Primary health care is provided to the population. Primary Health Care

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

With changes and additions from:

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in Russian Federation"(Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724) I order:

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

2. Recognize as invalid:

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

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

Registration N 24726

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

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

Assistance is provided free of charge within the framework of the Program of State Guarantees for the Free Provision of Medical Assistance to Russian Citizens at the expense of Compulsory Medical Insurance Funds and funds from the relevant budgets, as well as in other cases established by law.

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

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

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

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

Registration N 24726

Present Order

(PHC) (as defined by WHO) - meeting the needs of the population (each individual, family and community) by providing medical services at the first contact with the healthcare system, a comprehensive service close to where you live and work.

primary health care sanitary assistance is currently defined as the "zone of first contact" of the population with health services, as the first stage of public health protection. It is PHC that determines the implementation of the basic principle of national health care - prevention, as it is the most massive medical service. The provision of PHC is one of the guarantees of medical and social assistance.

Primary health care is a complex of health, curative, preventive and hygiene measures: treatment of diseases and injuries, supply of the most necessary medicines, maternal and child health, immunization against essential infectious diseases, prevention of local endemic diseases and control, family planning, health education, sufficient supply of safe drinking water, promoting food security and good nutrition.

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

A major contribution to the development of primary health care was made by the WHO International Conference on Primary Health Care, held in Alma-Ata in 1978. The conference noted main feature PHC for present stage: the difference in medical care for the wealthy and unsecured segments of the population in different countries and within each country. The conference proclaimed the slogan "Health for all by the year 2000", which meant the achievement of equal opportunities in the accessibility of equal medical care. The conference recognized PHC as the main means of achieving this. At the conference, it was found out that the problems of PHC in Russia are not so acute due to the uniqueness of the domestic system outpatient care.

For many years, Russian healthcare has focused on the development of outpatient care. By the end of the 1990s. more than 80% of the appeals of the population accounted for PHC facilities. But at the same time, more and more problems were accumulating related to the material and technical condition of PHC institutions, the level of training of personnel, the quality and culture of the assistance provided, and the level of training of medical personnel. This led to the need to reform PHC.

There is a transition to the organization of primary health care on the principle family doctor(doctor general practice). This implies a significant expansion of the functions performed by district therapists and pediatricians. The main function of the family doctor is to provide the population with multidisciplinary outpatient medical care. In this regard, there is a need to reorient the activities of district therapists and pediatricians: a significant expansion of the scope of their activities in related specialties, training in practical skills that are now performed by narrow specialists. The volume of medical and diagnostic manipulations that a family doctor is obliged to perform is very diverse: surgical manipulations, otolaryngological, ophthalmological, gynecological, etc. It should be noted that a significant role in the activities of a family doctor is given to the organization of medical and social assistance social protection population, charitable organizations, mercy services) lonely elderly, disabled, chronically ill.

However, the transition to the family doctor system involves many problems: the length of the working day and the work schedule of the family doctor have not been determined, the mechanism for the social and legal protection of doctors and general practitioners has not been developed, etc.

In order to improve the GTMSP, in addition to the existing components of PHC, children's rehabilitation centers, rehabilitation centers for women with pathology of pregnancy, medical social rehabilitation, medical genetic consultations, etc.

GENERAL PROVISIONS

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

Primary pre-medical health care is provided by paramedics, obstetricians and 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 mass view 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. The availability and free of charge of PHC to the population is ensured by the SGBP providing free medical care to citizens.

Continuity and stages of treatment

PHC is the first stage of a unified technological process providing medical care "polyclinic - hospital - institutions rehabilitation treatment". As a rule, the patient first turns to the local doctor of the clinic. If necessary, he can be sent to a consultative and diagnostic center (CDC). dispensary (oncological, anti-tuberculosis, neuropsychiatric, etc.), hospital, medical and social rehabilitation 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 primary health care are called upon to play a leading role in the formation of a healthy lifestyle as a set of measures that allows maintaining and strengthening the health of the population, and improving the quality of life.

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

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

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

important direction preventive work institutions providing primary health care - vaccination work. Child population preventive vaccinations carried out according to the appropriate calendar, for an adult - 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 an increased risk of diseases of cardio-vascular system, oncological and other socially significant diseases;

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

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

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

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

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

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

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

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

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

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

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

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

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

Currently, 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 existence of a single for all municipal polyclinics free number phone. By typing it, the patient enters the call center, where specially trained operators make an appointment for a minute within a minute. necessary specialist. In addition to the call center, you can make an appointment with a doctor through a specialized Internet portal with easy navigation. If the doctor is unavailable for any reason, the patient is offered alternatives: either make an appointment with a specialist in another medical institution, or stand in line. Informational resources call-center allow the operator to offer the patient the fastest and 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 help population living in the assigned area. 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 (urban district) or structural subdivision MPU (city or central district hospital) to provide outpatient obstetric and gynecological care to women.

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

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

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

The main tasks of the antenatal clinic:

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

Provision of PHC to women with gynecological diseases;

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

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

Providing social and legal assistance in accordance with the law;

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

Carrying out activities to improve knowledge, sanitary culture of the population in the field of 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 small gynecological operations and manipulation.

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

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

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

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

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

A birth certificate is issued at the antenatal clinic at the place of residence at a gestational age of 30 weeks (in the case of multiple pregnancy - 28 weeks) or more. A prerequisite is registration and continuous observation in this antenatal clinic for at least 12 weeks. The certificate is issued for a woman, not for a child, so even in the case of multiple pregnancy, it is only one. A woman who, during pregnancy, was observed in the antenatal clinic on a paid basis or entered into an agreement with the maternity hospital on 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 the locality where she 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 wages personnel providing medical care to women during pregnancy and childbirth, dispensary observation a child of the 1st year of life, as well as for the purchase of 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.

special social significance has family planning work, which is carried out by the antenatal clinic.

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

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

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

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

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

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

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

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

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

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

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

CENTER FOR GENERAL MEDICAL (FAMILY) PRACTICE

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

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

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

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

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

The position of GP (family doctor) is assigned to specialists with 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 effective forms provision of PHC to the population. They are organized for the examination and treatment of patients with acute illnesses and exacerbations of chronic diseases or pathology of pregnancy that do not require round-the-clock inpatient treatment, 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 arrhythmia, exacerbation chronic bronchitis and bronchial asthma(without hormonal dependence), radiculitis, pain syndromes on the basis of osteochondrosis, peptic ulcer stomach 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 to 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.

The cost of purchasing medicines and dressings are established in accordance with the settlement standards in force in this institution.

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

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

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

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

The organization of hospitals at home involves the daily observation of a 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 hospital nurse at home takes biological materials for analysis, 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 according to indicators of medical and social efficiency in some cases it 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-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 para. Treatment and preventive care ). Its organization in our country has peculiarities. In cities, this assistance is provided by territorial polyclinics for adults and children's polyclinics (see. children's Hospital , Polyclinic ), medical units (see Medical unit ), women's consultations (see Women's consultation ), medical and feldsher health centers (see. health center ). In rural areas, medical institutions are the first link in the system of this assistance. rural medical area : district hospital, dispensary , feldsher-obstetric stations (see. Feldsher-obstetric station ), health centers, medical dispensaries. For residents of the district center, the main institution providing P. m.-s. n., is the polyclinic of the central district hospital (see. Hospital ).

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

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

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

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

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

Further development of P. m.-s. 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 allocation of material, personnel and financial resources for its development; development and implementation of a system of special training for doctors, secondary medical and social workers for work in P.'s establishments of m. P.; security effective measures contributing to the prestige of the service P. m.-s. 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. Members of the public should be involved in the evaluation of the existing situation in their areas, in the allocation of resources, in the organization and implementation of health programs. The public can provide support financial resources and with your 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. p. is the interaction of health care with other social and economic sectors, whose activities are aimed at solving major social problems in society, creating conditions for the protection and improvement of public health.

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

7. City polyclinic.

13. Health centers.

Medical care, definition of the concept.

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

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

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

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

First up medical assistance provided by persons with special training in the provision of medical care. This is the average medical staff (paramedic, nurse) or pharmacist, pharmacist. This is their level of knowledge and skills.

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

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

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

Medical care can be provided in following conditions:

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

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

3. In day hospital(in conditions that provide for medical supervision and treatment during the day, but do not require round-the-clock medical supervision and treatment);

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

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

Types of medical care

Forms of medical care

Conditions for the provision of medical care

Primary Health Care

planned and urgent

Outpatient and day hospital

Specialized, including high-tech, medical care

Not installed

Inpatient and outpatient

Ambulance, including specialized ambulance, medical care

Emergency or urgent outside the medical organization

Outpatient and inpatient

Palliative care

Not installed

Outpatient and inpatient

Primary health care facilities.

Types of institutions providing PHC (in the future):

I. out-of-hospital care:

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

2.territorial polyclinics (in cities);

3. Stations and substations for emergency medical care;

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

II. hospital care.

Hospital PHC system, incl. social, should

include:

Precinct, district, city general hospitals;

Stationary rehabilitation centers;

Hospitals for the chronically ill;

Houses nursing care;

Boarding houses.

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

City Polyclinic.

The central institution of PHC is the polyclinic

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

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

2. This is a cheaper type of medical care.

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

Definition

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

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

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

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

Structure of the MSCH.

1. Polyclinic: Workshop areas. specialized departments.

2. Health centers (medical, feldsher).

3. Hospital for 400-600 beds.

4. Sanatorium, dispensary.

5. Diet table.

6. Children's health institutions.

Tasks of the MSC.

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

2) Clinical examination in accordance with the Basic Health Insurance Program.

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

4) Examination of temporary disability.

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

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

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

8) Identification and hospitalization in the prescribed manner of infectious patients and carrying out, together with the Center for Epidemiology, anti-epidemic measures.

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

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

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

12) Participation in the work of engineering and medical teams

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

There are 2 types of health centers:

1. medical

2. paramedic

Medical health centers are organized at industrial enterprises with no more than 1,200 employees, and medical assistants with at least 500 employees. A dental office can function at the health center. A medical health center and a feldsher health center are part of the medical unit or polyclinic.

Tasks of health centers:

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

2) Carrying out preventive work in the shops.

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

4) Dispensary observation.

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

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

8) Improvement of sanitary and hygienic working conditions.

9) Monitoring compliance with safety regulations.

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

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

1. Medical care, definition of the concept.

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

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

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

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

6. Institutions providing primary health care.

7. City polyclinic.

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

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

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

11. Organization of medical care at home.