Medical care is provided under conditions. Organization of medical care for the population of the Russian Federation

Order of the Ministry of Health and social development RF dated May 15, 2012 N 543n
"On approval of the Regulations on the organization of the provision of primary health care to the adult population"

With changes and additions from:

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, N 48, Art. 6724) I order:

1. To approve the attached Regulations on the organization of the provision of primary health care to the adult population.

2. Recognize as invalid:

order of the Ministry of Health and Social Development of the Russian Federation of July 29, 2005 N 487 "On approval of the Procedure for organizing the provision of primary health care" (registered by the Ministry of Justice of the Russian Federation on August 30, 2005, registration N 6954);

order of the Ministry of Health and Social Development of the Russian Federation of August 4, 2006 N 584 "On the procedure for organizing medical care of the population according to the precinct principle" (registered by the Ministry of Justice of the Russian Federation on September 4, 2006, registration N 8200).

Registration N 24726

The Regulations on the organization of the provision of primary medical care have been approved. It's about on assistance to the adult population in Russia.

This type of assistance is the basis of the system for providing medical care. It includes measures for the prevention, diagnosis, treatment of diseases and conditions, rehabilitation, monitoring the course of pregnancy, the formation healthy lifestyle life and health education.

Assistance is provided free of charge within the framework of the State Guarantees Program free provision citizens of Russia of medical care at the expense of compulsory medical insurance and funds from the relevant budgets, as well as in other cases established by law.

Assistance is provided in planned and emergency forms, on an outpatient basis and in a day hospital. It includes pre-medical, medical and specialized health care.

To improve the effectiveness of care for sudden acute diseases, conditions, exacerbation chronic diseases that are not dangerous to the life of the patient and do not require emergency intervention, an emergency department (office) can be organized in medical organizations.

Orders on approval of the procedure for organizing the provision of primary medical care and on the procedure for organizing medical care for the population on the basis of the district principle were declared invalid.

Order of the Ministry of Health and Social Development of the Russian Federation of May 15, 2012 N 543n "On approval of the Regulations on the organization of the provision of primary health care to the adult population"

Registration N 24726

Present Order

primary health care sanitary assistance(PHC), as defined by WHO, is meeting the needs of the population (each person, family, community) by providing medical services at the first contact with the health care system, a comprehensive service close to the place of residence and work.

The provision of PHC is one of the guarantees of medical and social assistance.

PHC is a complex of health, medical, preventive and hygienic measures: diagnosis and treatment of diseases and injuries, supply of the most necessary medicines, maternal and child health, immunization against major infectious diseases, prevention of infectious diseases, family planning, health education, provision of safe drinking water and food, etc.

PMSM includes all types of outpatient care, ambulance and emergency services, obstetrics, sanitary and anti-epidemic institutions, health education centers.

Currently, PHC is in the process of reform. There is a transition to the organization of PHC on the principle of a family doctor (doctor general practice). main function family doctor is the provision of multidisciplinary outpatient medical care to the population. In this regard, there is a need to reorient the activities of district therapists and pediatricians: a significant expansion of the scope of their activities in related specialties, training in practical skills performed by narrow specialists. The volume of medical and diagnostic manipulations that a family doctor is obliged to perform is extremely diverse: surgical, otolaryngological, gynecological, ophthalmological manipulations.

In order to improve PHC, in addition to the existing ones, day hospitals, children's rehabilitation centers, rehabilitation centers for women with pregnancy pathologies, medical and social rehabilitation rooms, medical genetic consultations, etc. have been created.

Outpatient care for the population

Outpatient clinics are designed to provide medical care to incoming patients, as well as patients at home.

Polyclinic- a multidisciplinary medical institution designed to provide medical, including specialized, assistance to patients, and, if necessary, to examine and treat patients at home. In the clinic, doctors of various profiles receive appointments, as well as various diagnostic rooms. The basic principle of the polyclinic is territorial-district, when a district with a certain number of inhabitants is assigned to a local general practitioner and a nurse (1,700 people over 14 years old for 1 position of a local therapist, the load rate is five visits per hour at an appointment at a polyclinic and two at care of patients at home by a therapist).

The outpatient clinic, as well as the polyclinic, provides medical care to incoming patients and at home. It differs from a polyclinic in a smaller volume of work and limited opportunities for specialized medical care (no more than five specialists). Outpatient clinics tend to serve the rural population.

The main tasks of the clinic:

provision of qualified specialized medical care to the population when contacting a polyclinic and at home;

organizing and conducting medical examinations of the population;

organization and holding preventive measures among the population in order to reduce morbidity, disability and mortality;

examination of temporary disability;

organizing and carrying out work on sanitary and hygienic education of the population and the formation of a healthy lifestyle.

One of the structural subdivisions of the polyclinic is the prevention department, which includes a pre-medical control room, a women's examination room, etc. Patients from the registry who first come to see a doctor are sent to the prevention department. In the pre-medical control room, various certificates are issued and preliminary examinations are carried out.

Medical examination of the population

Clinical examination is the main means of prevention in the domestic health care system.

Medical examination is understood as active dynamic monitoring of the health status of certain contingents of the population (healthy and sick), taking these population groups into account for the purpose of early detection of diseases, dynamic monitoring and comprehensive treatment of patients, taking measures to improve their working and living conditions, prevent the development and the spread of diseases, restoration of working capacity and prolongation of the period of active life.

Clinical examination provides, first of all, the preservation of health in healthy people, the active identification of patients with early stages diseases and disability prevention. The ultimate goal of medical examination is to preserve and strengthen the health and working capacity of the medical examination contingent. This determines the social and hygienic essence of clinical examination.

Currently, there are various dispensaries: medical and physical education, dermatovenerological, anti-tuberculosis, narcological, cardiological, oncological, neuropsychiatric.

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) availability of 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 the Republic of 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 aid (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 assistance).
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 - in necessary cases 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.

7. City polyclinic.

13. Health centers.

Medical care, definition of the concept.

Health care- a set of measures aimed at maintaining and (or) restoring health and including the provision of medical services.

(the federal law R.F. November 21, 2011 No. 323 - Federal Law "On the basics of protecting the health of citizens in the Russian Federation").

Types of medical care: first aid, first pre-medical, first medical, qualified, specialized.

First aid carried out by people who do not necessarily have a special medical education. The first aid level does not involve the use of any special medical instruments, medicines or equipment.

First first aid turns out to be persons with special training for the provision of medical care. This is the average medical staff (paramedic, nurse) or pharmacist, pharmacist. This is their level of knowledge and skills.

First aid turns out to be a doctor who has the necessary tools, medicines, and the amount of such assistance is regulated by the terms of its provision, i.e. where she ends up - outside of hospital conditions or in a clinic, an ambulance, in admissions office hospitals.

Qualified medical care turns out specialist doctors high qualification in conditions multidisciplinary hospitals or trauma centers;

Specialized medical care can be rendered directly high level in the conditions of specialized clinics, institutes and academies.

Medical care can be provided in following conditions:

1. Outside a medical organization (at the place where an ambulance brigade is called, including specialized ambulance, medical care, as well as in vehicle at medical evacuation);

2. Outpatient (in conditions that do not provide for round-the-clock medical supervision and treatment), including at home when a medical worker is called;

3. In a day hospital (under conditions that provide for medical supervision and treatment in daytime, but not requiring round-the-clock medical supervision and treatment);

4. Stationary (in conditions that provide round-the-clock medical supervision and treatment).

Types, forms and conditions of medical care (Table 1).

Types of medical care

Forms of medical care

Conditions for the provision of medical care

Primary Health Care

planned and urgent

Outpatient and day hospital

Specialized, including high-tech, medical care

Not installed

Inpatient and outpatient

Ambulance, including specialized ambulance, medical care

Emergency or urgent outside the medical organization

Outpatient and inpatient

Palliative care

Not installed

Outpatient and inpatient

Primary health care facilities.

Types of institutions providing PHC (in the future):

I. out-of-hospital care:

1. FAP, rural outpatient clinics; city medical outpatient clinics;

2.territorial polyclinics (in cities);

3. Stations and substations for emergency medical care;

4. other types of institutions: medical and social centers for serving the elderly and old age, polyclinic rehabilitation centers(single and multidisciplinary), medical genetic consultations, "Marriage and Family" consultations, centers mental health and etc.

II. hospital care.

Hospital PHC system, incl. social, should

turn on:

Precinct, district, city general hospitals;

Stationary rehabilitation centers;

Hospitals for the chronically ill;

Houses nursing care;

Boarding houses.

The district principle remains, however, this does not exclude the free choice of a doctor. The patient is given the right to choose a doctor and institution.

City Polyclinic.

The central institution of PHC is the polyclinic

Why is the polyclinic the most important institution in the system of organizing medical care?

1. This is the institution of the most massive medical care (which is received by about 80% of all patients, of those who apply to the clinic, they start and finish treatment in it).

2. This is a cheaper type of medical care.

3. This is the main institution where it is possible to develop the principles of prevention (patients turn to initial stage diseases, the main type of preventive activity of doctors is developing here - clinical examination, promotion of healthy lifestyles will be introduced, prevention noncommunicable diseases and etc.).

Definition

POLYCLINIC(from the Greek polis - city and clinic), a multidisciplinary or specialized medical institution for providing medical care to incoming patients and patients at home.

Polyclinic- the main link in the organization of medical and preventive care for the population living in the territory of their activity, as well as for employees of enterprises attached to it.

Ambulatory(from lat. ambulare- walk). Hospital for walking patients.

(Conventionally, an outpatient clinic differs from a polyclinic in that it is a small institution with no more than 5 medical positions).

Structure of the MSCH.

1. Polyclinic: Workshop areas. specialized departments.

2. Health centers (medical, feldsher).

3. Hospital for 400-600 beds.

4. Sanatorium, dispensary.

5. Diet table.

6. Children's health institutions.

Tasks of the MSC.

1) Qualified, specialized medical care both in the clinic and in the hospital.

2) Clinical examination in accordance with Basic program medical insurance.

3) Organizing and conducting, together with the CSES, preliminary, upon admission to work, and periodic preventive medical examinations.

4) Examination of temporary disability.

5) Accounting and analysis of morbidity with temporary disability, prof. illness, disability, injury.

6) Measures for the rehabilitation of sick and disabled people (together with the administration), including recommendations for transfer to other areas of work.

7) Medical selection of those in need for health reasons in the direction of a sanatorium, dispensary, on a diet.

8) Identification and hospitalization in in due course infectious patients and carrying out, together with TSES, anti-epidemic measures.

9) Participation in the development, together with the administration and the trade union, of a comprehensive plan for sanatorium and recreational activities and joint control over its implementation.

10) Carrying out sanitary and preventive measures together with the department of industrial hygiene of the Central Sanitary and Epidemiological Service.

11) Preparation and management of the social and sanitary asset, conducting sanitary and educational work.

12) Participation in the work of engineering and medical teams

health center- This is a primary medical institution at industrial enterprises, in construction and transport organizations, and educational institutions.

There are 2 types of health centers:

1. medical

2. paramedic

Medical health posts are organized at industrial enterprises with no more than 1200 employees, and medical assistants with at least 500 employees. A dental office can function at the health post. A medical health center and a feldsher health center are part of the medical unit or polyclinic.

Tasks of health centers:

1) First aid for sudden illnesses, accidents and injuries.

2) Holding preventive work in the shops.

3) Training of workers to provide self-help and mutual assistance in order to provide first aid to the injured or suddenly ill.

4) Dispensary observation.

5) Decrease in morbidity and injuries among workers and employees.

6) Accounting and analysis of morbidity with temporary disability. 7) Identification, together with TsSEN, of production sites with occupational hazards.

8) Improvement of sanitary and hygienic working conditions.

9) Monitoring compliance with safety regulations.

To date, ORDER No. 846 dated June 24, 1985 “On approval of the Regulations on the medical unit and the therapeutic department of a polyclinic for providing medical care to workers” remains a worker.

Topic 1. Organization and structure of the primary health care system

1. Medical care, definition of the concept.

2. Types of medical care: first aid, first pre-medical, first medical, qualified, specialized.

3. Legal basis provision of primary medical care in the Russian Federation.

4. Primary health care: "primary health care", "primary health care", "outpatient care".

5. Organization of primary medical care according to the district principle.

6. Institutions providing primary health care.

7. City polyclinic.

8. The main activities of the city polyclinic serving the adult population.

9. The structure of health care institutions providing primary health care.

10. Features of providing primary medical care to workers of industrial enterprises, rural residents.

11. Organization of medical care at home.

12. Features of the organization of medical care according to the type of "hospital at home" and "day hospital".

13. Health centers.

14. Organization of primary medical care on the principle of a general practitioner (family doctor).

1. Types of medical care

ü First aid carried out both by a medical worker of any level, and by people who do not have medical education outside the hospital and in the hospital. The level of first aid does not involve the use of any special medical instruments, medicines or equipment;

ü First aid turns out medical workers any level at health centers, feldsher-obstetric stations;

ü First aid is carried out by doctors who have the necessary tools, medicines, and the volume of such assistance is regulated by the conditions for its provision, i.e. where she ends up - outside the hospital or in the clinic, ambulance, in the hospital's emergency department.

ü Qualified medical care- a complex of surgical and therapeutic measures carried out by doctors of the relevant profile in medical institutions(departments) aimed at eliminating the consequences of the defeat, in the first place life threatening. Optimal time rendering is considered the first 8-12 hours after injury.

ü Specialized medical care- a complex of therapeutic and preventive measures carried out by specialist doctors in specialized medical institutions (departments) using the necessary equipment and equipment in order to maximize the restoration of the lost functions of organs and systems. Should be provided as far as possible early dates but no later than 3 days.

2. Primary Care

Primary Health Care- the first level of contact of a person, family, society with the national health care system, which brings medical care as close as possible to the place of residence and is the first element of health care aimed at improving the health of the healthy, treating and rehabilitating the sick.

It includes:

1. Treatment of the most common diseases, injuries, poisonings and others emergency conditions;

2. Carrying out sanitary and hygienic and anti-epidemic measures, medical prevention major diseases;

3. Sanitary and hygienic education;

4. Carrying out measures to protect the family, motherhood, fatherhood and childhood.

PHC is the main, accessible and free type of medical care for every citizen.

Implementation this right should be carried out regardless of gender, nationality, social origin, place of residence, religious beliefs as well as other circumstances.

Citizens of the Russian Federation who are outside its borders are also guaranteed the right to health care in accordance with international treaties of the Russian Federation.

The volume of PHC is determined by the local administration in accordance with state guarantees of free medical care and territorial programs of compulsory medical insurance.

The procedure for providing PHC is established by the governing bodies of the municipal healthcare system on the basis of regulations of the Ministry of Health and Social Development of the Russian Federation.

3. Primary care institutions

PHC is provided by institutions of the municipal health system and the sanitary and anti-epidemic service. Assistance may be provided by state and private systems health care on the basis of contracts with insurance medical organizations.

Primary health care is provided:

1. Outpatient;

2. At the place of departure of the mobile medical team

3. In a day hospital, including a hospital at home.

The leading link in the system of organization of PHC are outpatient clinics. In polyclinic conditions, 80-85% of patients begin and finish treatment.

Organization of PHC according to the district principle

The territorial-district principle of organizing the provision of PHC consists in the formation of groups of the served contingent on the basis of residence (stay) in a certain territory or on the basis of work (training) in certain organizations.

The distribution of the population by areas is carried out by the heads of medical organizations providing primary health care, depending on the specific conditions for the provision of primary health care to the population in order to maximize its accessibility and observance of other rights of citizens.

In order to ensure the right of citizens to choose a doctor and a medical organization, it is allowed to attach citizens living or working outside the service area of a medical organization to district general practitioners, general practitioners (family doctors) for medical observation and treatment, taking into account the recommended number of attached citizens.

In medical organizations, sections can be organized:

ü paramedic;

ü therapeutic (including workshop);

ü general practitioner (family doctor);

ü complex;

ü obstetric;

at the medical assistant's station - 1300 people of the adult population.

in the therapeutic area - 1700 adults (for the therapeutic area located in countryside, - 1300 people of the adult population);

at the site of a general practitioner - 1200 people of the adult population.

at the family doctor's site - 1,500 adults and children;

on the complex site - 2000 and more people of the adult and children's population.

Depending on the specific conditions for the provision of PHC to the population, in order to ensure its accessibility, permanent medical teams consisting of a district general practitioner, paramedics, obstetricians and nurses, with distribution between them functional duties by competence.

City Polyclinic

Polyclinic - a specialized or multidisciplinary medical institution designed to provide medical care to incoming patients, as well as to patients at home, to implement a set of therapeutic and preventive measures for the treatment and prevention of diseases and their complications.

Classification of polyclinics:

1. On an organizational basis - united with a hospital and not united (independent);

2. On a territorial basis - urban and rural;

3. By profile - general for serving the adult and children's population or only adults and children;

4. By level of specialization - highly specialized and multidisciplinary.

Tasks of the city polyclinic:

1. provision of qualified and specialized medical care to the population of the served area directly in the clinic and at home;

2. organization and implementation of a set of preventive measures aimed at reducing morbidity, disability and mortality among the population living in the service area, as well as among those working at attached industrial enterprises;

3. organization and implementation of medical examination of the population (healthy and sick);

4. organizing and conducting activities for sanitary and hygienic education of the population and promotion of a healthy lifestyle.

In carrying out these tasks, City Polyclinic renders:

1. first and emergency medical care for patients with acute and sudden illnesses, injuries, poisoning and other accidents;

2. conducts early detection diseases (qualified and full examination visiting the clinic);

3. Provides timely and qualified medical assistance population (for outpatient appointment and at home)

4. promptly hospitalizes persons in need of inpatient treatment, examining them as fully as possible in advance in accordance with the profile of the disease;

5. spends rehabilitation treatment sick;

6. all kinds preventive examinations;

7. clinical examination, incl. selection of persons (healthy and sick) subject to dynamic observation;

8. carries out a complex of anti-epidemic measures (vaccinations, identification of patients infectious diseases, dynamic monitoring of persons who were in contact with such patients, etc.);

9. conducts an examination of temporary and permanent incapacity for work (issuance and extension of a certificate of incapacity for work), and also sends persons with signs of permanent disability to the medical and labor expert commissions;

10. carries out activities to improve the skills of doctors and paramedical personnel).

The polyclinic closely cooperates with hospitals, institutions providing specialized medical care, and the ambulance service.

It is necessary that all information about the patient's health be concentrated at the local doctor, who should be given the opportunity to use advisory and diagnostic assistance from more qualified specialist or institutions.