Primary health care goals. Organization of medical care for the population of the Russian Federation
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 districts, ambulance stations or ambulance departments have been organized at central district hospitals. A special place in the system P. m.-s. occupies outreach assistance provided by mobile medical teams, as well as mobile devices and medical complexes (Mobile devices 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 assigned 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).
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. 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 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 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. 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.: Bolshaya Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.
Lecture number 1.
- it is the zone of the first contact of the population with health services, which provides not only medical, but also preventive work, as well as the organization of medical care for the attached population.
The value of primary health care for the population is determined high availability of medical care, opportunity obtaining a qualified examination and treatment without hospitalization, and often without exemption from work or school. For the state great importance has a reduction in financial costs for expensive inpatient treatment, as well as the possibility of increasing the share of extrabudgetary funding through the development of paid services and contracts with organizations and enterprises.
PHC includes:
1. outpatient service
2. ambulance and emergency medical care
3. sanitary and epidemiological service
4. pharmacy service.
Principles of PHC provision
1. Availability of medical and social services.
2. The complexity of the examination of patients.
3. Consistency in work with other services and departments.
4. Continuity of observation of patients in various healthcare organizations.
5. Orientation of activities towards the provision of medical, social and psychological assistance.
Functions of PHC
1. Treatment of the most common diseases, injuries, poisoning and other emergency conditions.
2. Obstetrics.
3. Carrying out sanitary-hygienic and anti-epidemic measures.
4. Medical prevention of diseases.
5. Hygienic education of the population.
6. Carrying out measures for family planning, protection of motherhood, fatherhood and childhood.
PHC institutions
In cities, this assistance is provided by territorial polyclinics for adults and children's polyclinics, medical outpatient clinics, medical units, women's consultations, medical and feldsher health centers. In rural areas, the first link in the system of this assistance is the medical and preventive institutions of the rural medical district: feldsher-obstetric station, health center, GP outpatient clinic, district hospital, medical outpatient clinic. For residents of the district center, the main institution providing primary care is the polyclinic of the central district hospital.
To provide emergency medical care in cities, a wide network of relevant stations (substations) has been created; in rural administrative districts, emergency departments have been organized at central district hospitals.
The implementation of sanitary-hygienic and anti-epidemic measures is assigned to the sanitary-epidemiological service with the direct participation of doctors and paramedical workers of territorial and industrial medical sites.
In the implementation of PSM, the role of health workers in outpatient clinics (APUs) is the greatest. The obligation of APU to provide primary health care is performed by medical workers of these institutions: district therapists, district pediatricians, general practitioners (family), obstetrician-gynecologists, other doctors, as well as specialists with secondary medical (paramedic, midwife) and higher nursing education .
An important condition for the successful implementation of the PHC guidelines is the interaction of healthcare with social and economic sectors, whose activities are aimed at solving the main social problems in society, creating conditions for protecting and improving public health.
Organization of PHC according to the principle of a general practitioner
General doctor- a specialist with a higher basic medical education in the specialty "General Medicine", who has completed additional professional education, focused on primary health care, and admitted to medical activities in the manner prescribed by the legislation of the Republic of Belarus.
The main goal of introducing a general practitioner into the healthcare system is further development primary health care to the population, improving accessibility, improving its quality and efficiency.
The main task of general practice is an independent solution of most problems related to the health of the population served, aimed at its preservation and strengthening.
Basic principles of GP activities: preventive orientation, accessibility, continuity, universality, comprehensiveness, group approach, coordination, confidentiality.
The nature of care provided by a general practitioner, along with therapeutic and pediatric care, includes care for the most common types of pathology in the field of neurology, minor outpatient surgery, otorhinolaryngology, ophthalmology, obstetrics and gynecology.
In our country, GPs most often work in rural areas and in outpatient clinics of a general practitioner in the city.
ORGANIZATION OF THE WORK OF THE POLYCLINIC
In accordance with the Decree of the Ministry of Health of the Republic of Belarus No. 35 of September 28, 2005 “On approval of the nomenclature of healthcare organizations”, outpatient organizations include:
Ambulatory; polyclinic; dispensary; center; medical and rehabilitation expert commission; military medical commission; medical unit.
Polyclinic- a medical and preventive organization designed to provide qualified assistance to the population living in the service area, both in organizations and at home.
The capacity of the clinic is determined by the number of visits per shift.
Ambulatory - a medical and preventive organization designed to provide first aid. Outpatient clinics include healthcare organizations with no more than 7 full-time medical positions in 4 main specialties: internal medicine, pediatrics, obstetrics and gynecology, and dentistry.
In the Republic of Belarus, outpatient clinics operate mainly in rural areas (rural medical outpatient clinic, outpatient clinic for a general practitioner).
Outpatient clinics are divided by organizational principle :
1. independent
2. combined with a hospital;
By territorial principle: district, city, central, regional;
According to the profile of activity: general (for serving the adult and children's population), organizations separately for adults and children.
The service area of the polyclinic and its work schedule are established by the health authorities and coordinated with the administrative-territorial authorities. In order to ensure the availability of medical care, the polyclinic is located as close as possible to the place of residence of the population attached to it.
The central district (city) polyclinic is entrusted with the organizational and methodological management of medical care for the population.
Principles of organizing medical care for the population in outpatient settings: accessibility, locality, preventive orientation, continuity, phasing.
Precinct-territorial principle of service: the population living in the service area of the polyclinic is assigned to the local general practitioner of the polyclinic to receive medical care. In the Republic of Belarus, except territorial(therapeutic, pediatric, obstetric-gynecological) sites, functioning general practitioner's station, rural medical station, ascribed and workshop areas. The basic place of work of district doctors is a polyclinic. In rural areas - a rural district hospital (SUB) or a rural medical outpatient clinic (SVA) of a rural medical district.
This consolidation provides a number of advantages in the organization of medical care for the population. One of the most valuable is the awareness of polyclinic doctors about the population, health status, including the demographic situation, morbidity, as well as working conditions, life, local customs, traditions, etc.
In accordance with the Decree of the Council of Ministers of the Republic of Belarus No. 811 dated 06.20.2007 "On approval of minimum standards for public services" approved the average number of residents served at the therapeutic site is 1700 people, the site of a general practitioner is 1200 people (adults and children).
The population, even in single-profile areas, can be different. This is due to the fact that the management of the polyclinic, when forming sites in order to ensure equal accessibility, takes into account the length of the sites (presence of a private sector), remoteness from the clinic, and the state of transport links.
Tasks of the clinic:
1. Organization and implementation of a set of preventive measures.
2. Organization and implementation of medical examination of the population.
3. Organization and implementation of anti-epidemic measures in the service area.
4. Organization and holding of activities for hygienic education and training of the population, promotion of a healthy lifestyle.
5. Organization and implementation of medical and diagnostic assistance to the population in the clinic and at home.
6. Organization and implementation of activities aimed at improving the demographic situation in the service area.
7. Analysis of the health status of the population attached to the clinic for medical care.
8. Improving the organizational forms and methods of work of the polyclinic to improve the quality and efficiency of medical and diagnostic work, medical rehabilitation of patients and the disabled, the introduction of hospital-replacing technologies into the practice of the polyclinic.
STRUCTURE OF THE POLYCLINIC
The structure of the polyclinic depends on its capacity and is represented by the following functional units:
1) management of the polyclinic;
2) registry;
3) prevention department;
4) medical departments;
5) laboratory and diagnostic department:
Clinical diagnostic laboratory;
X-ray room; fluorography room;
Cabinet of ultrasound diagnostics;
Cabinet (office) functional diagnostics;
Endoscopy room.
6) department of medical rehabilitation;
7) centralized sterilization;
8) organizational and methodological department (office of medical statistics);
9) administrative and economic part; accounting;
Human Resources Department,
Lawyer's office;
Civil Defense Engineer's Office;
Occupational health and safety engineer's office;
All specialized service The clinic is intended primarily for to help the local doctor in its preventive, diagnostic and therapeutic work.
Department of Medical Rehabilitation. The Department of Medical Rehabilitation is a structural subdivision of the polyclinic. The polyclinic department of medical rehabilitation is multidisciplinary and includes, if possible, the entire arsenal of rehabilitation facilities.
The purpose of the outpatient stage of medical rehabilitation is to provide patients with all available training tools and conditions that allow, under the guidance and supervision of a rehabilitation doctor, to more fully compensate for lost functions, restore health and performance.
Patients are referred to the department of medical rehabilitation of the polyclinic by the attending physicians, heads of the treatment and prophylactic departments of the polyclinic. Reception and selection of patients in rehabilitation centers is carried out by the medical advisory commission of the polyclinic, rehabilitation doctors or, if necessary, selection committees.
The department accepts patients after stopping the acute period of the disease or its exacerbation, as well as disabled people with an individual rehabilitation program.
The structure of the medical rehabilitation department depends on the capacity of the polyclinic. The medical rehabilitation department includes rooms;
Therapeutic physical education;
Mechanotherapy (simulators);
functional stimulation;
Acupuncture;
massage;
Occupational therapy and household rehabilitation; speech therapist;
Physiotherapy;
As well as a day care unit and a swimming pool.
The main tasks of the Department of Medical Rehabilitation are:
1. Timely formation of an individual rehabilitation program.
2. Implementation of an individual rehabilitation program for the disabled and patients.
3. The use of a complex of all necessary methods and means of rehabilitation to restore the patient's health.
4. Explanatory work among the population about the means and methods of restoration and strengthening, maintaining health and working capacity.
In accordance with the tasks set, the specialists of the department carry out:
Individual rehabilitation program for the sick and disabled; its timely implementation using modern means and methods;
Implementation of an individual rehabilitation program drawn up by the MREK;
Mastering and introducing into practice the work of the department of new modern means and methods of rehabilitation, based on the achievements of science, technology and best practices;
Involvement for consultation of the necessary specialists of the hospital, polyclinic, in the structure of which this department is located, and other medical and preventive organizations;
Examination of working capacity and referral to the MREK in accordance with the current regulations;
Relationship and continuity with other departments of the polyclinic, as well as social security institutions;
Conducting clinical reviews of defects in the management of the patient at the stages of treatment, the ineffectiveness of ongoing rehabilitation measures, etc.;
If necessary, refer patients to rehabilitation departments in hospitals;
Accounting and reporting in the forms and within the time limits approved by the Ministry of Health of the Republic of Belarus.
Day care unit. The day care department of the city polyclinic is part of the medical rehabilitation department. His leadership is carried out by the head of the department of medical rehabilitation, and in the absence of a department of medical rehabilitation - by another person as prescribed by the head physician of the polyclinic.
The profile of the department, its capacity, staffing structure and mode of operation are determined and approved by the chief doctor of the organization in agreement with the higher health authorities, taking into account the population, nature of activity, needs, and the existing base of the medical and preventive organization.
Treatment and diagnostic assistance to patients of the day care department is carried out with the involvement of all structural divisions of the polyclinic.
Main tasks day care units are:
1. Security in outpatient settings medical diagnostic, advisory and rehabilitation assistance to patients who do not require round-the-clock medical supervision.
2. Providing emergency medical care to visitors who are in the clinic.
3. Introduction into practice of modern methods of prevention, diagnosis and treatment of patients based on the achievements of medical science and best practices.
4. Ensuring the relationship and continuity with other structural units of the polyclinic and medical and preventive organizations in the examination, treatment and medical rehabilitation of patients and the disabled.
5. Conducting an examination of temporary disability for persons undergoing treatment in the day care unit.
6. Implementation of savings and rational use financial and material and technical resources of the polyclinic.
Indicators characterizing the volume and level of care in outpatient settings.
1. Average number of visits to doctors per inhabitant per year:
Number of doctor visits e th polyclinic + number of visits vra chami at home
Average annual population living in the service area
2. Distribution of visits to the polyclinic by type of treatment:
The number of visits to the clinic for the disease (with preventive purpose) 100
Total number of clinic visits
3. The structure of visits to doctors by specialty:
Number visited ii to doctors this specialty 100
Total number of visits
4. The scope of medical care at home:
Number p therapist visits patient in n a house at 100
Number of visits by patients to therapists in the polyclinic + number of visits by therapists to patients at home
Number of doctor visits by lickley nicknames (per day, month, year)
The number of hours actually worked according to the schedule at the clinic appointment (per day, month, year)
H islo visits to patients at home (per day, month, year e)
Number of hours actually worked for home care
Indicators characterizing the preventive work of the polyclinic.
1. Completeness of coverage by preventive examinations of contingents population to be examined:
Number fact about viewed l ic 100
Number of persons to be examined according to the plan
2. Coverage of the population with preventive examinations in order to detect a specific disease:
Number of persons examined with aim early his detection of diseases 100
Average annual population of the area of operation of the health organization
GENERAL PROVISIONS
Primary health care is the basis of the medical care system, which includes 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 other medical workers with a 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 specialist doctors, including medical specialists of medical organizations providing specialized medical care, including VMP.
PHC is provided on an outpatient basis and in 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 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 provision of medical care "polyclinic - hospital - institutions of 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 center. 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 work with certain groups of 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 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 implementation of a complex of preventive measures among the attached population aimed at reducing morbidity, disability and mortality;
Clinical examination of the population, especially those with increased risk diseases of the cardiovascular 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 doctor conducts the selection of medical and administrative personnel, is responsible for their work, gives encouragement to well-working initiative employees and attracts disciplinary responsibility violators of 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.
From among the most qualified and possessing organizational skills, the 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 constant control department head.
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, the project "Electronic Registry" is being implemented in a number of cities of the country. 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 convenient 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 records. 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 their streets and houses, 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 registry office, 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 district 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 (city 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.
The structure and staffing of the 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 of modern methods of 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 reproductive health, 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 childbirth, it is recommended to use traditional methods of psychophysical preparation of pregnant women for childbirth, as well as teaching them the rules of personal hygiene, preparing for future childbirth and caring for a child 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 to 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 the case of multiple pregnancy - 28 weeks) or more. Required condition- 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 has entered into an agreement with the maternity hospital for the provision of 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% were sent to antenatal clinics, 63% to maternity hospitals, and 5% to children's polyclinics. The funds received by these health care institutions under the Birth Certificate program were used to increase the salaries of personnel providing medical care to women during pregnancy and childbirth, dispensary observation of a child of the 1st year of life, as well as to purchase medicines and medical products, medical equipment, tools, soft inventory, and in stationary institutions- Supplementary nutrition for 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 there are 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 best way pregnancy protection.
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 site family doctor- 1200 adults and children.
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.
The practice that has developed in recent years shows that the activities of the TsOVP 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 TsOVP is shown in fig. 5.5.
The position of a GP (family doctor) is assigned to specialists with a 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 social protection agencies and mercy services, for lonely, elderly, disabled, 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 the effective forms of providing PHC to the population. They are organized for the examination and treatment of patients with acute diseases and exacerbations of chronic diseases or pregnancy pathologies 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, gastric ulcer and duodenum(uncomplicated), chronic gastritis, obliterating atherosclerosis 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 individually determined 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 the organization of hospitals at home is treatment acute forms diseases (not requiring 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 simple surgical interventions, etc.
Hospitals at home can be organized as part of polyclinics, polyclinic departments of 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.) is carried out in the presence of 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.
PRIMARY HEALTH CARE- a set of medical and sanitary-hygienic measures carried out at the first (primary) level of contact between the population and health services.
The concept of "primary health care" as a reflection of the strategy and program of the World Health Organization (see) was proposed by her in the 70s. 20th century with the goal of "health for all by the year 2000". At the same time, P. m.-s. p. was identified as the main means of achieving the goal of the strategy. The concept and concept of P. m.-s. items have undergone significant changes as the experience of developing health care and social services is studied and generalized, under the influence of the active position of the USSR and other socialist countries at WHO sessions and in its daily activities. Initially, this form of medical care was interpreted as mainly medical, primitive, provided to residents of rural communities. developing countries persons without medical education, and received only the initial skills in providing first aid and vaccination, at the expense of the community. Moreover, this form of medical care in most countries was opposed to professional, including state, health services, which were unable to provide medical care to the majority of the population due to an acute shortage of medical care. personnel and health care institutions and the exorbitantly high and ever-increasing cost of medical care. It was proposed to call this form of primary health care, and consider its implementation the responsibility of communities not associated with professional medical care. organization. However, such a position contradicted the goals and objectives of healthcare as an inseparable part of social development and deprived the population of developing countries, broad sections of the working people of economically developed capitalist countries of modern medical care because of its high cost, one of the basic human rights - the right to health; it was at odds with the decisions of the WHO itself, and above all with the resolution adopted at the XXIII World Health Assembly (1970) on the basic principles of national health care, with the successes in building public health systems in the socialist countries and the experience of a number of other countries. Ideas about the primitive character of P. m.-s. detached from health care services and from plans and programs for socio-economic development, should have been replaced by a progressive concept that meets the needs of the population, the principles and tasks of the UN, following the example of a number of countries, and above all socialist ones, which have demonstrated real opportunities providing public, qualified health care through the creation of its comprehensive systems and services. Long-term experience of development in the USSR P. of m.-s. n., primarily within the medical area, had a fruitful effect. After discussing the diverse problems of P. m.-s. item at national and international conferences, including in regional committees and at the World Health Assemblies, WHO and UNICEF it was decided to convene a special international conference on P. m. - s. On the initiative and invitation of the government of the USSR, such a conference was held in September 1978 in Alma-Ata. Participants of the conference not only discussed numerous and diverse aspects of the concept of P. m.-s. item and its implementation in various countries, but were also able to get acquainted with the medical profession, institutions of the Kazakh SSR and other Central Asian republics, appreciating the organization and efficiency of their work very highly, Tue. hours rendered by them to P. m.-s. The conference adopted the Alma-Ata Declaration and other documents, in which the concept and concept of P. m.-s. the item, possibilities of the countries, the main ways, means of realization of this form medical - a dignity are defined. assistance, duties of states, governments, international organizations. The decisions of the Alma-Ata conference were widely known and supported throughout the world. They form the basis of the new strategy being developed by WHO, confirmed and developed in the documents of subsequent World Health Assemblies (XXXII, XXXIII, especially XXXIV). WHO believes that through P. m.-s. it will be possible to gradually move towards the creation of comprehensive health systems for the entire population. Already in 1979, the WHO synthesis document "Developing a strategy for achieving health for all by the year 2000" spoke of providing each individual with access to primary health care, and through it to all levels of a comprehensive health system. The concept of P. m.-with. the item means existence of service or system of health care, a cutting edge a cut it is; assumes the existence of several levels (primary - P. m.-s. p., secondary, etc.). There is still no complete idea of the structure, forms and functions of P. m.-s. etc., its connections with other levels (echelons). It is indisputable (and this was recognized at the Alma-Ata conference and subsequently) that the highest form of P. m.-s. takes place in the USSR and a number of other socialist countries, where a comprehensive state health care system has been created as essential part socio-economic and political development, the edge ensures the protection and improvement of the health of the entire population, where there is a strong connection of all parts of medical care - outpatient, outpatient, rotational, specialized, where the basis of the health care system, and above all P. m.-s . the item, is prevention (see), the social and preventive direction.
Understanding the concept of P. m.-s. as a universal doctrine does not mean that it does not take into account the different levels of socio-economic development of countries and their health services. Accordingly, specific forms, possibilities for the development of P. m.-s. n. are different. However, common concept and the concept of P. m.-s. n. The Declaration of Alma-Ata states: “Primary health care includes essential health interventions that are universally available individual people and families in the community and carried out with their full participation on the basis of practically applicable, scientifically sound and socially acceptable methods and technologies and at costs within the material capabilities of the community and the country as a whole at each stage of their development in accordance with the principle of self-sufficiency and self-determination. Primary care is an integral part of both the national health system, performing its main function and being its central link, and the entire process of socio-economic development of societies. It is the first level of contact of individuals, families and communities with the national health system, brings health care as close as possible to where people live and work, and represents the first stage in the ongoing process of protecting the health of the people. In the Alma-Ata Declaration and other WHO documents P. m.-s. the item is called a basis of services of system of health care, its integral part, the core providing all actions medical - a dignity. character, moreover, provides nek-ry social and medical actions at the first stage of activity for protection of health of the population. WHO emphasizes that P. M.-s. It is aimed at solving the main problems of protecting the health of the population and includes measures to promote health, prevention, treatment and rehabilitation.
Since the nature of these functions reflects the economic and social conditions of the country and various groups of its population, and is also conditioned by them, depending on the country and district system P. m.-s. n. may have features, but should include the following functions: promotion of rational nutrition and an adequate supply of good quality water; carrying out the main dignity. events; maternal and child health, including family planning; vaccination against major inf. diseases, prevention and control of local epidemic diseases; dignity. education on current health issues and how to address them, including prevention, treatment of common diseases and injuries. Considering the extremely low social and economic level of nek-ry developing countries, in documents of WHO, including materials of the World health assemblies, there are attempts to define a minimum a dignity. and honey. requirements P. m.-s. n. (e.g., the availability of good-quality water in houses or within a 15-minute walk from the dwelling;, immunization against diphtheria, tetanus, whooping cough, measles, polio, tuberculosis; provision of medical care at the place of residence, including the use of a minimum 20 drugs; availability of staff for obstetric and gynecological care).
In the conditions of our country, P. m.-s. the item should be considered as a system of such industries and services as an outpatient clinic (including polyclinics, health centers, medical units); emergency and emergency medical care, obstetrics; as well as partially hospitals where patients are initially treated or delivered. To institutions P.m.-s. the item also includes feldsher and feldsher-obstetric stations, precinct-tsy in rural areas. More than 80% of all patients begin and complete treatment in this system; it is also called upon to carry out practically all preventive, sanitary and anti-epidemic work. This system requires increasing attention, solving many organizational problems - improving prevention, medical examinations, examinations, continuity, specialization, management at various levels of its hierarchy, and participation of the population in it. P.'s system m.-with. the item as the main link of health care and the system of bodies and institutions of health care passed the difficult and long evolution which is closely connected with development of the Soviet health care (see. Health care ).
At the first stages, in connection with the heavy legacy received by the young Soviet Republic from tsarist Russia, the organization of P. m.-s. The item was based on attraction to participation in health care of wide masses of workers and creation in the cities and countryside of a considerable network of first-aid posts and points of health care. Soon, outpatient facilities, dispensaries, ambulance and emergency medical services, sanitary and anti-epidemic services, institutions for the protection of mother and child health began to develop on a large scale.
The most important form of work of the outpatient clinics of the country (combined with BCs and independent), located in cities and rural areas, as the basis for organizing the system P.m.-s.p. became the principle of locality.
Each medical site integrates primary medical sanitary, social and specialized medical care to the population of the site. The district doctor coordinates the activities of the first-aid posts located on the territory of the site and its paramedical staff, the entire sanitary and social asset of the site, as well as medical specialists of the outpatient clinic.
The locality in medical aid to the population creates optimum conditions for carrying out a complex to lay down. - the prof., and a dignity. - gig. measures, studying the causes of morbidity and determining ways to reduce and eliminate them (see Medical site).
In more difficult conditions functioning rural medical sites (see. Rural medical site), which is associated with the nature of settlement, the peculiarities of the working and living conditions of rural residents and leads to a staged provision of medical care to them. The rural medical district is the first medical link in the system of medical care for the rural population. The organization and implementation of P. m.-s. are mainly assigned to it. The following honey is located on the territory of the rural medical site. institutions: district hospital with an outpatient clinic or an independent outpatient clinic (see Outpatient clinic), feldsher-obstetric stations (see), feldsher health centers (see Health center) in state farms and enterprises, collective farm maternity hospitals, preschool institutions. These institutions carry out diversified activities to provide P. m - s. P.
In the cities of P. m.-s. The item turns out both at the place of residence and at the place of work through medical territorial and production (shop) sites (see. Shop medical site), which are part of the territorial and factory polyclinics (see. Medical and sanitary part).
P. m.-s. the item to children it turns out hl. arr. in a children's polyclinic (see) according to the district principle, and its main method, as in other medical and professional institutions, is medical examination (see).
For P.'s rendering m. - page. the item to women are intended special out-patient establishments - women's consultations (see). In their work, the leading place also belongs to the dispensary method.
In work of medical staff of medical sites and medical workers of out-patient and polyclinic establishments the dignity takes the big place. education of the population, directs and coordinates a cut a network of houses of sanitary education (see).
A special place in the system P. m.-s. the item in the USSR is occupied by fast and emergency medical care (see), and also nek-ry types of exit medical care (see the Help at home). To provide emergency medical care, a wide network of institutions has been created: emergency medical centers, stations and departments of emergency and emergency medical care, functioning around the clock in cities and rural areas.
A variety of functions to provide P. m.-s. mobile (field) services are provided to the predominantly rural population: mobile medical teams, mobile outpatient clinics, laboratories, X-ray fluorography, dental and other rooms, as well as emergency and planned advisory services of regional (regional, republican) hospitals (see Regional hospital) with the air ambulance stations organized at them (see). Mobile services are formed at the central regional, regional (regional, republican) and large city-tsakh for the purpose of mass inspection of the population, prophylactic medical examination and rendering the qualified medical and advisory help.
One of the most important tasks of the system P. m.-s. the item is carrying out a dignity. - gigabyte. and sanitary and anti-epidemic measures, to-rye in the USSR are carried out, in addition to the medical staff of medical sites and dignity. asset, state sanitary and epidemiological service (see). This service has a significant network of scientific and practical health care institutions. Functions of development of projects of state standards, a dignity are assigned to it. norms and rules and other legislative acts - on ensuring a dignity. protection of environmental objects (see Sanitary legislation), optimal conditions work and life, physical. development of the population, its nutrition, disease prevention. Workers of this service not only carry out functions of sanitary supervision (see), but also take direct part in carrying out a dignity. and anti-epidemic measures.
Thus, to lay down. - the prof., medical and advisory and a dignity. activity of various links and services of the Soviet public health care on rendering P. of m. - page. urban and rural population of the country not only fully complies with the definition developed by WHO, but also goes far beyond its scope. In the USSR, the concept of "primary health care" is much broader and deeper. It should be interpreted as primary medical health care, combined on a state basis with all other types and forms of medical care for the population of the country, with the entire Soviet socialist health care and the entire system of the socialist state and socio-political system.
Bibliography: Alma-Ata Conference on Primary Health Care, WHO Chronicle, vol. 33, no. 3, p. 123, 1979; Burenkov S. P. Development of Soviet health care, Owls. health care, No. 11, p. 3, 1979; Constitution (© main law) of the Union of Soviet Socialist Republics, M., 1978; Lisitsyn Yu. P. International conference on primary health care in Alma-Ata, Zdravookhr. Ros. Federation, No. 3, p. 31.1979; Fundamentals of the legislation of the USSR and the Union republics ® health care, M., 1970; Primary health care, WHO / UNICEF, M., 1978; Petrovsky B. V. Main stages, state and prospects for the development of medical and preventive care for the population of the USSR, M., 1978; The work of WHO in 1978-1979, Geneva, WHO, 1980; Serenko A. F., Ermakov V. V. and Petrakov B. D. Fundamentals of the organization of polyclinic assistance to the population, M., 1976; Sharmanov T. Sh. Experience in organizing primary health care in the Kazakh SSR, Alma-Ata, 1978.
Yu. P. Lisitsyn, N. I. Gavrilov.
Most often, a person first encounters the health care system at the level of primary health care (according to Yu.P. Lisitsin - “medical and social”). There are several formulations - the meanings of PHC, but their essence is the same.
Primary health care (WHO 1978) - is the first level of contact of the population with the national health 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.
PHC (according to Yu.P. Lisitsin) - it is the primary element of a multifaceted structure of public health care, which brings medical care as close as possible to the place of residence and is built on the principle "from the periphery to the center".
Primary Health Care(in the wording of the "Concept for the development of health care until 2020") - a set of medical, social and sanitary and hygienic measures that ensure health improvement, prevention of non-infectious and infectious diseases, treatment and rehabilitation of the population.
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). In particular, it states that PHC is an integral part of the healthcare system of each country, its main function and purpose, an essential component of the overall social and economic development of society. Those. Russia is the birthplace of PHC.
Primary health care includes:
Ø outpatient clinic,
Ø ambulance,
Ø emergency
Ø general medical care.
PHC must meet the basic health needs of the population:
Health promotion;
Treatment;
Rehabilitation and support;
Assistance in self-help and mutual assistance.
It is advisable to single out two main strategic elements of PHC:
The need to orient health care services in such a way that PHC is the core of the health system, while secondary and tertiary health care act as ancillary advisory elements;
Development of modern medical and organizational technologies for effective use resources and their reallocation from hospitals to the PHC sector.
Thus, PHC should include the following components:
Health education on topical health problems and ways to solve them, including prevention;
Ensuring sufficient food and promoting healthy nutrition;
Supply of sufficient clean drinking water;
Carrying out basic sanitary and hygienic measures;
Maternal and child health, including family planning;
Vaccination against major infectious diseases;
Treatment of common diseases and injuries;
Provision of essential medicines.
Currently, the legal basis for financing health care is determined by the Constitution of the Russian Federation, the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, and the Law "On health insurance of citizens in the Russian Federation".
In accordance with the 1993 Constitution (Article 41), the Russian Federation finances federal programs protection and promotion of public health, measures are being taken to develop state, municipal and private systems healthcare. Medical care in state and municipal health care institutions in accordance with this article should be provided to citizens free of charge at the expense of the relevant budget, insurance premiums, and other revenues.
Sources of funding for health care were previously indicated in Art. 10 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens.
Currently, the sources of funding are as follows - (see diagram).
From these sources, the financial resources of the state, municipal health care systems and the state compulsory medical insurance system are formed:
Despite all the decisions to reduce the cost of the most expensive medical care - hospital care, it absorbs at least 60% of all costs, and the most massive outpatient care - no more than 25%.
Even the Alma-Ata conference, which we discussed above, recommended that at least 50% of all consolidated budget funds be spent on primary health care, which should cover at least 90% of the total population. Such a goal is set in the Concept for the Development of Health Care and Medical Science in the Russian Federation, along with the tasks of restructuring medical care, primarily inpatient care.
Let us dwell on the main Regulatory documents for the provision of primary health care in health facilities:
1. The Constitution of the Russian Federation (Art. 41);
2. the federal law RF "On the basics of protecting the health of citizens in the Russian Federation" dated November 21, 2011 No. 323
3. Order of the Ministry of Health and Social Development of the Russian Federation of May 15, 2012 No. 543n
4. Order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 923n “On approval of the procedure for providing medical care to the adult population in the profile “Therapy”
5. Order of the Ministry of Health and Social Development of the Russian Federation of October 07, 2005 No. 627 (as amended on February 19, 2007 No. 120 and on November 19, 2008 No. 653)
6. Order of the Ministry of Health and Social Development of the Russian Federation
dated November 20, 2002 No. 350 (ed. Orders of the Ministry of Health and Social Development of Russia dated January 17, 2005 No. 84, dated May 18, 2012 No. 577n)
7. Order of the Ministry of Health of the Russian Federation No. 237 of August 26, 1992 "On a phased transition to the organization of primary medical care on the basis of a general practitioner (family doctor)". Order of the Ministry of Health of the Russian Federation No. 350 dated November 20, 2002 “On improving outpatient care for the population of the Russian Federation” (as amended by the MHSD Regulation dated January 17, 2005 No. 84 and dated May 18, 2012 No. 577n).
8. Annual Decrees of the Government of the Russian Federation "On the program of state guarantees for the provision of free medical care to citizens of the Russian Federation for the next year."
In this material, we dwelled on the main issues of formation, structure, management mechanisms, financing of PHC, the basics of integration of the health services of the Russian Federation, as well as interaction with state, public organizations and the population in the organization of primary health care. In Russia, the concept of primary health care is focused primarily on the provision of medical care in outpatient clinics.
47. General principles organization of the clinic.
The city polyclinic is an outpatient institution that provides medical and preventive care to the population aged 18 years and older and is called upon to carry out extensive preventive measures in the area of its activity to prevent and reduce morbidity; early detection of patients; clinical examination; provision of outpatient qualified specialized medical care to the population. The city polyclinic is actively working on sanitary and hygienic education of the population, the formation of a healthy lifestyle, etc.
These polyclinics are organized in cities, workers' settlements and urban-type settlements to provide outpatient care to the population living in the area of its activity, according to the territorial principle, as well as to attached workers of industrial enterprises, construction organizations and transport enterprises - according to the workshop (production) principle.
The main tasks of the city polyclinic (polyclinic department of the city hospital) are:
Providing qualified specialized medical care to the population directly in the clinic and at home;
Organization and implementation of a set of preventive measures aimed at reducing morbidity, disability and mortality among the population of the served area and workers of attached industrial enterprises;
Implementation of medical examinations of the population and, first of all, those with an increased risk of diseases of the cardiovascular system, oncological and other diseases;
Organization and holding of events for sanitary and hygienic education of the population, promotion of a healthy lifestyle.
To accomplish these tasks, the city polyclinic organizes and conducts:
Providing first and emergency medical care to patients with acute and sudden illnesses, injuries, poisoning and other accidents;
Providing medical care at home to patients who, due to health reasons and the nature of the disease, cannot visit the clinic, need bed rest, systematic medical supervision or a decision on hospitalization;
Early detection of diseases, qualified and full examination of patients and healthy people who applied to the clinic;
Timely and qualified provision of medical care to the population at an outpatient appointment in a polyclinic and at home;
Timely hospitalization of persons in need of inpatient treatment, with a preliminary maximum examination;
Rehabilitation treatment of patients;
All types of preventive examinations (preliminary upon admission to work, periodic, targeted, etc.);
Medical examination of the population;
Anti-epidemic measures that are carried out in close contact with the Central State Sanitary and Epidemiological Service (vaccinations, identification of infectious patients, dynamic monitoring
for persons who have been in contact with an infectious patient, and for convalescents, signaling in the Central State Sanitary and Epidemiological Service, etc.);
Examination of temporary and permanent disability, issuance and extension of certificates of incapacity for work and labor recommendations for those in need of translation into
other areas of work, selection for sanatorium treatment;
Direction to medical and social expertise persons with signs of persistent disability;
Sanitary and educational work among the population;
Accounting for the activities of personnel and departments, compiling reports according to the forms approved by the Ministry of Health of the Russian Federation, and analyzing statistical data;
Involving the community of the district to assist in the work of the polyclinic and control its activities;
Measures to improve the skills of doctors and paramedical personnel.
The city polyclinic (not part of the unified city hospital) enjoys the rights legal entity, has a stamp and a seal with the designation of its name. The structure of the polyclinic is determined by its capacity and the number of people served, let's look at Fig. 2.2s exemplary scheme organizational structure of the city polyclinic for adults, which includes:
1. Management of the polyclinic.
2. Registry.
3. Department of prevention (pre-hospital reception room, women's examination room, clinical examination room, health education and hygienic education of the population).
4. Medical and preventive units:
Therapeutic departments;
shop therapeutic departments;
Surgery department(cabinet);
Traumatology department (office);
Urological office;
Ophthalmological department (office);
Otorhinolaryngological department (office);
Neurological department (office);
Cardiology office;
Rheumatology room;
Endocrinological department (office);
Office of Infectious Diseases;
Department of Rehabilitation and Rehabilitation Treatment;
day hospital;
Physiotherapy department (office);
Branch (office) physiotherapy exercises;
Cabinet of laser therapy;
Inhalation;
Treatment room.
5. Auxiliary medical and diagnostic units:
X-ray department (office);
Clinical and biochemical laboratory;
Department (office) of functional diagnostics;
Endoscopy room;
Cabinet of accounting and medical statistics;
economic part;
Self-supporting departments and departments of additional paid services.
In addition, on the basis of polyclinics, departments can be deployed: medical and social rehabilitation and therapy; care services; day hospitals; outpatient surgery centers; medical and social care centers, etc.
The main figure in the urban polyclinic for adults, the specialist with whom, as we have said, the patient most often meets for the first time, is the local therapist. The number of district therapists working in a polyclinic depends on the number of people served - there are 5.9 positions per 10,000 people aged 18 and over.
The district therapist provides in the clinic and at home qualified therapeutic assistance to the population living in the assigned area, as we have already said in 1700 people. In his work, he reports directly to the head of the therapeutic department.
The local therapist is obliged to provide:
Timely qualified therapeutic assistance to the population of their site in the clinic and at home;
Emergency medical assistance to patients, regardless of their place of residence, in case of their direct treatment in the event of acute conditions, injuries, poisoning, etc.;
Timely hospitalization of patients with mandatory preliminary examination at planned hospitalization;
Patient counseling (in necessary cases) the head of the therapeutic department, doctors of other specialties;
The use of modern methods of prevention, diagnosis and treatment in their work;
Examination of temporary disability of patients in accordance with the current regulations;
Organization and implementation of a set of measures for the medical examination of the adult population of the site in accordance with the list of nosological forms subject to dispensary observation by a general practitioner, analysis of the effectiveness and quality of medical examination;
Issuance of conclusions to residents of their site undergoing medical examinations;
Early detection, diagnosis and treatment of infectious diseases, immediate signaling to the head of the therapeutic department and the doctor of the infectious diseases cabinet about all cases of infectious diseases or patients suspected of infection, about food and occupational poisoning, about all cases of violation of the regimen and non-compliance with anti-epidemic requirements by infectious patients left for treatment at home, sending an emergency notification to the Central State Sanitary and Epidemiological Service;
Systematic improvement of their qualifications and the level of medical knowledge of the district nurse;
Active and systematic conduct of sanitary and educational work among the population of the site, the fight against bad habits and the preparation of the public asset of the site.
The work of the local therapist is carried out according to a schedule approved by the head of the department or the head of the institution, which provides for fixed hours for outpatient appointments, time for home care, preventive and other work. The distribution of the time of reception and assistance at home is determined depending on the size and composition of the population of the site, on the prevailing attendance, etc.
An important role in the organization of medical and preventive care for the population is played by doctors of narrow specialties, who in their work are directly subordinate to the head of the department, the deputy head physician for the medical unit or the head of the institution.
To perform the main tasks, the specialist doctor provides:
Carrying out preventive measures;
Early detection of diseases, qualified and timely examination and treatment of patients of their profile;
Conducting an examination of temporary disability, timely referral of patients with chronic forms of diseases to MSEC;
Continuity between the hospital and the clinic in the treatment of patients;
Timely hospitalization of patients according to indications; dispensary observation of patients of their profile, disabled people and participants of the Great Patriotic War, personal pensioners, participants in the liquidation of the consequences of the accident at the Chernobyl nuclear power plant and other categories of persons subject to dispensary observation;
Systematic improvement of the level of their theoretical training and professional qualifications; systematic advanced training of paramedical personnel;
Active participation in carrying out sanitary and preventive work, hygienic education of the population;
Timely and high-quality maintenance of medical records, established accounting and reporting forms and reports on their activities.
Tasks of outpatient clinics:
1. Providing qualified and specialized care population serving the territory in the clinic and at home.
2. Carrying out a set of preventive measures among the population aimed at reducing disability, morbidity and mortality.
3. Organization and conduct of clinical examination of patients and decreed groups of the population.
4. Sanitary and hygienic education and training, promotion of a healthy lifestyle.
There are two main types of polyclinics: integrated with hospitals and non-integrated - independent.
The main structural parts of the polyclinic are:
1. Management of the polyclinic.
2. Registration.
3. Department of prevention.
4. Treatment and prevention units.
5. Auxiliary diagnostic departments.
6. Office for registration of medical documentation.
7. Cabinet of accounting and medical statistics.
8. Administrative and economic part.
To the task registries includes:
Organization of preliminary and urgent appointments of patients to see a doctor;
· Regulation of the intensity of the flow of the population in order to create a uniform workload of doctors and distribute it according to the types of care provided;
· Selection and delivery of medical documentation to doctors' offices, maintenance and storage of the polyclinic file cabinet.
Main tasks prevention departments are:
Organization of medical examination of the population;
Organization and conduct of preliminary and periodic medical examinations;
· Early detection of diseases and persons with risk factors;
Sanitary and hygienic education and promotion of a healthy lifestyle.
As part of the prevention department, there are rooms: an anamnestic room, a centralized medical examination room, a functional research room, an express diagnostics room, a women's examination room, and a healthy lifestyle promotion room.
Work therapeutic department polyclinics are organized according to district principle, which consists in the fact that the territory served by the clinic is divided into territorial sections, based on the population in the area of 1700 people. Each site is assigned a specific therapist and nurse. The tasks of the local therapist are:
1. Provision of qualified therapeutic assistance to the population of the site at the reception in the clinic and at home.
2. Organization and direct implementation of preventive measures among the population.
3. Decreased morbidity and mortality in the assigned area.
The Assistant Physician is district nurse(for each position of a district doctor, 1.5 positions of a district nurse are established). Her responsibilities include:
1. Preparing the office for a medical appointment, checking the receipt of medical records from the registry, preparing the necessary documentation, identifying those in need of a priority appointment.
2. Assistance to the doctor during an outpatient appointment: following his instructions, maintaining accounting and reporting documentation, registering the results of analyzes and conclusions, helping the doctor to conduct dispensary observation.
3. Organization of observation of patients at home and fulfillment of doctor's prescriptions.
4. Carrying out preventive sanitary and anti-epidemic measures at the site.
48. Organization of dispensary services for the population.
The preventive direction of domestic health care is most fully expressed in the dispensary method of work of many outpatient clinics. Under dispensary method 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, comprehensive treatment of the sick, taking measures to improve their working and living conditions, prevent the development and spread of diseases , restoration of working capacity and prolongation of the period of active life (A.F. Serenko). According to this method, special dispensary medical institutions operate in the country: dispensaries - anti-tuberculosis, dermatovenereological, neuropsychiatric, oncological, cardiological, anti-goiter, medical and physical education; it is widely used in work antenatal clinics, MSCh, children's polyclinics and polyclinics for adults.
The country has repeatedly set the task of universal medical examination of the population, but it was not implemented due to the lack of the necessary material base and financial resources.
It should be noted that the general medical examination of the population is the highest level of state concern for the health of the people. Its implementation is possible only if special personnel and resources are provided for this. This should be taken into account when organizing dispensary observation in individual medical institutions, in particular in polyclinics, a doctor should be allocated special time to perform medical examinations, due to his main workload. In no case should this work be an additional burden.
The main person in the organization of dispensary services in the clinic is the local general practitioner. Physicians of all specialties deal with this issue to some extent. The district therapist is responsible for organizing dispensary services for the population of his district. In the organizational process of clinical examination, the following stages are distinguished; selection of contingents through active detection, their registration, implementation of a complex of therapeutic and social and preventive measures, i.e. implementation of the actual dispensary observation, and evaluation of the results of the effectiveness of prophylactic medical examination. There should be no more than 120-150 prophylactic patients per one local general practitioner. Identification of persons subject to medical examination is carried out, as a rule, when patients are admitted by a doctor in a polyclinic or when visiting them at home. Known value also have various preventive examinations, where the most early stages diseases. All patients selected for dispensary observation are registered on the "Control cards of the dispensary patient". With the help of this document, the doctor can establish control over the timing of the appearance for re-examinations. Main medical document is an outpatient card with a corresponding note that the patient is under dispensary observation. The experience of the polyclinic turned out to be very successful, when books are given to dispensary patients, where the doctor notes medication and other appointments, indicates the date of the next appointment. As observations have shown, such books to some extent discipline patients, contribute to the fact that they, without an additional call, are at the appointed time for an appointment with a doctor. The first stage of clinical examination ends with the identification and registration of the patient. Then the second, more important stage begins - the dispensary observation itself. A thorough comprehensive medical examination, active treatment and systematic monitoring with the implementation of sanitary and recreational measures are carried out here. Importance It also takes into account the effectiveness of all dispensary work carried out in the clinic. There are a large number of methods for conducting medical examinations: 1) the introduction of uniform dispensary days for the entire clinic; 2) introduction of unified dispensary days for departments; 3) daily call dispensary patients for 2-3 people per appointment. Over time, it became obvious that a more organized medical examination takes place on days specially allocated for this. On this day, the local doctor does not conduct the usual reception of patients in the clinic. Emergency patients are sent to the doctor on duty. Repeated patients are not appointed for these days. On the dispensary day, all auxiliary services of the polyclinic work only for dispensary care. Patients can be examined in the laboratory, x-ray room, functional diagnostics room, consulted by relevant specialists.
Upon completion of the annual medical examination, the following 3 groups are distinguished; healthy - persons who do not complain, do not have a history of chronic diseases, in whom no changes were found during a medical examination individual bodies and systems, the results of laboratory diagnostic studies without deviations from the norm; practically healthy - persons with a history of a chronic disease that does not lead to impaired body functions and does not affect their ability to work and social activity; in the group of practically healthy individuals with risk factors for cardiovascular, oncological, nonspecific lung diseases, endocrine, etc., stand out; Patients with chronic diseases are subdivided depending on the stage of compensation of the process: full compensation, subcompensation, decompensation.
Dynamic monitoring of group I (healthy) is carried out in the form of annual preventive medical examinations. For this group of dispensary observation, a general plan of medical and health-improving preventive and social measures is drawn up, which includes measures to improve working and living conditions, to combat healthy lifestyle life, promotion of sanitary and hygienic knowledge.
Dynamic monitoring of group II aims to eliminate or reduce the influence of risk factors, increase resistance and compensatory capabilities of the organism. This group is reviewed using the generally accepted minimum of studies, as well as additional studies related to the nature of the risk. For the second time in a year, this group is examined only with the use of methods that make it possible to identify early forms of diseases that “threaten” the prophylactic. For each of this group, in addition to the general plan of measures, individual medical and recreational activities are provided. So, for example, if the prophylactic is frequently ill with acute diseases, the plan should provide for measures aimed at increasing the body's resistance to the influence of the external environment (hardening procedures, physical culture, physiotherapy, pharmacotherapy of a general strengthening Action and aimed at etiological factor, elimination of bad habits, etc.). Individual measures are recommended to the patient and carried out by the doctor during preventive medical examinations.
Thus, dynamic dispensary observation of 1-2 groups of people provides for primary prevention - preventing the onset of diseases and improving the health of those undergoing medical examination.
Dynamic Face Monitoring Group III dispensary registration (convalescents after acute diseases, chronic patients) aims to prevent relapses, exacerbations and complications of existing diseases, i.e. is an important part of secondary prevention.
During the medical examination, each doctor should make the most of any appearance of the patient in a medical institution for any reason (disease, preventive examination, obtaining a certificate, issuing a sanatorium-and-spa card, visiting a patient by a doctor at home, inpatient treatment, etc.) for him to undergo a minimum of examinations necessary for the medical examination of this population group, and the implementation of medical and recreational activities.
The dispensary group of patients subject to dynamic observation by general practitioners, including district physicians, according to clinical scientists and healthcare organizers, should be patients with the following diseases: stage I hypertension, myocardial infarction, chronic coronary heart disease with and without hypertension ; convalescents after acute pneumonia, chronic pneumonia, chronic bronchitis, bronchial asthma, bronchiectasis and cystic hypoplasia of the lungs, lung abscess; peptic ulcer of the stomach and duodenum, atrophic chronic gastritis, chronic hepatitis, chronic pancreatitis, chronic cholecystitis, cholelithiasis, chronic colitis and enterocolitis, cirrhosis of the liver, post-resection syndromes (2 years after surgery for abdominal cavity); post-surgery condition acute glomerulonephritis, chronic pyelonephritis, chronic diffuse glomerulonephritis, chronic kidney failure in the process of compensation. At the same time, in accordance with the basic compulsory medical insurance program approved in 2001, patients who have had acute myocardial infarction and acute cerebrovascular accident are subject to dispensary observation in polyclinics for adults.
Therapists of specialized rooms carry out advisory functions. At the same time, the most severe patients requiring specialized observation and treatment can and should be under the supervision of relevant specialists for some period and then be sent back to the district doctor.
The most important condition for the proper organization of medical examinations is the annual summing up and an objective assessment of its effectiveness.
DISPENSARY CARE OF THE POPULATION
The source of information on periodic inspections is the "Map subject to periodic inspection" (f. 046 / y).
Completeness of coverage of the population with preventive examinations (%):
number actually examined? 100 / number to be inspected according to the plan.
The frequency of detected diseases (“pathological involvement”) is calculated for all diagnoses that are indicated in the report for 100, 1000 examined:
number of diseases detected during medical examinations? 1000 / total number of examined persons.
This indicator reflects the quality of preventive examinations and indicates how often the detected pathology occurs in the “environment” of those examined or in the “environment” of the population of the area where the polyclinic operates. More detailed results of preventive examinations can be obtained by developing "Dispensary observation cards" (f. 030 / y). This allows you to examine this contingent of patients by sex, age, profession, length of service, duration of observation; in addition, to evaluate the participation in examinations of doctors of various specialties, the performance of the required number of examinations per person, the effectiveness of examinations and the nature of the measures taken to improve and examine these contingents.
Dispensary observation of patients For the analysis of dispensary work, three groups of indicators are used:
1) dispensary observation coverage indicators;
2) indicators of the quality of dispensary observation;
3) indicators of the effectiveness of dispensary observation.
1. Frequency indicators.
The coverage of the population with medical examinations (per 1000 inhabitants) consists of:
"D"-observation during the year? 1000/ / total population served.
The structure of patients under "D"-observation, according to nosological forms (%):
the number of patients under "D"-observation according to this disease? 100 / total number of dispensary patients.
2. Indicators of the quality of clinical examination.
Timeliness of taking patients on "D"-account
(%) (for all diagnoses):
the number of patients newly diagnosed and taken under “D” observation G 100 / total number of newly diagnosed patients.
Completeness of coverage of "D"-observation of patients (in%): the number of patients on the "D"-registration at the beginning
years + newly taken under "D"-observation - never appeared? 100 / number of registered patients requiring "D"-registration.
Compliance with the terms of dispensary examinations
(scheduled observation), %: the number of prophylactic patients who observed the terms of appearance for "D"-observation? 100 / total number of medical examinations.
Completeness of medical and recreational activities (%):
Have you undergone this type of treatment (recovery) in a year? 100 / needed this type of treatment (recovery).
PERFORMANCE INDICATORS OF DISPENSARY SUPERVISION
The effectiveness of dispensary observation depends on the efforts and qualifications of the doctor, the level of organization of dispensary observation, the quality of medical and recreational activities, the patient himself, his material and living conditions, working conditions, socio-economic and environmental factors.
It is possible to evaluate the effectiveness of clinical examination based on the study of the completeness of the examination, the regularity of observation, the implementation of a complex of medical and recreational activities and its results. This requires an in-depth analysis of the data contained in the " Medical card outpatient" (f.025 / y) and "Control card of dispensary observation" (f.030 / y).
Evaluation of the effectiveness of clinical examination should be carried out separately by groups:
1) healthy;
2) persons who have had acute illnesses;
3) patients with chronic diseases.
The proportion of patients removed from the "D"-registration in connection with recovery:
the number of persons removed from the "D"-registration in connection with recovery? 100 / the number of patients on the "D"-registration.
The proportion of relapses in the dispensary group:
number of exacerbations (relapses) in the dispensary group? 100 / number of persons with the disease undergoing treatment.
The proportion of patients on "D"-observation who did not have temporary disability (TWT) during the year:
the number of patients in the dispensary group who did not have VUT during the year? 100 / number of employees of the dispensary group.
The proportion of newly taken on the "D"-registration among those under observation:
the number of newly taken patients on the "D"-registration with this disease? 100 / the number of patients on the "D"-registration at the beginning of the year + newly taken patients in a given year.
