What does outpatient care include? Outpatient medical care

Outpatient care

Outpatient outpatient care- the type of medical care provided to patients at the reception in a polyclinic (outpatient clinic) and when visiting patients by a medical worker at home.

Outpatient care is the most widespread type of medical and preventive care for urban and rural population. In 1986, St. 40 thousand outpatient medical institutions, which are the main link in the health care system, carrying out constant dynamic monitoring of healthy and sick people, ensuring a wide range of preventive, therapeutic, diagnostic and recreational activities.

Outpatient care is provided by independent polyclinics and those united with hospitals, medical and sanitary units, dispensaries, children's polyclinics, antenatal clinics, polyclinic departments of central district hospitals, outpatient clinics of rural district hospitals, medical outpatient clinics. In addition to medical institutions, outpatient care is provided under the guidance of doctors at feldsher-obstetric stations (for the rural population) and feldsher health centers (working at small industrial enterprises, transport, construction, communications enterprises).

The main medical and preventive institutions providing out-of-hospital care to the population are multidisciplinary polyclinics, in which patients are admitted for 20-25 medical specialties and more. The structure of such polyclinics includes various specialized departments and offices.

The features of outpatient care are its mass character and general accessibility, the wide interconnection of curative and preventive medicine, the possibility of active identification early forms diseases, the introduction of prevention and specialized types out-of-hospital care, district principle of work.

In connection with the transition of Soviet health care from clinical examination individual groups of the population to universal medical examination, the role and importance of outpatient clinics in the implementation of integrated program work to strengthen disease prevention and improve public health. Under the systematic supervision of polyclinics, dispensaries, women's consultations and outpatient clinics, there is a significant number of practically healthy people (children, adolescents, workers in a number of professions and industries, machine operators in agricultural production and animal husbandry, pregnant women, disabled people, war veterans, etc.). Annual medical examinations are held by St. 120 million people, dispensary observation covered approx. 70 million people suffering from various diseases.

At the heart of all the activities of territorial outpatient clinics and polyclinics is the district principle, and the district general practitioner is the leading specialist. The principle of locality also applies to doctors of other specialties - obstetricians, psychiatrists, etc. The district allows you to establish a systematic honey. observation of the attached population, provide measures for the formation healthy lifestyle life and disease prevention.

The network of territorial and guild medical districts is constantly growing, they are being subdivided. The improvement of outpatient care is facilitated by its specialization and the creation of a multi-level system. At the first level, in territorial polyclinics and medical units, outpatient care is provided, as a rule, in the main medical profiles (therapeutic, surgical, neurological, otorhinolaryngological, ophthalmological, dermatovenereological, gynecological). At the second level, in the city polyclinics of consultative and diagnostic care, there are specialized rooms and departments (urological, endocrinological, gastroenterological, pulmonological, etc.). The third level can be represented by city centers of specialized medical care, including a polyclinic consultative office, an inpatient department of the corresponding profile, and sometimes a round-the-clock emergency service.

Outpatient care is interconnected with emergency and inpatient care. The degree of interaction and continuity in the work of medical and professional institutions depends on the effectiveness of not only outpatient care, but also the entire medical diagnostic. The development of care affects the use of the final fund of hospitals and sanatoriums.

The relationship of institutions providing this species medical care, with other medical institutions is provided by document management, joint scientific and practical conferences, the practice of rotation in joint hospital institutions (doctors take turns working for a certain period in a polyclinic and a hospital) and other events.

In order to improve the qualifications of outpatient doctors, a number of advanced training institutes for doctors have organized special courses, departments, faculties, and in some cities there are permanent seminars.

An important role in the provision of outpatient care to the population is played by paramedical workers (midwife, nurse, average medical worker, paramedic). Nurses of polyclinics, outpatient clinics, dispensaries and medical units take an active part in all sections of the work of providing outpatient care - from organizing timely service to visitors in the registry and receiving them by doctors to direct participation in preventive work, patronage of patients, pregnant women and newborns at home, conducting immunization of the population, assisting doctors at the reception, performing medical diagnostic, physiotherapy and other procedures, participating in rehabilitation treatment. Nurses carry out activities primary prevention, carry out sanitary and educational work, maintain accounting and reporting medical documentation (medical reporting), assist doctors in analyzing the performance of outpatient clinics, etc. Machulskaya E.E. Social security law: textbook / E. E. Machulskaya. -- 2nd ed., revised. and additional -- M.: Yurayt Publishing House; ID Yurayt, 2011. S. 357

Outpatient care- the most massive form of assistance to the population. About 80% of all patients are treated annually in outpatient clinics. They are the main link in the medical examination of the population.

Outpatient (i.e. out-of-hospital) care in cities is provided by polyclinics, outpatient departments dispensaries, in countryside it is provided by feldsher-obstetric stations, outpatient clinics, polyclinic departments of district, regional and republican hospitals, at industrial enterprises - medical units and health centers.

Polyclinic(from the Greek "polis" - city and "klinike" - treatment) - a multidisciplinary or specialized healthcare facility that provides medical care to incoming patients (i.e. outpatient, out of hospital) and at home.

The polyclinic has medical offices for the main clinical profiles: therapy, surgery, gynecology, neurology, eye diseases, diseases of the ear, throat and nose, and in some polyclinics - and narrow profiles: endocrinology, hematology, orthopedics, urology, etc.

The modern polyclinic has a full set of necessary diagnostic and treatment rooms equipped with the latest equipment, which makes it possible to provide patients with qualified medical care. In addition to the laboratory, the X-ray room, there are endoscopic, ultrasound, physiotherapy rooms, a day hospital, an office for physiotherapy exercises, rehabilitation, a prevention department, etc. The clinic also has a reception desk, office rooms, utility rooms.

Clinics are located in cities. In large cities, there are two types of polyclinics: integrated with hospitals and independent.

The urban area served by the polyclinic is divided into sections based on the number of residents. The average recommended size of the therapeutic area is 1300 adults, the pediatric area is 800 children. Based on the length of the site, its remoteness from the clinic, the availability of vehicles, the population on the site may fluctuate.

If the patient is due disease state cannot come to the clinic, the doctor can be called to the house. Some clinics have emergency care. Patients suffering from chronic diseases are registered at the dispensary and visit a doctor for preventive examination.

Functions of the clinic:

1) provision of first aid in case of acute and sudden diseases, injuries;

2) treatment of patients at the address and at home;

3) organization and conduct of clinical examination (see below);

4) examination of temporary disability

5) release of patients from work;

6) direction to medical and social expertise persons with signs of persistent disability (disability);

8) carrying out preventive, anti-epidemic measures, sanitary and educational work;

9) study of health indicators of the served population, morbidity, including at attached industrial enterprises.

Ambulatory(from Latin “ambulatories” - mobile, walking) - a medical institution designed to provide medical care to incoming patients (outpatient) and differs from a polyclinic in a lower level of specialization and volume of activity (has no more than five medical positions).

Outpatient clinics, as a rule, are located in rural areas, in small urban-type settlements and belong to district hospitals.

Previously, medical examination was repeatedly mentioned as one of the forms of work of outpatient clinics. We present brief explanation about this question.

Clinical examination- This is a system of work of health facilities based on the dispensary method.

dispensary method– method medical care, which consists in active dynamic monitoring of the health status of certain groups of the population (healthy and sick), taking them into account in order to early detection diseases and prevention of exacerbation of chronic diseases, implementation of individual and public prevention And medical measures, studying and improving the conditions of their work and life.

Target dispensary method- prolongation of the time of active life and life expectancy.

Dispensaries provide specialized dispensary medical care to the population.

dispensary(from lat. "dispenso" - I distribute) - a medical facility designed for active early detection, registration, observation and treatment (outpatient or inpatient) of patients with certain groups of diseases: tuberculosis, dermatovenerological, oncological, cardiological, psychiatric.

In its structure, the dispensary, as a rule, has a hospital (see below) and a unit for outpatient reception sick.

It is also necessary to mention medical unit (MSCh) , which is organized to provide specialized outpatient, and in the presence of a hospital and hospital medical care to workers and employees of various enterprises. MSCH are of closed and open types.

Closed MSCh It is intended to provide medical care exclusively to those working at the enterprise in which it was formed.

MSCH open type also provides medical assistance to family members working at the enterprise and to the population of adjacent microdistricts.

Basically, the functions and principles of work of the medical unit coincide with those of the city polyclinic. The differences lie in the contingent served and the specifics of the industrial enterprise.

At present, the MSC can be independent government agency right legal entity, or a structural subdivision of an enterprise of a non-state form of ownership. In the latter case, the legal status of the MSCh is determined by the charter of the enterprise.

Closest to employees of enterprises or pupils (students) educational institutions forms of medical care are health posts , which, as a rule, are subdivisions of medical units, district (city) polyclinics or hospitals. Health centers can be medical or paramedical. With the number of employees (students) of 1200 people and more, a medical health center is organized, with the number of people served by 500–1200 people - a paramedical one. The health center provides first medical, pre-medical and first qualified assistance in case of injuries, sudden illnesses and occupational poisoning, and also conducts sanitary and hygienic and treatment and preventive measures to prevent and reduce morbidity with temporary disability.

Women's consultation- Dispensary-type health care facility providing all types of outpatient obstetric and gynecological care to the population. It builds its work according to the territorial-district principle, i.e. each obstetrician-gynecologist serves a certain part of the female population living in a fixed territory (site). Along with the provision of medical obstetric and gynecological care, women's consultations monitor pregnant women during the entire period of pregnancy, preventive examinations women, assists the population in family planning.

Similar information.

Primary health care (PHC) - is the first level of contact of the population with the 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.

The organization of the activities of APU (outpatient clinics) is based on 4 basic principles:

1. Locality - assigning a certain area to the clinic.

2. Continuity and stages in treatment (polyclinic - the first stage, patients get to the hospital on the direction of a doctor.)

3. Preventive focus, implemented through a set of measures aimed at preventing the disease (medical examination, health schools, vaccinations, etc.)

4. Availability - i.e. you can easily get into it at any time. The city polyclinic is a multidisciplinary medical and preventive institution designed to provide medical care to the population aged 18 years and older at the pre-hospital stage and carry out measures to improve the health of the population. According to the organizational principle, polyclinics are divided into those associated with a hospital and those not associated with a hospital.

By capacity, polyclinics are divided into 5 categories depending on the number of visits per shift or the number of people served:

The operating mode of the polyclinic is established by the local authority on whose territory the medical institution is located, while proceeding from the ability of the population to visit the polyclinic in their free time. The most rational work schedule of the city polyclinic should be considered the work of the institution on weekdays from 800 to 20 hours, and on Saturdays, Sundays and holidays from 900 to 16-18 hours. The preferred mode for the city polyclinic is a six-day working week, which creates more favorable conditions for an even distribution of attendance by day of the week. On Saturdays, the reception of patients in the polyclinic is carried out by a general practitioner on duty, medical specialists and an auxiliary medical and diagnostic service.

The main tasks of the clinic:

Providing qualified and specialized medical care in the clinic and at home.

Organization and holding preventive measures– clinical examination of the population, sanitary and educational work, promotion of a healthy lifestyle, anti-epidemic measures.

High-quality conduct of clinical and expert work - examination of temporary and identification of signs of permanent disability.

Timely hospitalization of persons in need of inpatient treatment, with a preliminary maximum examination.

Compliance with successive ties with other health facilities.

In carrying out these tasks, City Polyclinic provides first and emergency medical care to patients with acute and sudden illnesses, injuries, poisoning and other accidents; renders medical assistance at home, patients who, due to health reasons and the nature of the disease, cannot visit the clinic, need bed rest, systematic medical supervision or hospitalization; conducts early detection of diseases (qualified and complete examination of those who applied to the clinic): provides timely and qualified medical assistance to the population (on an outpatient appointment and at home); conducts rehabilitation treatment of patients, all types of preventive examinations, clinical examination, incl. selection of persons (healthy and sick) subject to dynamic observation; carries out dynamic monitoring of the state of health of students of secondary special and students of higher educational institutions, a complex of medical and recreational activities. Together with the Central State Sanitary and Epidemiological Service, it conducts a set of anti-epidemic measures (vaccination, early detection of patients with infectious diseases, dynamic monitoring of persons who have been in contact with such patients, convalescents, etc.). Conducts an examination of temporary and permanent disability (issuance and extension of a certificate of incapacity for work, recommendations for rational employment, etc.), and also sends persons with signs of permanent disability to the Bureau of Medical and Social Expertise.

The structure of the city polyclinic includes:

1. control unit

Chief physician's office

Office of the Deputy Chief Physician

Chief Nurse's Office

2. registry

3. treatment and prophylactic block

Cabinet of local therapists

Office of district surgeons

Cabin of different specialists

manipulative, procedural

Vaccination cab

Cab Infectious Diseases

dispensary department

4.laboratory and diagnostic unit

Laboratory, ultrasound, ecg, etc.

5. auxiliary unit

Pharmacy, cso

6. administrative block

Accounting, office, service personnel, warehouses

If the polyclinic is combined with the hospital, then it is not managed by chief physician, A

deputy chief physician of the clinic.

And this is for general development 

The treatment and prophylactic part of the clinic begins with the registry. The registry organizes preliminary and urgent appointments of patients to see doctors both by direct contact with the clinic and by phone, and regulates the flow of people seeking medical help in order to create an even workload for doctors.

Timely pick up and delivery medical records to doctors' offices, the correct layout of medical records in the card storage. Registrars fill out the front part of medical records, monitor their aesthetic appearance. A book of house calls is kept, the timeliness of taking calls by doctors is controlled. In the registry, patients of the polyclinic receive information about the time of reception of doctors of all specialties, about the procedure for the work of the polyclinic, about the rules for calling a doctor at home, about the procedure for making an appointment with doctors, about the rules for preparing for research, about the time and place of reception of the population by the head doctor and his deputies; addresses of pharmacies, polyclinics and hospitals providing emergency medical care to the population in the evening and at night.

The main and in most cases the first doctor in the clinic, to whom the patient addresses, is the local general practitioner. Specialists with a higher medical education in the specialty "General Medicine" or "Pediatrics" and a certificate of a specialist in the specialty "Therapy" are appointed to the position of a local general practitioner - order of the Ministry of Health and social development of the Russian Federation dated December 7, 2005 No. 765. The district general practitioner carries out his activities to provide primary health care to the population in medical organizations predominantly of the municipal health care system: polyclinics; dispensaries; inpatient polyclinic institutions of the municipal health care system; other medical and preventive institutions providing primary health care to the population.

The work of most outpatient clinics in our country is based on the district principle. The entire territory served by the clinic is divided into sections, each of which is assigned to a district doctor and a district nurse. The organization of the medical site creates favorable conditions for effective treatment preventive work. The local doctor has the opportunity to know not only the patient, but also his family, for a long time in dynamics to monitor the health status of those living on the site, to consider the incidence in connection with specific working and living conditions, which is necessary for the implementation of medical and recreational activities. Plots are formed on the basis of population standards per site. District standards: for a general practitioner - 1,700 residents aged 18 and over; for a general practitioner - 1,500 residents aged 18 and over; For family doctor- 1200 people of all ages.

All doctors of the polyclinic provide medical care at home according to the schedule within the monthly norm of working hours. The volume of home care, as well as the contingent of people providing treatment at home, largely depends on the availability of various organizational forms of home care - a hospital at home, emergency departments (points), departments for the care of the sick and the elderly, short-term or day care. hospitals with subsequent aftercare of the patient at home. The vast majority of polyclinic patients seeking help at home are patients with a therapeutic profile. The duration and nature of treatment at home depend on the patient's condition. In acute diseases, the doctor is most often limited to 1-2 visits, further transferring the patient to ambulatory treatment to the clinic. However, it should be remembered that the practice of premature transfer of patients with acute illnesses from a home regimen to an outpatient one, it threatens with the occurrence of complications and the development of chronic forms of the disease. It should also be taken into account that, despite the higher cost of one medical visit at home, compared to outpatient appointments, the correct organization of the treatment and diagnostic process, including at home, allows you to quickly achieve positive results and thus contributes to greater economic efficiency in in general. During an exacerbation of chronic diseases, home visits often take the form of systematic treatment, in some cases as close as possible to hospital conditions. In this situation, it is especially important to organize a full-fledged examination of the patient, timely and regular fulfillment of all appointments at home, and, if necessary, care for the patient by relatives, medical staff, employees of social security institutions.

The ratio of acute and chronic diseases, which served as the reason for seeking help at home, differs by the seasons of the year. During the summer period, a significant part of the home visits of local therapists are visits to people suffering from chronic diseases, mainly cardiovascular, respiratory and nervous system. The share of doctor's house calls due to acute illnesses noticeably increases in autumn and winter. To a certain extent, the quality of the doctor's work at the site can be judged by repeated visits to patients at home. Active visits initiated by the attending physician testify to the correct organization of home care. Repeated calls to the doctor for the same disease, especially requests for emergency and emergency care, are most often associated with the inadequacy of the prescribed treatment, underestimation by the doctor of the severity of the patient's condition, and incorrect planning of the timing of repeated active visits.

Nursing staff may be entrusted with repeated visits to check patient compliance with bed rest, the implementation of the prescribed treatment. A large role belongs to the nursing staff in the implementation of such an active form of home visits as patronage, especially for lonely elderly citizens with malignant neoplasms. The effectiveness of preventive and curative work is largely determined by the relationship between the medical staff and the patient, the ability of the doctor and nurse to find ways to influence the lifestyle of a sick or healthy person. Therefore, each visit at home should be used more widely for preventive work in the family, conversations with relatives of patients, explaining to them the peculiarities of the psychology of patients, caring for them, and teaching rehabilitation measures at home.

Home care in the evening and at night for residents of the neighborhood served by the polyclinic (or several polyclinics) is provided by the emergency department, organized in one of the polyclinics. By decision of the local health authority, the provision of emergency care in the evening and at night can be completely entrusted to the centralized ambulance service.

A day hospital is a progressive and effective form of providing qualified medical care to patients, which allows for treatment at the hospital level without hospitalization of the patient. A day hospital can be organized for 5-25 or more beds, work in one or two or three shifts. It provides treatment for persons with chronic pathology and some acute diseases. In surgical day hospitals, operations can be performed to remove benign tumors of soft tissues, hernias; orthopedic interventions. In day hospitals, patients are examined: phonocardiography, urography, endoscopy, etc. The number of working doctors, paramedical and other personnel, the list of necessary equipment is established by the head of the institution. The treatment in day hospitals of patients with vascular diseases of the lower extremities, chronic diseases of the respiratory and digestive organs, and the consequences of an acute disorder is quite effective. cerebral circulation and others. Transportation of patients to the day hospital can be organized by the transport of the polyclinic for medical reasons. Day hospitals widely use physiotherapy, balneological treatment, mud therapy, massage, physiotherapy and other types rehabilitation treatment. The average length of stay of patients in a day hospital is 10-12 days.

A home hospital is organized to treat patients who suffer from chronic diseases and, due to social and domestic reasons, refuse to be hospitalized. Treatment is carried out by a polyclinic doctor who visits the patient at home at least 3 times a week, his appointments are performed by nursing staff.

Analyze the activities of the clinic according to the annual report. The analysis of the work of the polyclinic should begin with determining the scope of its activities, the dynamics and structure of visits (preventive, for diseases). It is very important to establish the population per doctoral area, the staffing level, and the actual workload of doctors. According to the polyclinic, it is possible to study the incidence of the population, as well as the organization of preventive work and its results.

Outpatient care is the most massive type of median care, which is received by about 80% of all patients who apply to healthcare organizations. The main types of outpatient clinics (APUs) include: polyclinics (for adults, children, dental clinics), dispensaries, general medical (family) practice centers, antenatal clinics, etc.

The organization of the APU activity is based on four fundamental principles shown in fig. 10.1.

Rice. 10.1. Basic principles for the provision of outpatient care

Preventive focus

The priority activity of the polyclinic is dispensary work. Dispensary is a line of business medical institutions, which includes a set of measures to promote a healthy lifestyle, prevention and early diagnosis diseases, effective treatment patients and their dynamic observation.

In the preventive activities of APU, primary, secondary and tertiary prevention(see section 2.9).

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 clinical examination, these contingents are taken into account for the purpose of early detection of diseases, complex treatment, carrying out measures to improve working and living conditions, restore working capacity and extend the period of active life.

Vaccination is an important area of ​​preventive work of the APU. Child population preventive vaccinations are carried out according to the appropriate vaccination schedule, for the adult population - at will and indications.

Precinct

When forming sites to ensure equal working conditions for district doctors, one should take into account not only the population, but also the length of the site, the type of development, remoteness from the clinic, transport accessibility and other factors.

Availability

Continuity and stages of treatment

There should be continuity between these links in the provision of medical care to avoid duplication. diagnostic studies, maintaining medical records, thereby ensuring the complexity in the prevention, diagnosis, treatment and rehabilitation of patients. One of the ways to achieve this is the introduction of an electronic medical history (electronic patient passport).

Further development of outpatient care should be aimed at solving the following problems: 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 the APU; increasing the efficiency of the APU, improving management; improving the culture and quality of medical and social care.

O.P. Shchepin, V.A. Medic

Outpatient treatment involves the continuity and consistency of a number of diagnostic, treatment-and-prophylactic and rehabilitation measures. Characteristic features- polyclinic care is the availability and opportunity to receive qualified treatment, being in and visiting a polyclinic for testing and control examinations. At the same time, you can get a referral from your doctor and be examined by specialists of any profile, as well as receive the results of diagnostic tests. The only thing you have to buy is the designated medications at your own expense.

Inpatient treatment in hospitals involves you living in them around the clock, with a bed, necessary diagnostics and appointments, medicines are provided to you free of charge. It is assumed that in this case you are also provided with a 24-hour medical supervision and carrying out all necessary medical procedures.

Which treatment to choose

No matter how unbearable the eternal smell of disinfection and hospital rooms are, you should be guided by common sense, because in some cases you can only get the necessary appointments in a hospital. And if we are talking about surgical intervention, there is nothing to say.