia, the concept of primary health care is focused primarily on the provision of medical care in outpatient clinics.