Rural health care. Organization of medical care for the rural population
Medical care for the rural population is based on the same principles as for the urban population, but the peculiarities of the life of the rural population (the nature of settlement, low population density, specific conditions of the labor process, household activities and everyday life, poor quality or lack of roads) require the creation of a special system organization of medical and preventive care. The organization of medical care in the countryside, its volume and quality depend on the remoteness of medical institutions from the place of residence of patients, the staffing of medical institutions with qualified personnel and equipment, and the possibility of obtaining specialized medical care. A feature of medical care for the rural population is the staging of medical care. There are three stages of providing medical care to rural residents:
1. Rural medical area - unites a rural district hospital, a medical outpatient clinic, feldsher-obstetric points, feldsher posts, preschool institutions, medical assistant health centers at enterprises, a dispensary. At this stage, the rural population can receive qualified medical care. Qualified medical care - medical medical care provided to citizens for diseases that do not require specialized diagnostic methods, treatment and the use of complex medical technologies.
2. District medical institutions - CRH, district hospitals, district centers of state sanitary and epidemiological surveillance. At this stage, rural residents receive specialized medical care.
3. Republican (regional, regional) medical institutions: Republican (regional, regional) - hospitals, dispensaries, clinics, centers of state sanitary and epidemiological surveillance. At this stage, highly qualified and highly specialized medical care is provided.
102 First stage. Rural medical area includes the following medical institutions: a local hospital with an outpatient clinic (polyclinic) or an independent hospital (a medical outpatient clinic, FAP, state farm (collective farm) medical dispensaries, pharmacies, dairy kitchens. primary health care to the rural population and promote successful solution tasks to provide this assistance in conditions of considerable remoteness of settlements from district and central district hospitals.
The first stage is a rural medical area, where patients receive qualified medical care; the second stage - regional medical institutions and the leading institution at this stage is the central regional hospital, which provides specialized medical care for its main types; the third stage - regional institutions and, in particular, the regional hospital, which provides highly qualified specialized medical care in almost all specialties.
The rural medical area is the first link in the system of medical care for the rural population. In addition to a rural district hospital or an independent medical outpatient clinic, the rural medical district includes feldsher-obstetric points, seasonal and permanent nurseries, and medical assistant health centers at industrial enterprises and trades. The network of these institutions is built depending on the location and size of settlements, the radius of service, the economy of the region and the condition of the roads. Average number the population in the medical area fluctuates between 5-7 thousand inhabitants with an optimal radius of the site of 7-10 km (the distance from the settlement village where the SUB is located to the most remote settlement of the rural medical area). Depending on natural and economic-geographical factors, the size of the medical areas, the population on them may be different.
All medical institutions that are part of the medical department are organizationally united and work according to a single plan under the leadership of the chief physician of the local hospital.
The nearest medical institution to which rural residents turn for medical help is a feldsher-obstetric center (FAP). The presence of feldsher-obstetric points is one of the features of rural health care, due to the need to bring medical care closer to the population in conditions of a large radius of service of a district hospital and a low density rural residents.
The recommended standard for the number of residents when organizing FAP-700 and more with a distance to the nearest medical institution of at least 5 km. If the distance to the nearest medical institution exceeds 7 km, then FAP is organized in settlements with 300-500 inhabitants.
The main tasks of the FAP are:
Providing first aid;
Conducting sanitary and health-improving and anti-epidemic measures to prevent and reduce morbidity and injuries;
Timely and in full compliance with the doctor's prescriptions;
Organization of patronage for children and pregnant women;
Systematic monitoring of the health status of disabled veterans and leading specialists Agriculture;
Implementation of measures to reduce infant and maternal mortality.
The main medical institution in a rural medical area is a local hospital or an independent medical outpatient clinic (polyclinic).
Regardless of the capacity in any local hospital, outpatient and inpatient care should be provided to therapeutic and infectious patients, assistance in childbirth, treatment and prophylactic care for children, emergency surgical and trauma care, dental care.
There are four categories of rural district hospitals: I - 75-100 beds, II - 50-75 beds, III - 35-50 beds, IV - 25-35 beds. The specialization of beds in the SC depends on their number. Thus, category I hospitals (75-100 beds) should have specialized beds for therapy, surgery, obstetrics, pediatrics, infectious diseases, and tuberculosis. As a rule, such hospitals are equipped with clinical diagnostic equipment. Category IV hospitals (25-35 beds) should have beds for therapy, surgery and obstetrics.
At a rural district hospital, as a department, there should be a mobile outpatient clinic for the approximation of medical care.
The main functions of the rural medical area are:
Provision of medical and preventive care to the population;
Conducting sanitary and anti-epidemic work.
Outpatient medical care is provided to the population of the rural medical district in the local hospital and at the feldsher-obstetric stations. SUB doctors conduct outpatient appointments for adults and children, provide home assistance and emergency care. A rural doctor must be a general practitioner (family doctor), he must continue the traditions of a rural doctor.
In the organization of medical care in the SMS, the following features can be distinguished:
There is no clear time limit for outpatient appointments;
Hours of admission to patients should be appointed at the most milking time for the population, taking into account the seasonality of agricultural work;
The possibility of receiving a patient by a paramedic in the absence of a doctor for one reason or another;
House calls are made by a doctor only in a village center, house calls in another settlement of a rural medical district are made by a paramedic;
Duty in a hospital with the right to stay at home and obligatory information of the staff about their location in case of emergency.
103 Second stage. District medical institutions : the central district and the so-called zonal district hospitals with polyclinics and departments of ambulance and emergency medical care located in the district, district dispensaries and other medical institutions
The second stage of medical care for rural uniforms:
Regional healthcare institutions: central regional hospital, numbered regional hospitals, regional center of state sanitary inspection, dispensaries, medical and sanitary units, etc.
The main link in the system of organizing medical care for rural residents is the central district hospital (CRH), which provides specialized care for its main types to residents of the entire district, respectively, of all rural medical districts.
The main tasks of the Central District Hospital:
Providing the population of the district and the district center with qualified specialized medical care;
Operational and organizational methodological management of health care institutions in the region;
Planning, financing and organization of material and technical supply of the district health care institutions;
Development and implementation of measures to improve the quality of medical care and improve the health of the population.
In addition to the CRH, located in the district center, in the territory of the district there may be other district hospitals, the so-called "numbered" hospitals, which can function as a branch of the CRH or specialize in one or another type of medical care. On the so-called attributed area, i.e. on the site located around the Central District Hospital, there is no rural district hospital, its functions are performed by the Central District Hospital itself.
The chief physician of the Central District Hospital is also the chief physician of the district. In his work on the management of the district health care and the central district hospital, the chief doctor of the CRH relies on his deputies;
For organizational and methodological work (usually he is in charge of the organizational and methodological room of the Central District Hospital);
Childhood and obstetrics;
On the medical side;
Organizational forms of leadership:
1. Work of the Medical Council under the head physician of the Central District Hospital.
2. Activity of the organizational and methodological office of the Central District Hospital.
3. Activities of regional specialists.
The head physician uses the organizational and methodological room and the doctors of the CRH specialists for the organizational and methodological guidance of the district health care institutions, which is carried out by:
Organization of planned visits of doctors - specialists to rural district hospitals for consultation and practical assistance to doctors of these institutions on the issues of medical, diagnostic and preventive work;
The systematic study of the main qualitative indicators of the work of the district medical institutions by the employees of the organizational and methodological office is the development on this basis of measures to improve the qualifications of medical personnel.
To improve the qualifications of doctors on the basis of the central regional hospital, clinical and analytical conferences, seminars, meetings, lectures and reports are organized and held by regional and regional specialists, at which doctors get acquainted with new methods of work of the best medical and preventive institutions of the region, region. Specialization and advanced training of paramedical workers of FAP also takes place on the basis of the Central Regional Hospital.
Currently, the priority direction in the development of rural health care is the strengthening and improvement of outpatient and polyclinic care: new assigned therapeutic and pediatric sections are being organized, various types of mobile medical care are being developed, in particular, mobile medical teams, mobile dental offices and prosthetic laboratories. Much attention is paid to emergency and emergency medical care in rural areas, staffing them with doctors and nurses, equipping them with modern diagnostic and medical equipment.
104 Third stage. Regional medical institutions : regional hospital with an advisory clinic and an air ambulance department, dispensaries, a dental clinic, a psychiatric hospital, etc.
Third stage medical assistance to rural residents - regional health care institutions located in the regional center. The regional hospital is the main institution at this stage. It is a medical, scientific-organizational, methodological and educational center of the region's healthcare. The regional hospital performs the following main functions:
Providing the population of the region in full with highly qualified specialized consultative polyclinic and inpatient medical care;
Organizational and methodological assistance to medical and diagnostic institutions of the region in their activities;
Coordination of treatment-and-prophylactic and organizational-methodical work carried out by all specialized medical institutions of the region;
Provision of emergency medical care by means of air ambulance and ground transport with the involvement of specialist doctors from various institutions;
Management and control over statistical accounting and reporting of health care facilities of the region;
Analysis and management of the quality of medical care provided in the regional hospital itself and in all medical institutions of the region;
Study and analysis of morbidity, disability, general and infant mortality of the region's population;
Participation in the development of measures aimed at reducing them;
Generalization and dissemination of advanced experience in the work of medical institutions in the region on the introduction of new organizational forms of providing medical care to the population, the use of modern methods of diagnosis and treatment;
Carrying out activities for the specialization and improvement of doctors and nurses of medical institutions in the region;
Structural departments of the regional hospital: in-patient department, consultative polyclinic, treatment and diagnostic departments, offices and laboratories, an organizational and methodological department with a department of medical statistics, a department of emergency and planned consultative care.
The regional hospital should have a boarding house for patients coming from the regions of the region, and a hostel for medical workers who come to various types of specialization.
Department of Emergency and Planned Advisory Medical Aid:
Provides emergency and planning consultative assistance on the spot on calls from the districts;
Provides transportation of patients to specialized medical institutions of the region and outside the region, urgent delivery of various medications and means necessary to save the lives of patients, as well as to carry out urgent anti-epidemic measures;
Maintains constant communication with teams sent to provide medical care;
Organizational and methodological work is part of activities of all departments of the hospital. Each department plays the role of an organizational and methodological center for medical institutions in the region. This work is coordinated by the organizational and methodological department of the region. hospital, which performs the functions:
Examines the volume and nature of the activities of medical institutions in the region;
Provides organizational, methodological and medical advice to health authorities and institutions of the region;
Studying the health indicators of the region's population;
Organizes professional development of personnel;
Specialization and improvement of medical personnel is carried out in the regional hospital:
At regional seminars, conferences, ten days;
In workplaces with complete separation from work;
On intermittent part-time courses;
With the participation of specialists from the regional hospital on the basis of city and central regional hospitals.
Currently, the following tasks of rural health care and ways of solving them can be distinguished:
1. Approaching city health care facilities and improving the quality of outpatient care by:
Construction of rural medical outpatient clinics, work of general practitioners, family doctors;
Development of a network of assigned therapeutic and pediatric sites;
Expansion of mobile health care.
2. Approximation of specialized care by:
Strengthening the Central District Hospital;
Creation of interdistrict specialized departments;
Creation of mobile dental offices and dental laboratories.
105 MATERNITY AND CHILD SECURITY SYSTEM. state program "generic certificates" (see question 106)
Protection of mothers and children (OMID) is a system of state social and medical measures that ensure the birth of a healthy child, the correct and comprehensive development of the younger generation, the prevention and treatment of diseases of women and children. Tasks: rational nutrition and physical development. Group 6 - school age. tasks - accustoming children to health-improving procedures, conducting sanitary and hygienic training, promoting a healthy lifestyle. Principles of organizing medical care for mothers and children. 1. The principle of a single pediatrician - that is, one doctor serves children from 0 to 14 years old 11 months. 29 days. Since 1993, the child population under the contract can be served by two pediatricians. 2. The principle of precinct. The size of the pediatric site is 800 children. The central figure of the outpatient network is the district pediatrician; now the responsibility of the district pediatrician within the framework of compulsory medical insurance (MHI) is being increased and criteria for individual responsibility (or personification) are being sought. 3. Dispensary method of work. All children, regardless of age, health status, place of residence and attendance at organized preschool and school institutions, must be examined as part of preventive examinations, which, as vaccine prophylaxis, is free of charge. 4. The principle of unification, that is antenatal clinics combined with maternity hospitals, children's polyclinics are combined with hospitals. 5. The principle of alternation of medical care: at home, in a polyclinic, in a day hospital. Only healthy children or convalescents come to the outpatient clinic at the outpatient clinic, patients are served at home. 6. The principle of continuity. It is carried out between the antenatal clinic, the maternity hospital and the children's clinic in the form of · antenatal care · visits to the newborn within 3 days after discharge from the hospital · monthly examinations of the baby in the children's clinic for 1 year of life 7. for antenatal clinics - the principle of early dispensary registration ( up to 12 months) 8.the principle of social and legal assistance, that is, there is a lawyer's office in the children's clinic and antenatal clinic 3. Establishments of OMID. Child welfare institutions. 1. Outpatient polyclinic: · children's polyclinic · children's dental clinic · children's consultation 2. inpatient: · children's somatic hospital · children's infectious diseases hospital · children's department in the structure of general somatic adult hospitals 3. Specialized · children's homes · children's sanatoriums · nurseries · nurseries dairy kitchens for developmentally retarded children Maternity protection· Maternity clinics · maternity hospitals · obstetric and gynecological departments of somatic hospitals · departments of pathology of pregnant women in general hospitals. All OMID institutions are divided into categories and types. Let's take a look at the categories of maternity hospitals as an example. 1 category (high) 150 - 200 beds 2 category - 101 - 150 beds 3 category 81 - 100 beds 4 category - 60-80 beds
106 Women's consultation, maternity hospital: their tasks, structure, performance indicators, state program "birth certificates"
Women's consultation. Objectives: 1. Carrying out preventive measures in order to reduce complications in pregnancy 2. Carrying out preventive examinations of all women 3. Dispensary registration of pregnant women, as well as patients with chronic gynecological diseases. 4. Organizational and methodological work 5. sanitary and hygienic education, promotion of a healthy lifestyle. The structure of the antenatal clinic: registration office · offices of district specialists (the size of the area is 3400-3800 women aged 15 and older). 6. Treatment room. 7. Office of psycho-preparation for childbirth. 8. Lawyer's office 9. Dentist's office 10. Venereologist's office Accounting documentation for antenatal clinics 1. Individual card of a pregnant woman and woman in labor 2. Static coupon 3. Disability certificate 4. Exchange card 5. Emergency notice 6. Dispensary observation checklist 7. Polyclinic doctor's diary Reporting forms antenatal clinic... · Form 30 · Form 16 VN · Report on pregnant women and women in labor (Form No. 32, insurance indicators of the antenatal clinic). Quantitative indicators - see the Adult Clinic. Qualitative: 1. The proportion of late registration in dispensary registration 2. The proportion of pathology in pregnant women 3. The proportion of premature babies 4. Maternal mortality (per 1000 population) 5. Ante- and intranatal mortality 6. Perinatal mortality 7. Indicators of examination for Rh- factor 8.the incidence of gynecological diseases (general and with VUT)
A maternity hospital is a stationary type institution that provides medical care for women in labor, it can be independent or combined with an antenatal clinic. Structural subdivisions of the maternity hospital: 1. An admission and access block, operating as a sanitary inspection, an examination room, sanitation 2. Physiological department 3. Observation department 4. Department of pregnancy pathology one bed, this is both a reporting and a planned indicator. Accounting documents maternity hospital:· Birth history · pregnancy termination card · hospital exit card · newborn development history · medical certificate of perinatal mortality Reporting documents of the maternity hospital: · form No. 14 (hospital report), according to it the following indicators are calculated: 1.bed turnover - the number of patients treated on one bed in 1 year 2.the average bed occupancy - the average number of days that the bed was occupied (the ratio of the total number of bed-days to the total beds. For a maternity hospital, this figure is 310 days. 3. Average length of stay of a patient in bed (6 days in the physiological department) 4. maternal mortality 5. still fertility 6. Perinatal mortality 7. frequency of caesarean section 8. expert analysis of each case of maternal mortality
Generic Certificate Program
The generic certificate program has been in effect since January 1, 2006 in all regions of Russia within the framework of the priority national project"Health", which provides a series of measures to improve demographic situation... This program aims to increase the interest of medical organizations in providing quality medical care. The main purpose of birth certificates is to improve the quality of medical care for women during pregnancy, during childbirth and in the postpartum period, as well as during preventive medical examinations of a child during the first year of life in medical organizations.
A generic certificate is a document of additional financial support for the activities of medical organizations, which gives the right to pay for medical care services provided medical organizations women during pregnancy, during childbirth and in the postpartum period, as well as during preventive medical examinations of the child during the first year of life. The certificate is issued to a pregnant woman registered for pregnancy from 30 weeks in singleton pregnancies and from 28 weeks in multiple pregnancies.
The generic certificate consists of six parts: registration (stub), four coupons and the certificate itself:
· The back of the birth certificate is intended to confirm its issuance, it remains in the medical institution that issued the certificate.
· Coupon No. 1 of the birth certificate is intended to pay for medical services provided by antenatal clinics during pregnancy (3 thousand rubles for each woman who received the appropriate services). Transferred from the consultation to the regional office of the Foundation social insurance for payment.
· Coupon No. 2 of the birth certificate is used to pay for medical care provided to women during childbirth in obstetric facilities (6 thousand rubles for each woman who received the appropriate services). Transferred from the maternity hospital or maternity ward to the regional branch of the Social Insurance Fund for payment.
· Ticket number 3 consists of two parts. Coupon No. 3-1 of the generic certificate is intended for payment of services to health care institutions for the first six months of dispensary observation of a child (1,000 rubles for each child registered during the first year of life at the age of up to 3 months and received within the next 6 months from the date of registration of the relevant services). Coupon No. 3-2 of the birth certificate is intended to pay health care institutions for services for the second six months of the child's dispensary observation (1,000 rubles for each child who received the appropriate services). Coupons No. 3 are transferred from children's clinics to the regional branch of the Social Insurance Fund for payment.
· The birth certificate serves as a confirmation of the provision of medical care to a woman during pregnancy and childbirth by health care institutions. A birth certificate (without coupons), which records the date of birth, weight and height of the baby, is issued to the woman upon discharge from the maternity hospital. The birth certificate is accompanied by a Memo containing information on the rights and obligations of women within the framework of the “Birth certificate” program.
The regional branch of the Social Insurance Fund of the Russian Federation transfers funds to pay for the services of a medical organization on the basis of the concluded agreement and submitted coupons of generic certificates confirming the provision of medical care services to women during pregnancy (coupon No. 1), medical assistance to women and newborns during childbirth and postpartum period (coupon number 2), as well as dispensary (preventive) supervision of the child during the first year of life (coupons number 3-1 and 3-2);
107 Center family planning: tasks of the function of the structure
The Family Planning and Reproduction Center provides specialized consultative and therapeutic and diagnostic assistance for reproductive health disorders associated with endocrinopathies in various sex and age groups ranging from 14 to 60 years old due to integrated approach, clear specialization, standardization of modern technologies, prevention, diagnosis and treatment of reproductive disorders.
The main tasks of the Family Planning Reproduction Center are:
· Providing public policy in the field of reproductive health protection of the population of Omsk;
· Carrying out a set of measures to prevent reproductive health disorders of the population of Omsk;
· Reduction of the terms of restoration of lost health through the introduction of modern technologies, prevention, diagnosis and treatment into practice;
· Providing a set of measures to protect the reproductive health of adolescents in Omsk.
The main function is to provide specialized outpatient medical diagnostic and consulting assistance on a wide range of problems related to the protection of the reproductive health of the population:
· Preconceptional preparation of pregnancy in women with endocrinopathies;
· Providing advice on family planning, contraception, prevention of unwanted pregnancies in women of fertile age suffering from endocrinopathies;
· Medical, psychological and psychotherapeutic assistance to adolescents with impaired reproductive function;
· Diagnostics and treatment of infertile marriage;
· Rendering assistance to women and men of transitional age in order to preserve and prolong their social functioning and improve the quality of life;
· Identification of breast pathology;
· Organizational and methodological work with antenatal clinics on reproductive health, analysis of the prevalence of abortion and contraception, development of proposals for improving this work;
· Professional development of specialists in health care facilities and health education on issues of reproductive health protection.
work organization
In accordance with the tasks and functions, the Family Planning and Reproduction Center conducts the following specialized receptions:
1. "Gynecological endocrinology"
· Provides consultative and diagnostic assistance in the direction of specialist endocrinologists to patients with endocrinopathies;
· Diagnosis of breast pathology and referral to specialized hospitals; prevention of unwanted pregnancy, contraception in women with endocrine pathology.
2. "Pathological formation of reproductive function in adolescents"(2 rates of gynecologist-juvenile doctors) provides reception, diagnosis, treatment and rehabilitation for:
· Delayed sexual development;
· Premature puberty;
Obesity;
· Diseases of the thyroid gland;
· Hyperandrogenemia;
· Hypothalamic syndrome;
Diabetes mellitus, neurogenic anorexia
3. "Reproductive health of adolescents"- carry out the prevention, diagnosis, treatment and rehabilitation of inflammatory diseases of the pelvic organs, STIs, psychosomatic and psychological problems, unwanted pregnancy; selection of contraception, early gestational abortion, comprehensive preparation for termination of pregnancy for medical reasons and referral to a specialized hospital, health education on reproductive health.
4. "Andrology and Reproduction" carries out reception, diagnosis and treatment of puberty disorders in young men, prognosis of male fertility, male infertility, incl. with endocrinopathies, consultations for men of transitional age with diseases of the endocrine system (according to the indications of consultations of specialists - sexologist, psychotherapist, psychologist), complex examination for men during IVF.
5. �Female infertility� carries out reception, diagnosis and treatment of female infertility, consultations on the prognosis of a woman's reproductive function, preconception preparation of pregnancy in women with endocrinopathies, comprehensive training of women for IVF.
6. "Women's health after 40" carries out reception, diagnosis, treatment and consultation of women in the pre- and postmenopausal periods and after oophorectomy.
7. Reception of a psychotherapist
8. Reception of a psychologist
9. Reception of a sexologist- Specialized assistance is provided on issues of violations of sexual relations both in a married couple and individually.
108. Reproductive loss. Measures to prevent maternal and perinatal mortality, morbidity in newborns. Improvement of perinatal services within the framework of the national project "Health".
Reproductive losses are maternal and perinatal deaths, as well as loss of products of conception due to abortion and ectopic pregnancy.
Reproductive health care - methods, technologies and services that contribute to the formation, maintenance and strengthening of reproductive health by preventing the elimination of reproductive disorders throughout a person's life;
Mortality is understood as the process of population extinction, characterized by the statistically registered number of deaths in a particular population for a certain period of time.
Maternal mortality is an indicator characterizing the number of women who died during pregnancy, regardless of its duration and location, or within 42 days after its termination from any cause associated with pregnancy, burdened by it or its management, but not from an accident or a sudden onset of the cause, correlated with the number of live births
The perinatal period is the period from 28 weeks of gestation to the 7th day of a newborn's life. In turn, it is subdivided into antenatal (intrauterine), intrapartum (labor) and postnatal (1st week of life). The perinatal mortality rate is calculated as the ratio of the sum of the number of stillbirths and the number of children who died in the first 168 hours of life, to the number of live births and deaths, multiplied by 1000.
INFANT MORTALITY This is the number of children who died under one year of age per 1000 live births. There are 2 ways to calculate infant mortality. The lowest infant mortality rate is in Japan (5 ppm), in the Scandinavian countries 6-7 ppm, in the USA - 10 ppm. The infant mortality rate is considered as an operational criterion for assessing the sanitary well-being of the population, the level and quality of medical and social assistance, and the effectiveness of obstetric and pediatric services. IMPORTANT unification of the concepts of "live birth", "stillborn", "fetus" (late abortion). calculate such indicators as: - early neonatal mortality (the ratio of the number of children who died in the 1st week of life in this year, to the number of live births in a given year, multiplied by 1000) (in Russia - 6-9 ‰); - late neonatal mortality (the ratio of the number of children who died at 2-4 weeks of life in a given year, to the number of live births in a given year, multiplied by 1000); - neonatal mortality (the ratio of the number of children who died in the first 28 days of life in a given year to the number of live births in a given year, multiplied by 1000) (in Russia - 9-11 ‰); - postneonatal mortality (the ratio of the number of children who died at the age of 29 days to 1 year, to the difference between the number of live births and the number of deaths in the first 28 days of life, multiplied by 1000) (in Russia - 7-8 ‰). Perinatal period from 28 weeks of gestation to the 7th day of the newborn's life. Divide into antenatal (intrauterine), intrapartum (labor) and postnatal (1st week of life). Factors influencing infant mortality: 1. Gender of the child: boys die more often than girls. Infant mortality is higher in premature babies. 2. Age of mother: the lowest infant mortality rate in children born to mothers aged 20-30 years. The highest child mortality is observed in first-borns and after 6-7 children. The healthiest 4 child. 3. Socio-ethnic factors (in countries with high fertility, high infant mortality).
MEASURES FOR PREVENTION OF MATERNAL AND PERINATAL MORTALITY AND DISEASE IN NEWBORNS
reducing the influence of risk factors: social-econ (welfare, labor conditions), social-biol (inherited, suffered a disease), social-hygiene (activity, nutrition, work-rest, honey literacy), environmental hygiene (kept in cart and soil and everyone's water), medical and organizational (low level of access to help, low level of qualifications of personnel, inadequate services to standards, low level of medical activity of patients). , popul) - a set of measures aimed at preventing the appearance of certain diseases or deviations in the state of health. Secondary prophylaxis - a set of honey, social services, san-gig, psychol and other measures, sent to early identified the disease and prevented exacerbations and chronicity. tertiary prfil - honey, psychol, teacher, social measures, I sent to restore or compensate for violations of physiology, social f-th org-ma, quality of life and work, and formir health.
National Project "Health" (vaccination, diagnostics of congenital metabolic defects, financing of antenatal clinics and perinatal services)
The main goals of the priority national project "Health":
1. Strengthening the health of the population of Russia, reducing the level of morbidity, disability, mortality;
2. Increasing the availability and quality of medical care;
3. Strengthening primary health care, creating conditions for the provision of effective medical care at the pre-hospital stage;
4. Development of preventive health care;
5. Meeting the needs of the population for high-tech medical care.
Legal basis medical activities for family planning and planning of human reproductive function.
Artificial fertilization of a woman and implantation of an embryo are carried out in institutions that have received a license for the specified type of activity, with the written consent of the spouses (single woman).
A child born with the help of artificial insemination has the same rights in relation to parents as children born naturally. A husband who has given consent to the artificial insemination of his wife with the help of a donor is recorded by the father of the child she has born and cannot challenge paternity in court.
Information about the artificial insemination and implantation of the embryo, as well as the identity of the donor, constitutes a medical secret. In the event of disclosure of information about specific persons who participated in this procedure, the medical staff shall be held liable under the law.
The woman's rights to the information provided by the doctor performing the medical intervention on the procedure for artificial insemination and implantation of the embryo, the medical and legal aspects of its consequences, on the data of the medical and genetic examination, external data and the nationality of the donor are enshrined in Art. 35 Basics.
Artificial termination of pregnancy can be performed at the request of the woman (with gestational age up to 12 weeks), as well as for social reasons (with gestational age up to 22 weeks). The legislator highlighted one more point - medical indications and the woman's consent. In this case, the termination of pregnancy is carried out regardless of the gestational age.
The list of social indications approved by the Government Russian Federation... These can be social and economic conditions of life, age, etc.
The list of medical indications for artificial termination of pregnancy is determined by the Ministry of Health of the Russian Federation. These include tuberculosis (all active forms), syphilis, HIV infection, malignant neoplasms of all localizations in the present or in the past, acute and chronic leukemia, congenital heart disease, etc.
If a pregnant woman is diagnosed with a disease that is not indicated in the list, but it poses a threat to the life or health of the pregnant woman or the newborn, the issue of terminating the pregnancy is decided individually. Medical indications for termination of pregnancy are established by a commission consisting of an obstetrician-gynecologist, a doctor of the specialty to which the disease (condition) belongs, and the head of a healthcare facility.
Artificial termination of pregnancy is carried out within the framework of compulsory medical insurance programs in institutions that have received a license for the specified type of activity, by doctors with special training.
Medical sterilization is permitted by law, i.e. surgical intervention, the result of which is the deprivation of a person's ability to reproduce offspring. To carry it out, a written statement of a citizen is required, age is more than 35 years or the presence of at least two children, and with medical indications and the consent of the citizen, it is performed regardless of the age and presence of children. Medical sterilization of both men and women is carried out.
Medical indications for medical sterilization (determined by the RF Ministry of Health) include chronic ischemic heart disease, epilepsy, mental retardation, etc.
Medical sterilization is carried out in institutions of the state or municipal health care system that have received a license for the specified type of activity.
Illegal implementation of artificial insemination and embryo implantation, artificial termination of pregnancy, as well as medical sterilization entails criminal liability established by the legislation of the Russian Federation.
Polyclinic.
The polyclinic is a highly developed specialized medical and preventive institution, which provides medical assistance to incoming patients, as well as to patients at home, a complex of medical and preventive measures is carried out to treat and prevent the development of diseases and their complications .
The main tasks of the polyclinic are: provision of primary health care to the attached population on a territorial basis, both in the clinic and at home for adults and children; organization and implementation of a set of preventive measures among the attached population; organization and implementation of dispensary observation of the attached population; organization and implementation of measures for the sanitary and hygienic education of the attached population and the promotion of a healthy lifestyle.
Polyclinic structure
1 Reception
2 Prevention departments
3 Treatment-and-prophylactic units
4 Auxiliary diagnostic units
The main objectives of the national health project:
Strengthening the health of the population, reducing the level of morbidity, disability, mortality;
Improving the availability and quality of medical care;
Strengthening primary health care, creating conditions for the provision of effective medical care at the pre-hospital stage;
Development of preventive health care;
Meeting the needs of the population in high-tech types of medical care.
Primary medical and social assistance to the urban population is provided by outpatient clinics (territorial polyclinics serving the adult population) and institutions for the protection of mothers and children (children's clinics and women's clinics).
The main organizational and methodological principles of the work of polyclinics and territorial medical associations (TMO) are precinct (assignment to a medical position of the normative number of residents) and the widespread use of the dispensary method (systematic active monitoring of the health of certain contingents). The main planning and normative indicators regulating the work of polyclinics are indicated: the standard for the district (1700 people for 1 position of the district therapist); load rate (5 visits per hour at an appointment at a polyclinic and 2 - when serving patients at home by a therapist); the staffing standard for district therapists (5.9 per 10,000 residents over 14 years old).
The measure of the capacity of polyclinics is the number of visits per shift (more than 1200 visits - I category, less than 250 visits - V category). TMO, to a greater extent than polyclinics and antenatal clinics, meet the new principles of organization and financing of primary medical and social care. They can more effectively organize the work of family doctors (order of the Ministry of Health of the Russian Federation No. 237 dated 26.08.92). In a number of TMOs, conditions have been created for family health care, for example, joint work at the site of a therapist, pediatrician and gynecologist (obstetric-pediatric-therapeutic complex - APTK). At the same time, the indicator of work is not the dynamics of attendance, but changes in the state of health of the population (decrease in morbidity, disability, infant mortality, the number of advanced oncological diseases, the state of health of patients from dispensary groups, etc.).
The main activities of primary medical and social care institutions are: preventive work, medical examination, hygienic training and education of the population, promotion of a healthy lifestyle; medical and diagnostic work (including examination of temporary disability); organizational and methodological work (management, planning, statistical accounting and reporting, analysis of activities, interaction with other health care institutions, professional development, etc.); organizational mass work.
The polyclinic is headed by the chief physician. The structure of the polyclinic includes: registration, prevention department, treatment and prophylactic departments and offices, treatment and diagnostic units, administrative and economic part, rehabilitation treatment departments, etc. The continuity of the polyclinic and hospital work is assessed by the number of patients prepared for planned hospitalization, and the exchange of documentation before and after their treatment in a hospital.
Similar information.
Unity of principles of providing medical and preventive care urban and rural population: 1) preventive nature; 2) district; 3) mass character; 4) specialization of medical care 5) general availability.
The peculiarity of the provision of medical and preventive care to the rural population:
1) stages of assistance
2) mobile types of medical care (mobile medical teams).
Features of the organization of rural medical care:
1) low population density - the number of rural population in 2004 2.803.600, 2005 2.744.200, 2006 2.691.500. Compared to 2002, the rural population decreased by 118 thousand. In 2005, 90.307 people were born, of which 24.205 (26.8%) were in the countryside. The birth rate in 2005 was 9.2 in the Republic of Belarus, in the countryside - 8.9. The mortality rate in the countryside is 2.2 times higher than in the city. Infant mortality in general is 6.4, in rural areas - 9.3. Life expectancy in the countryside is 64.52, in the city 70.53.
Population - the number of people in a locality. The average rural population is 200 people.
2) the scattering of settlements over a large territory - rural settlements 24 thousand. The average population density in the Republic of Belarus is 48 people per km2, in a village - 10 people per km2. Proximity is the distance between settlements, the radius of service is the distance from a settlement where there are medical institutions to the most remote settlement, whose residents are attached to this institution for medical care. This value is manageable and varies with population.
3) poor quality of roads
4) the specifics of agricultural labor: seasonality, dependence on the weather
5) conditions, lifestyle, traditions
6) low availability of specialists
Stages of providing medical and preventive care to the rural population and the main organizations:
Stage I - earlier - a rural medical district (SVU), including a complex of medical institutions:
A) a rural district hospital (SUB, provides both outpatient and inpatient care) or a rural medical outpatient clinic (SVA, provides only outpatient care)
B) feldsher-obstetric station (FAP)
C) health centers (if there is an industrial enterprise in the served area).
Currently There are no IEDs, SVA and district hospitals are branches of the Central District Hospital, FAPs are branches of SVA.
The main function of the stage: provision of first aid, first qualified medical aid with possible elements of specialized medical aid.
FAPs- are created for medical care of 400 people or more at a distance of 2 km or more from a medical institution. When serving more than 400 people. in the states of FAP there are: 1 position of a paramedic or midwife or nurse and 0.5 positions of a nurse. The cost of FAPs is 1.5-2.0% of the budget of the ZO district.
FAP functions:
- provision of first aid medical care and timely fulfillment of doctor's prescriptions;
- Carrying out preventive work and anti-epidemic work;
- organization of patronage for pregnant women, children,
- Carrying out measures to reduce infant and maternal mortality;
- hygienic training and education of the population.
Rural medical station (SVU)- served 7-9 thousand people within a radius of 7-9 km.
District hospital- This is the main institution on the SVU, consists of a hospital and an outpatient clinic. Depending on the number of beds, there can be category I - for 75-100 beds, II - 50-75 beds, III - 35-50, IV - 25-35 beds. At the local hospital All types of qualified medical and preventive care are provided... Medical assistance to the population during field work is of great importance. Considerable work is being done to protect the health of women and children, to introduce modern methods of prevention, diagnosis, and treatment.
All types of medical and preventive care for pregnant women, mothers and children are provided District hospital doctor... If there are several doctors, then one of them is responsible for the health of children and women in this area.
At Unprofitable activities of local hospitals, they are closed or repurposed into branches Rehabilitation of district hospitals, and for medical care of the population, Independent rural medical outpatient clinics(SVA), the staff of which should be: a general practitioner, dentist, obstetrician-gynecologist, pediatrician. A dentist (dentist) provides medical assistance to patients with dental diseases in a local hospital or in a rural medical outpatient clinic.
From the standard standards of the medical personnel of local hospitals:
1. The positions of doctors for the provision of outpatient care to the population are established on the basis of 10,000 of the population:
2. The positions of doctors of the hospital departments are established at the rate of 1 position:
- therapist - 25 beds;
- pediatrician - for 20 beds;
- surgeon - 25 beds;
- dentist - for 20 beds.
The bed capacity of the rural district hospital is 27-29 beds.
Organization of SMS work:
- provision of medical and preventive care to the population
- introduction into practice of modern methods of prevention, diagnosis and treatment of patients
- development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care
- organization and implementation of a set of preventive measures among the population of the site
- carrying out medical and preventive measures to protect the health of mothers and children
- study of the causes of general morbidity and morbidity with temporary disability and the development of measures to reduce it
- organization and implementation of medical examination of the population, especially children, adolescents
- implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.)
- implementation of current sanitary supervision over the condition of production and communal facilities, water supply sources, children's institutions, public catering establishments;
- Carrying out therapeutic and prophylactic measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms
- organization and implementation of measures for sanitary and hygienic education of the population, promotion of a healthy lifestyle, including rational nutrition, increased physical activity; combating alcohol consumption, smoking and other bad habits
- wide involvement of the public in the development and implementation of measures to protect public health
Stage II - Territorial Medical Association (TMO).
Managed by TMO Chief physician of the TMO(he is also the chief physician of the Central District Hospital) and his deputies:
- Deputy for medical care of the population (he is also the head of the organizational and methodological office);
- Deputy for the medical department (with the number of beds 100 or more);
- Deputy for Medical and Social Expertise and Rehabilitation (if the number of the served population is at least 30,000 people);
- Deputy for obstetrics and childhood (if the number of the served population is at least 70,000 people);
- Deputy for Economic Affairs;
- Deputy for the administrative part.
The medical council includes: chief physician, his deputies, chief physician of the Center for Hygiene and Epidemiology, head of the central regional pharmacy, leading specialists of the region, chairman of the regional committee of the trade union of medical workers, chairman of the Red Cross and Red Crescent Society.
The decision to create a TMT is made parent body health department. In small towns and rural areas, TMO usually unites all medical institutions and replaces the city health department and the central district hospital. V large cities with a population of more than 100,000, there may be several TMOs, one of them is the head one.
TMO Is a complex of health care facilities, functionally and organizationally related to each other. The TMO may include:
polyclinics (adults, children, dental);
antenatal clinics, dispensaries, hospitals, maternity hospitals;
ambulance stations;
children's sanatoriums and other institutions.
Consolidation of institutions should be expedient, not mandatory. Institutions that are not included in the TMO act independently. As a rule, these are health centers and centers of hygiene and epidemiology, forensic medical examination bureaus, blood transfusion stations.
Principles of TMO formation:
1. A certain size of the population - the optimal size of TMT is 100-150 thousand population.
2. Organizational and financial separation of outpatient and inpatient institutions.
3. Coincidence of the boundaries of the TMO service area with the administrative boundaries of the region (city).
4. Rational association of institutions - an association of institutions that provide medical care to adults and children.
The tasks of the TMO- provision of affordable and qualified medical and preventive care to the population.
Functions of TMO:
1. Organization of medical and preventive care for the attached population, as well as any citizen who seeks medical help.
2. Carrying out preventive measures.
3. Provision of ambulance to the sick.
4. Timely provision of medical assistance at the reception, at home.
5. Timely hospitalization.
6. Clinical examination of the population.
7. Carrying out medical and social expertise.
8. Carrying out hygienic training and education.
9. Analysis of the activities of health care facilities.
The main medical institutions Stage II is the central district hospital (CRH) and other institutions of the district (see question 102).
For organizing Medical and preventive care for women and children at this stage, the district pediatrician and the district obstetrician-gynecologist are responsible. With a population of more than 70,000 people, the position of deputy chief physician for childhood and obstetrics is appointed - an experienced pediatrician or obstetrician-gynecologist.
Outpatient dental care at the second stage, it can be provided in dental clinics and dental departments of the Central District Hospital. Inpatient dental care in the dental department of the Central District Hospital or on special beds for dental patients in the surgical department.
Stage III - regional hospital and medical institutions of the region.
Regional Hospital Is a large multidisciplinary medical and prophylactic institution that fully provides highly qualified highly specialized assistance to residents of the region. This is the center for organizational and methodological management of medical institutions located in the region, a base for specialization and advanced training of doctors and nurses.
Regional hospital structure:
1. Hospital.
2. Consultative clinic.
3. Other units (kitchen, pharmacy, morgue).
4. Organizational and methodological department with a department of medical statistics.
5. Department of emergency and planned consulting assistance, etc. (see question 104).
The bed capacity of the regional hospital for adults is 1000-1100 beds, for children - 400 beds.
Consultative clinic provides the population with highly qualified, highly specialized medical care, provides field consultations, by phone - correspondence consultations, analyzes the activities of medical and preventive institutions, the discrepancy between the diagnoses of the sending institutions and the polyclinic, diagnoses of the polyclinic and the hospital, error analysis. Does not have the right to issue sick leave.
Children and women in the region receive all kinds of qualified specialized medical care in the consultative polyclinic. Inpatient care for women is provided in regional maternity hospitals, regional dispensaries and other medical institutions in the region.
Outpatient qualified specialized dental care patients are in the regional dental clinics, inpatient - in the dental departments of regional hospitals.
The number of hospital organizations in the countryside in 2005 was 274, of which there were 184 district hospitals, 90 nursing hospitals. The number of outpatient clinics was 3326. In 2005 there were 253 independent medical outpatient clinics, and 336 general practitioners outpatient clinics in 2005. FAPs in 2005 - 2524.
IVstage: republican level(Republican Scientific and Practical Center, republican hospitals).
The purpose of the lesson.
Students should know:
1. The system of organizing medical care for the rural population.
2. The main content and features of the work of medical institutions in rural areas,
3. Contemporary problems of rural health care and ways to solve them.
The main questions of the topic:
The structure of the district medical and sanitary network and the peculiarities of the organization of medical care for rural residents.
2. Rural medical area, its structure, principles of construction.
3. District hospital, its main tasks and scope of activities.
Feldsher-obstetric station, standards for its organization and main tasks.
Organization of medical and preventive care in a rural medical area (clinical examination, servicing rural workers during field work, the production principle of servicing agricultural workers).
Central regional hospital, its main functions.
District health department (medical council, organizational and methodological room of the Central District Hospital, district specialists, forms and methods of their work).
Regional hospital, its structure and main functions.
The main feature of the system of providing medical care to the villagers is its stages. Medical and preventive care for the rural population is provided by a complex of medical institutions, ranging from FAPs to regional (regional, republican) institutions.
First stage. Rural medical area includes the following medical institutions: a local hospital with an outpatient clinic (polyclinic) or an independent hospital (a medical outpatient clinic, FAP, state farm (collective farm) medical dispensaries, pharmacies, dairy kitchens. primary health care to the rural population and contribute to the successful solution of the tasks of providing this care in conditions of considerable remoteness of settlements from district and central district hospitals.
Second phase. District medical institutions : central district and so-called zonal district hospitals located on the territory of the district with polyclinics and departments of emergency and emergency medical care, district dispensaries and other medical institutions.
Stage three. Regional medical institutions : regional hospital with an advisory clinic and an air ambulance department, dispensaries, a dental clinic, a psychiatric hospital, etc.
Stages in the provision of medical care to rural residents pursues the goal of the fullest satisfaction of the needs of the population not only in primary health care, but also in its main types and in all narrow specialties.
LEVEL SYSTEM OF MEDICAL CARE ORGANIZATION.
Currently, for 10 territories of the region, a certain scheme of health care organization has been proposed, in which each medical and preventive institution or group of medical and preventive institutions represents a certain level of medical care (feldsher-obstetric points - one level, medical outpatient clinics - another, district hospitals - the third etc.).
The presence of certain levels of medical care, as well as their number for each municipality, are determined taking into account specific conditions - the material and technical equipment of medical institutions, the staff, the remoteness of settlements from the main medical and diagnostic bases, the need and provision of the population with outpatient and polyclinic and stationary types of medical care.
The specific volumes of medical and diagnostic assistance that should be provided at the FAP, in the district hospital, central district hospital, city, regional hospital are clearly indicated in the relevant Regulations on these medical institutions approved by the Ministry of Health of the Russian Federation.
The proposed level-based system of medical care is aimed at increasing the volume of outpatient care, reducing hospitals and more efficient use of bed capacity. A distinctive feature of this system is that it is determined individually for each specific territory of the region and contributes to effective control over the implementation of the Program of state guarantees for providing the population of the Irkutsk region with medical care.
The proposed scheme of the level organization of medical care provides a combination, on the one hand, of the volumes of medical and diagnostic care for each type of medical institution, as defined in the relevant Regulations of the Ministry of Health of the Russian Federation, on the other hand, the most rational network and structure of healthcare institutions for each city or district of the region, which these volumes are fulfilled.
For instance,
Ust-Kutsk district:
Ilevel: FAP (feldsher-obstetric points) - 11.
IIlevel: Medical outpatient clinics - 5, including pct. Yantal, Zvezdny district, Niya village, Ruchey village, Podymahino.
IIIlevel: District hospital with 35 beds.
IVlevel: Central regional hospital for 265 beds, including departments: therapy - 30 beds, infectious - 30 beds, surgical - 27 beds, trauma - 27 beds, dental - 6 beds, maternity and pregnancy pathologies - 45 beds, gynecological - 30 beds , neurological - 10 beds, dermatological - 30 beds, pediatric - 30 beds.
Polyclinic. Anti-tuberculosis dispensary for 35 beds.
Vlevel: OKB.
Bratsk district:
Ilevel: FAP - 33
IIlevel: Medical outpatient clinics - 7, including: pct. Transformed;
With. B-Oka, Shumilovo village, Tynkob village, Naragai village, Turma village, Chmir village.
IIIlevel: District hospitals - 4, including: Kaltuk village - 30 beds,
With. Pokosnoe - 25 beds, s. Tangui - 50 beds, s. Keys - Bulok - 15 beds.
IVlevel: Vikhorevsk city hospital with 90 beds, including departments: therapy - 30 beds, infectious diseases - 15 beds, maternity - 10 beds, gynecological - 15 beds, pediatric - 20 beds.
Polyclinic.
Bratsk Central District Hospital for 180 beds (therapy - 55 beds, surgery - 35 beds, traumatology - 25 beds, urology - 10 beds, dentistry - 5 beds, gynecology - 25 beds, neurology - 25 beds.).
Polyclinic.
Vlevel: OKB.
The main tasks of the VCA are:
providing medical and preventive care to the population,
introduction into practice of modern methods of prevention, diagnosis and treatment of patients based on the achievements of medical science and technology and advanced work experience;
development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care;
organization and implementation of a set of preventive measures among the population of the site aimed at reducing morbidity, disability and mortality;
carrying out treatment and prophylactic measures to protect the health of mothers and children;
study of the causes of the general morbidity of the population and morbidity with temporary disability of workers and employees with the development of measures to reduce it;
organization and implementation of clinical examination of the population (healthy and sick), especially children, adolescents, women and persons with an increased risk of cardiovascular, oncological and other diseases;
implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.);
implementation of current sanitary supervision over the condition of production and communal facilities, water supply sources, childcare facilities, catering establishments, etc .;
carrying out treatment and prophylactic measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms;
organization and implementation of measures for the sanitary and hygienic education of the population, the promotion of a healthy lifestyle, including rational nutrition, increased physical activity, the fight against alcohol consumption, smoking and other bad habits;
wide involvement of the public in the development and implementation of measures to protect the health of the population.
The main treatment-and-prophylactic institution of the SVU is district hospital... Its capacity depends on the number and agro-industrial enterprises, the radius of service, the distance to the regional hospital, the Central Regional Hospital, as well as on the geographical and other local conditions.
There are four categories of district hospitals. Category I hospitals have a capacity of 75-100 beds. They provide specialized beds for therapy, surgery, obstetrics, pediatrics, infectious diseases. Such hospitals should be well equipped with clinical diagnostic equipment. Category II hospitals (50-70 beds) should have beds for therapy, surgery, pediatrics, obstetrics, and infectious diseases. In category III hospitals (35-50 beds), beds for therapy for adults and children, surgery, obstetrics and infectious diseases are provided. Category IV hospitals (25-35 beds) should have beds for therapy, surgery and obstetrics.
Feldsher-obstetric station. This is a pre-hospital medical institution providing medical and sanitary assistance to the rural population. The medical staff of the FAP carries out on the territory assigned to them a complex of treatment-and-prophylactic and sanitary-anti-epidemic measures, provides patients with first aid at an outpatient appointment and at home. Medical assistance to patients is provided within the competence and rights of a paramedic and midwife, under the guidance of a local doctor.
Its main tasks are:
Providing the population with pre-hospital medical care;
Timely and in full implementation of doctor's prescriptions, organization of patronage of children and pregnant women, systematic monitoring of the health status of invalids of the Great Patriotic War and leading agricultural specialists (machine operators, livestock breeders, etc.);
Carrying out measures to reduce mortality, including child and maternal mortality;
Participation in the current sanitary supervision of institutions for children and adolescents, utilities, food, industrial and other facilities, water supply and cleaning of settlements;
Carrying out door-to-door rounds according to epidemic indications in order to identify infectious patients who have come into contact with them, and persons with suspected infectious diseases;
FAP is under the jurisdiction of the village Council of People's Deputies, has an independent estimate intended for the provision of medical care and preventive work in the assigned territory. The head of the FAP is obliged annually (in August-September) to submit to the village council a substantiated estimate according to the articles for the funds necessary for the item for the next year and to seek its approval. The FAP is managed by the hospital or outpatient clinic to which it is subordinate.
The main feature of providing medical care to the villagers is its stages. Conventionally, there are three stages in the organization of medical care for the rural population (Fig. 17.1).
First stage- healthcare institutions of a rural settlement, which are part of integrated therapeutic site. At this stage, rural residents receive first aid, as well as the main types of medical care: therapeutic, pediatric, surgical, obstetric, gynecological, and dental.
The first medical institution that a villager usually turns to is feldsher-obstetric station (FAP). It functions as a structural subdivision of a local or central district hospital. It is advisable to organize FAPs in settlements with a population of 700 or more with a distance to the nearest medical institution over 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.
The FAP is responsible for solving a large complex of medical and sanitary tasks:
Carrying out activities aimed at preventing and reducing morbidity, injuries and poisoning among the rural population;
Reducing mortality, especially infant, maternal, working age;
Providing the population with pre-hospital medical care;
Participation in the current sanitary supervision of preschool and school educational institutions, utilities, food, industrial and other facilities, water supply and cleaning of populated areas;
Carrying out door-to-door rounds according to epidemiological indications in order to identify infectious patients, persons in contact with them and those suspected of infectious diseases;
Improving the sanitary and hygienic culture of the population. Thus, FAP is a health care institution
more of a prophylactic focus. At FAP
Rice. 17.1. Stages of providing medical care to the rural population
entrust the functions of a pharmacy for the sale of finished dosage forms and other pharmaceutical goods to the population.
The FAP is headed by head of FAP, the main tasks of which are:
Organization of treatment-and-prophylactic and sanitary-epidemiological work;
Outpatient reception and treatment of patients at home;
Provision of emergency and emergency medical care in case of acute diseases and accidents (injuries, bleeding, poisoning, etc.) with the subsequent referral of the patient to the nearest medical and preventive institution;
Preparing patients for admission to a physician at a FAP, conducting clinical examinations of the population and preventive vaccinations;
Carrying out anti-epidemic measures, in particular household rounds for epidemiological indications in order to identify infectious patients, persons in contact with them and suspected of infectious diseases;
Provision of medical care to children in preschool and school educational institutions located in the territory of FAP activities and do not have corresponding nurses in their states;
Conducting sanitary and educational work among the population. A person who has received secondary medical education in the specialty "General Medicine" and has a certificate in the specialty "General Medicine" is appointed to the position of the head of the FAP.
In addition to the head of the FAP, there is a midwife and a visiting nurse.
FAP midwife is responsible for the provision and level of pre-medical care for pregnant and gynecological patients, as well as for health education among the population on the protection of mothers and children.
The midwife is directly subordinate to the head of the FAP, and the methodological guidance of her work is carried out by the obstetrician-gynecologist of the medical-prophylactic institution, who is responsible for providing obstetric and gynecological care to the population in the territory of the FAP.
Patronage nurse carries out preventive measures to improve the health of the child population. To this end, it solves the following tasks:
Carries out patronage of healthy children under the age of 1 year, including newborns at home, monitors the rational feeding of the child;
Carries out measures for the prevention of rickets and malnutrition;
Carries out preventive vaccinations and diagnostic tests;
Carries out preventive work in preschool and school educational institutions (located in the territory of FAP and does not have the corresponding nurses in their states);
Prepares sick children for admission to FAP by a pediatrician;
Conducts household visits according to epidemiological indications in order to identify infectious patients, persons in contact with them and suspected of infectious diseases, etc.
In the absence of a patronage nurse in the staffing table, the midwife, in addition to her duties, monitors the health and development of children of the 1st year of life. In the absence of a midwife and a visiting nurse on the staff of the FAP, their duties are performed by the head.
Despite the important role of the FAP, the leading medical institution at the first stage of providing medical care to the villagers is district hospital, which may include a hospital and a medical outpatient clinic. The types and volume of medical care in the district hospital, its capacity, equipment, staffing with medical personnel largely depend on the profile and capacity of other medical institutions that are part of the health care system of the municipal district (rural settlement). The main task of the district hospital is to provide the population with primary health care.
Outpatient and polyclinic care for the population is the most important section of the work of the local hospital. She may turn out outpatient clinic, included in the structure of the hospital, or an independent outpatient clinic. The main task of the outpatient clinic is to carry out preventive measures to prevent and reduce morbidity, disability, mortality among the population, early detection of diseases, and clinical examination of patients. Doctors of the outpatient clinic provide appointments for adults and children, make home calls and emergency care. Paramedics can also take part in the reception of patients, however, medical care in an outpatient clinic should mainly be provided by doctors. In the local hospital, an examination of temporary disability is carried out, and, if necessary, patients are referred to the ITU.
In order to bring specialized medical care closer to the residents of the village, the doctors of the central district hospital, according to the
On a divided schedule, they go to the outpatient clinic to receive patients and select them, if necessary, for hospitalization in specialized institutions. V Lately in many constituent entities of the Russian Federation, district hospitals and outpatient clinics are being reorganized into centers of general medical (family) practice.
The second stage the provision of medical care to the rural population is the health care institutions of the municipal district, and among them the leading place is taken by central district hospital (CRH). The central district hospital provides the main types of specialized medical care and at the same time performs the functions of a health management body in the territory of the municipal district.
The capacity of the CRH, the profile of specialized departments within it depend on the population size, structure and level of morbidity, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, CRHs have a capacity of 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatric, infectious and obstetric-gynecological (if there is no maternity hospital in the area).
The head physician of the CRH is the head of the health care of the municipal district, appointed and dismissed by the administration of the municipal district.
An approximate organizational structure of the CRH is shown in Fig. 17.2.
Methodological, organizational and advisory assistance to doctors of complex therapeutic areas, FAP paramedics is carried out by specialists from the Central Regional Hospital. Each of them, according to the approved schedule, travels to the integrated therapeutic area for medical examinations, analysis of dispensary work, and selection of patients for hospitalization.
In order to bring specialized medical care closer to the rural population, interdistrict medical centers. The functions of such centers are performed by large CRHs (with a capacity of 500-700 beds), capable of providing the population of the nearest municipal districts with the missing types of specialized inpatient and outpatient medical care.
The structure of the CRH has polyclinic, which provides primary health care to the rural population in the direction of
Rice. 17.2. Approximate organizational structure of the CRH
medical assistants of FAP, doctors of outpatient clinics, centers of general medical (family) practice.
The provision of out-of-hospital and inpatient medical and preventive care to children in the municipal district is entrusted to children's consultations (polyclinics) and children's departments of the Central District Hospital. Preventive and curative work of children's polyclinics and children's departments of the Central District Hospital is carried out on the same principles as in city children's polyclinics.
The provision of obstetric and gynecological care to women in the municipal area is entrusted to antenatal clinics, maternity and gynecological departments of the Central District Hospital.
The functional responsibilities of medical personnel, accounting and reporting documentation, the calculation of statistical indicators of the CRH's activities do not fundamentally differ from those in city hospitals and APUs.
The third stage Providing the rural population with medical care are healthcare institutions of the constituent entity of the Russian Federation, and among them the main role is played by regional (regional, district, republican) hospitals. At this stage, specialized medical care is provided in all major specialties.
Regional (regional, district, republican) hospital - a large multidisciplinary medical and prophylactic institution, designed to provide full specialized assistance not only to rural people, but also to all residents of the constituent entity of the Russian Federation. It is the center of organizational and methodological management of medical institutions located on the territory of the region (region, district, republic), the base of specialization and advanced training of doctors and nurses.
The approximate organizational structure of the regional (regional, district, republican) hospital is shown in Fig. 17.3.
The functional responsibilities of medical personnel, the method of calculating statistical indicators, accounting and reporting documentation of the regional (regional, district, republican) hospital do not fundamentally differ from those in city or central regional hospitals. At the same time, the organization of the work of the regional (regional, district, republican) hospital has its own characteristics, one of which is the presence in the hospital consultative clinic, where people come for help
Rice. 17.3. Approximate organizational structure of a regional (regional, district, republican) hospital
whether all municipal districts (urban districts) of a constituent entity of the Russian Federation. To accommodate them, a boarding house or hotel for patients is organized at the hospital.
As a rule, patients are referred to an advisory polyclinic after preliminary consultation and examination by regional (city) specialist doctors.
Another feature of the regional (regional, district, republican) hospital is the presence in its composition departments of emergency and planned consultative aid, which, using the means of medical aviation or ground vehicles, provides emergency and advisory assistance with travel to remote settlements. In addition, the department ensures the delivery of patients to specialized regional and federal medical centers.
The Department of Emergency and Planned Advisory Aid works in close connection with regional center for disaster medicine.
In cases of emergencies, practical work on the fulfillment of sanitary assignments is carried out by teams of specialized medical care of constant readiness.
Unlike the CRH in the regional (regional, district, republican) hospital functions organizational and methodological department much wider. In fact, it serves as an analytical center and scientific and methodological base of the healthcare management body of the constituent entity of the Russian Federation for the introduction of modern medical and organizational technologies into practice.
The organizational activities of the department include holding regional feldsher (nursing) conferences, generalizing and disseminating best practices of healthcare institutions, organizing medical examinations of the population, scheduled visits of specialists, publishing instructional and methodological materials, etc.
Basic principles of organizing medical care in rural areas:
· Stages
Free
General availability
Continuity of medical care
However, the peculiarities of living in rural areas leave an imprint on the entire system of organizing medical care.
Features of rural health care:
Local services for the rural population (with the organization of one or two medical assistant points and a pharmacy at the site, and hospitals with an outpatient clinic in the center of each site);
Low availability of specialists;
Lack of the right to choose a medical institution, since in small settlements medical care is provided, as a rule, by one doctor (paramedic);
The low level (in comparison with urban) consumption of the medical infrastructure of communications significantly reduces the availability of medical care for rural residents;
Low (in comparison with the city) population density, located on a larger territory, the scattering of settlements and their remoteness;
Non-working, retired people predominate among the population served.
Poor quality, and sometimes lack of roads;
The specifics of agricultural labor (seasonality of field work, dependence on weather conditions, etc.);
Features of conditions, lifestyle, national traditions and customs of the rural population
Rural health care structure
The primary link in the provision of health care in the countryside is represented by:
A network of feldsher-obstetric points (FAP)
Medical (paramedic) outpatient clinics
Central district polyclinics (as part of the Central Regional Hospital).
The stationary network includes:
Local hospitals
Central district hospitals (CRH)
· Regional (regional) hospitals.
The organization of medical and social assistance in the countryside, its volume and quality depend on:
The remoteness of medical institutions from the place of residence of patients;
Staffing with qualified personnel, equipment;
Opportunities for obtaining specialized medical care;
Possibilities for the implementation of standards for medical and social security.
The main feature of the organization of medical care for the rural population is the STAGE of its provision. Conventionally, there are three stages of providing medical and preventive care to the population.
The first stage is a rural medical district (SVU) or, taking into account new organizational structures, a territorial medical association (TMO). The territorial rural medical area includes: a local rural hospital or an independent medical outpatient clinic, feldsher-obstetric points (FAP), health centers at enterprises and state farms, dispensaries (they can be organized at large state farms), medical centers for children's educational institutions, a maternity hospital.
The main institution is a rural district hospital (SCH) or a medical outpatient clinic, where rural residents receive qualified medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).
The second stage is regional medical institutions.
The main institution is the central district hospital (CRH), which provides specialized medical care for its main types.
The third stage - regional (regional, district, republican) institutions. The main institution in the regional health care is the regional (regional, district, republican) hospital - a large multidisciplinary medical and prophylactic institution designed to provide in full highly qualified specialized care not only to rural people, but also to all residents of the constituent entity of the Russian Federation in all major specialties.
At these stages, institutions can be divided into two groups:
Institutions that are necessarily present in every district, region (FAPs, CRH, TsGSEN, etc.)
Institutions that, depending on local conditions, may or may not be available (district maternity hospitals, numbered hospitals, etc.) in certain regions.
FIRST STAGE
RURAL MEDICAL AREA (SVU). ORGANIZATION OF PRIMARY HEALTH CARE AT THE SITE.
Tasks of the VCA:
Provision of publicly available qualified medical care to the population
Conducting sanitary and anti-epidemic measures
Formation of attitudes and skills of a healthy lifestyle among residents.
The composition of the VCA:
Rural district hospital (SUB) or medical outpatient clinic
Maternity
First-aid posts for children's educational institutions
Feldsher health centers at enterprises and state farms
State farm dispensaries
The structure of the IED is formed depending on the number of the served population (5-9 thousand people), the radius of the service (7-10 km), the distance to the central district hospital and the condition of the roads. However, depending on the natural and economic-geographical factors affecting the availability of medical care, the size of the medical areas, the population in the area may be different.
All medical institutions that are part of the SVU are organizationally united and work according to a single plan under the leadership of the chief physician of the district hospital (outpatient clinic).
FELDSHER'S AND OBSTETRIC STATION (FAP)
The first institution that a patient usually goes to in rural areas is the feldsher-midwife point (FAP). FAP is organized in settlements with a population of 700 or more with a distance to the nearest medical institution over 2 km, and if the distance to the nearest medical institution exceeds 7 km, then a FAP can also be organized in a settlement with a population of up to 700 people.
At FAP, depending on the size of the population served, the following can work:
Paramedic;
Paramedic and midwife;
Paramedic, midwife and health visitor.
FAP functions:
Providing the population with the first pre-medical aid;
Provision of the population with medicines (according to the nomenclature approved by the health authorities);
Timely and in full compliance with the doctor's prescriptions;
Organization of patronage of children and pregnant women, dynamic monitoring of the health of certain categories of citizens;
Systematic monitoring of the health status of war invalids and leading agricultural specialists (machine operators, livestock breeders);
Carrying out measures to reduce child and maternal mortality;
Sanitary and hygienic training and education of the population
Providing emergency dental care (for example, relieving acute pain)
RURAL DISTRICT HOSPITAL (SUB)
The Rural District Hospital (SCH) is the leading institution at the SVU. It may include a hospital and a medical outpatient clinic.
The nature and volume of medical care in a local hospital is determined by the capacity, equipment, and availability of specialist doctors. However, regardless of the capacity, it is obliged, first of all, to provide outpatient care for therapeutic and infectious patients, help in childbirth, treatment and prophylactic care for children, urgent surgical and traumatological care.
The SUB staff should include doctors in the main specialties: therapy, pediatrics, dentistry, obstetrics and gynecology, and surgery.
SMS tasks:
Providing the population of the assigned territory with qualified medical care (outpatient and inpatient);
Planning and implementation of measures to prevent and reduce morbidity and injuries among various groups of the rural population;
Carrying out medical and preventive measures to protect the health of mothers and children;
Introduction into practice of modern methods of prevention, diagnosis and treatment, advanced forms and methods of organizing medical care;
Organizational and methodological guidance and control over the activities of FAPs and other health care institutions that are part of the medical department.
The organization of outpatient and polyclinic care for the population can be provided by an outpatient clinic (polyclinic), which is part of the SMS structure, or an independent rural medical outpatient clinic (polyclinic). The main tasks of this institution are: carrying out extensive preventive measures to prevent and reduce morbidity, early detection of patients, clinical examination, and the provision of qualified medical care to the population. Doctors see adults and children, make home calls and emergency care. Paramedics can also take part in the reception of patients, however, outpatient care in a rural medical outpatient clinic should be provided by doctors.
SMS functions:
Carrying out measures to bring out-of-hospital care closer to agricultural workers during the period of massive field work;
Carrying out a complex of sanitary and anti-epidemic measures (preventive vaccinations, ongoing sanitary supervision of institutions and facilities, water supply and cleaning of populated areas, etc.);
Scheduled visits of doctors to subordinate FAPs and children's educational institutions to provide practical assistance and control their work;
Expertise of temporary disability and, if necessary, referral to MSEC.
SECOND PHASE
CENTRAL DISTRICT HOSPITAL (CRH)
CRH - the main institution of the second stage of rural health care is the central district hospital, which provides the main types of specialized qualified medical care and at the same time performs the functions of a governing body. The CRH serves as the center of operational management of all health care institutions on the territory of the district, is responsible for the organization, delivery and quality of medical care to the population, carries out organizational and methodological work.
In different regions of the country, there are CRHs of different capacity, which depends on the population size, the availability of hospital facilities and other factors. The optimal capacity of the Central District Hospital is not less than 250 beds.
CRH composition:
· Hospital with departments for basic specialties;
· Polyclinic with treatment and diagnostic rooms and a laboratory;
· Department of ambulance and emergency medical care;
· Pathological department;
· Organizational and methodological office;
· Structural support units (pharmacy, kitchen, medical archive, etc.).
The profile and number of specialized departments within the CRH depend on its capacity, but the optimal number of them should be at least five:
1) therapeutic;
2) surgical with traumatology;
3) pediatric;
4) infectious;
5) obstetric and gynecological (if there is no maternity hospital in the area).
Tasks of the Central District Hospital:
Providing the population of the district and the district center with qualified specialized inpatient and polyclinic medical care;
Organization of emergency medical care;
Operational and organizational and methodological management of all health care institutions of the region, control over their activities;
Planning, financing and organization of material and technical support of health care institutions of the region;
Development and implementation of measures aimed at improving the quality of medical services for the population, reducing morbidity, infant and general mortality, health promotion;
Development and implementation of measures for the placement, rational use, advanced training and education of medical personnel in health care institutions.
The district health care is managed by the head physician of the Central Regional Hospital, who has deputies for the main areas of activity:
On the medical side;
Outpatient work;
Organizational and methodological work (head of the organizational and methodological department);
Administrative work
Childhood and obstetrics (in areas with a population of 70 thousand and more).
The sanitary-preventive service is headed by the chief state sanitary doctor of the region, who is the chief physician of the Central State Sanitary and Epidemiological Service.
For the provision of methodological, organizational and advisory assistance, the CRH assigns regional specialists to doctors of rural medical districts, who, within the framework of their specialty, carry out organizational and methodological leadership of all medical institutions of the district. These are, in fact, the heads of the departments of the Central District Hospital, the most experienced doctors.
Functions of the head of the department of the Central District Hospital:
Heads medical work in the region in his specialty;
Leaves for consultations;
Performs demonstration operations;
Examination and treatment of patients;
Sends teams of specialist doctors to medical institutions of rural medical districts;
Hears reports of doctors of local hospitals, heads of FAPs;
Analyzes work plans, statistical reports;
Conducts scientific conferences, seminars;
Carries out professional development in the workplace, etc.
Polyclinic Central District Hospital
The polyclinic (outpatient clinic) of the Central District Hospital provides qualified medical care to the rural population in 8-10 medical specialties.
Polyclinic objectives:
· Provision of qualified outpatient and polyclinic help to the attached population of the district and the district center;
· Organizational and methodological management of outpatient and polyclinic divisions of the district, control over their activities;
· Planning and implementation of activities aimed at preventing and reducing morbidity and disability;
· Timely and widespread introduction into the practice of all outpatient polyclinic institutions of the region of modern methods and means of prevention and treatment of diseases, advanced experience in the provision of outpatient care.
Rural residents apply to the district polyclinic for referrals from medical institutions of rural medical districts to receive specialized medical care, functional examinations, and consultations with specialist doctors.
In order to bring specialized medical care closer to the place of residence, on the basis of the CRH, out-of-hospital outpatient teams can be created from the number of full-time doctors and nurses.
An important role in the organization of medical and preventive care in the region is played by the organizational and methodological office of the Central District Hospital. It should be staffed with the most experienced doctors, and have data on the economy and sanitary condition of the region, on the network and staffing of medical institutions, on the provision of the population with various types of medical and social security, etc. Deputy Chief Physician of the Central Regional Hospital.
Interdistrict Specialized Departments (IES)
In order to bring specialized medical care closer to the rural population, inter-district specialized departments (centers) equipped with modern equipment can be created in regional centers.
The functions of interdistrict centers are performed by health care facilities that are able to provide the population with specialized highly qualified inpatient or outpatient medical care, in cases where the CRHs of the surrounding districts are unable to provide specialized care in this specialty.
Along with performing the function of a structural subdivision of a health care facility, interdistrict specialized centers (departments) carry out:
Functions of the ICO:
Consultative appointments in the outpatient clinic for patients in the direction of the doctors of the hospitals of the attached areas;
Hospitalization of patients from the attached areas;
Organizational, methodological and advisory assistance (including an examination of the ability to work) to doctors of hospitals in the attached areas, including through planned visits;
Implementation of modern means and methods of prevention, diagnosis and treatment of patients in the relevant specialty into the practice of health care institutions;
Analyzing the results of providing medical care to residents of the attached areas, providing information on the work of the interdistrict medical center;
Conducting joint control and expert commissions, thematic conferences, seminars.
Health care organizations of the attached districts provide transportation of patients and pregnant women to the interdistrict center (by agreement), referral of patients for consultation only subject to a full examination in accordance with medical and economic standards, inform the population about the working hours of the center's specialists. To coordinate the work of interdistrict medical centers and assigned districts, interdistrict medical councils are created.
Ambulance service
The ambulance service in the countryside remains today both the most demanded and the most problematic.
Tasks:
Providing the sick and injured with first-aid medical care aimed at preserving and maintaining the vital functions of the body;
Delivery of them as soon as possible to the hospital for the provision of qualified and specialized medical care.
At present, the main trends have clearly emerged that have an impact on the organization of emergency medical care for the population of the country.
They are primarily associated with the following factors:
Increase in injuries and other accidents associated with man-made human activities;
Deterioration of the economic conditions of the population, social
instability, increased stressful situations;
Increased appealability and deterioration of the operational environment;
Weighting and chronicity of pathologies;
Deterioration of the material and technical equipment of the ambulance service brigades, the exhausted resource of the equipment, etc .;
Lack of a system for organizing first aid at the scene of the accident (injury) before the arrival of the ambulance team;
Socio-psychological problems of the ambulance personnel themselves and the conflicts caused by them, staff turnover, an increase in morbidity among service workers;
Provision of medical care to residents of a large number of small settlements, with their remoteness from the main medical and preventive institutions, lack of communications and communications.
At the same time, the existing system of organization of emergency medical care for the population, focused on providing patients with the maximum amount of care at the prehospital stage, does not provide the necessary efficiency, being, moreover, high-cost.
For the ambulance service in the countryside, both all of the above problems are characteristic, as well as those inherent only to it - the provision of medical care to residents of a large number of small settlements, when they are far from the main medical and preventive institutions, there is no communication and communication.
One of the consequences of the socio-economic crisis in Russia was the deterioration in the health status of the population. Over the past decade, there has been a persistent trend towards an increase in the mortality rate due to an increase in injuries, poisoning, diseases of the cardiovascular system of medical prevention and limited availability of drugs have led to the chronicity of pathologies and an increase in the population's need for emergency medical care.
Emergency medical care is socially significant species medical care, which in the new conditions economic development cannot be fully translated into market conditions management. Emergency medical care is in the first place in the "Program of state guarantees for providing citizens of the Russian Federation with free medical care", which implies the priority of its financing.
Ambulance stations in rural areas, like urban ones, are divided into categories depending on the number of calls per year. In rural areas, these are mainly stations of the third and fourth categories, serving respectively from 25 thousand to 50 thousand and from 10 thousand to 25 thousand calls per year.
The main structural and functional unit of the ambulance station is the paramedic brigade:
Two paramedics;
Orderly;
Driver.
The team provides the necessary medical care within the competence defined by industry norms, rules and standards for paramedic personnel. The composition and structure of the brigade is approved by the head of the station (department) of emergency medical care.
A specialist with secondary medical education in the specialty "general medicine", who has a diploma and a corresponding certificate, is appointed to the position of a paramedic of an emergency medical brigade; a specialist with a secondary medical education specializing in "general medicine" or "nursing".
The duties and rights of the paramedic of the mobile ambulance brigade and the paramedic (nurse) for receiving and transmitting calls to the station (department) of the ambulance, as well as their responsibility, are regulated by order of the Ministry of Health of Russia dated 26.03.99 No. 100 "On improving the organization of emergency medical care for the population Russian Federation".
Departments (branches) of emergency medical care are created on the basis of district hospitals and rural medical outpatient clinics with round-the-clock assignment of ambulance transport to them. Such organizational models make it possible to provide emergency and medical care guaranteed, around the clock and free of charge in accordance with the standards and protocols of patient management.
It is impossible to implement the tasks set without taking effective measures at the regional level, without constant and painstaking work on training, certification and certification of emergency medical personnel, especially the paramedic staff as the main personnel link of the service. As well as the logistics of the mobile teams.
In the decisions of the collegium of the Ministry of Health of Russia dated May 22, 2001 "On the state of medical care for the rural population", the health authorities of the constituent entities of the Russian Federation were recommended to develop and approve territorial action plans for the development of rural health care, incl. and in terms of the development of territorial programs for the development of the ambulance service.
When creating such programs, it is necessary to take into account priority directions in the development of emergency medical care:
Creation of a management scheme for emergency medical care in the constituent entity of the Russian Federation as a whole and in each settlement in particular;
Equipment modernization. Implementation information technologies an ambulance dispatching service and admission departments of hospitals with a clear formation of hospitalization flows;
Expansion of the volume of medical and diagnostic care on the basis of uniform medical and economic standards for the provision of emergency medical care and developed protocols for the management of patients;
Improving the remuneration system and tariff policy for institutions providing emergency medical care in rural areas.
The provision of emergency medical care is one of the factors national security... The level of its organization directly affects the reduction of losses to society from acute diseases, injuries, poisoning and other conditions, life threatening and public health. The priority for the development of the ambulance service in the countryside should be unified ambulance stations with a developed network of service units as close as possible to the villager.
THIRD STAGE
REGIONAL (LOCAL, DISTRICT, REPUBLICAN) INSTITUTIONS
A regional (regional, district, republican) hospital is a large multidisciplinary medical and preventive institution designed to provide highly qualified specialized care not only to rural residents, but also to all residents of a constituent entity of the Russian Federation. Manages healthcare government agency healthcare management of the administration (government) of the constituent entity of the Russian Federation in accordance with the legislation and within the powers granted to it.
The regional hospital is the center of organizational and methodological management of medical institutions located on the territory of the region (region, district, republic), the base of specialization and advanced training of doctors and nurses.
The capacity of the hospital is determined by the population of the administrative territory (including the administrative center), and the states, in turn, depend on the capacity. The optimal capacity of a regional (regional, district, republican) hospital is 700 - 1000 beds.
Tasks of the regional (regional) hospital:
Provision of highly qualified specialized consultative, diagnostic and medical care to the population of the administrative territory on an outpatient and inpatient basis using highly effective medical technologies;
Provision of advisory and organizational and methodological assistance to specialists of other health care facilities of the administrative territory;
Organization and provision of qualified emergency and planned consultative medical care using medical aircraft and ground transport;
Examination of the quality of the treatment and diagnostic process in medical institutions of the administrative territory;
Implementation of other expert functions on a contractual basis with health authorities and medical institutions of the administrative territory, licensing and accreditation commissions, health insurance funds, medical insurance organizations, etc.;
Development and implementation of measures for the implementation of targeted programs for the development of medical care under contracts with health authorities;
Implementation of modern medical technologies, economic management methods and principles of medical insurance into the practice of health care facilities of the administrative territory;
Participation in training, retraining and advanced training of medical workers.
The structure of the regional (regional) hospital:
Organizational and Methodological Department;
Consultative clinic;
Diagnostic department
A hospital with an admission department;
Department of Clinical Expert and Organizational and Economic Work;
Department of Expert and Planning Advisory Assistance;
Pathological department (bureau - in the absence of an independent republican (regional, district) bureau);
Other structural units necessary for the normal functioning of the hospital (catering department, accounting department, medical archive, library, garage, etc.);
Boarding house for patients;
Dormitory for medical workers.
Regional (regional) consultative polyclinic (OKP)
The activities of the regional hospital have their own characteristics. One of these features is the presence of a regional consultative polyclinic (OKP) in the hospital, where residents of all cities and districts of the region come for help, which makes it necessary to organize their accommodation. For these purposes, a boarding house or hotel for patients is being created.
Tasks of the OKP:
Providing patients referred from medical institutions of the district or district level with specialized qualified advice on establishing or clarifying the diagnosis;
Prescribing the volume and methods of treatment, if necessary, inpatient care in the departments of the regional hospital;
Assesses the quality of work of rural doctors, district city and district hospitals;
Together with the Department of Emergency and Planned Advisory Aid, he organizes and conducts field consultations of specialist doctors.
As a rule, patients are referred to the regional consultative polyclinic after preliminary consultation and examination by regional specialist doctors. To evenly distribute the flow of patients, the PCP regularly informs about the availability of vacant places in the boarding house, in the departments of the hospital, and coordinates the dates of admission of patients from rural institutions. For each patient, the OKP gives a medical opinion, which indicates the diagnosis of the disease, the treatment carried out and further recommendations. The polyclinic systematically analyzes cases of discrepancies in diagnoses, mistakes made by doctors of regional health care facilities during the examination and treatment of patients on the spot.
Department of Emergency and Planned Advisory Assistance.
A feature of the regional hospital is the presence in its composition of the department of emergency and planned consultative aid, which, using the means of medical aviation or other transport, provides emergency and consultative assistance with a trip to a remote locality or places of deployment (work) of rural residents.
Department functions:
Transportation of patients to medical institutions;
Dispatch of call specialists from the districts and liaise with the teams sent to provide medical care;
In urgent cases, the organization of the delivery of patients accompanied by medical personnel to specialized institutions outside the region;
Urgent delivery of various medical products and supplies necessary to save the lives of patients;
This department, as a rule, has a car park (some with high traffic) for driving into the countryside. Air missions are carried out on the basis of contracts with local airlines, which requires significant financial costs. The staff of the department includes, in addition to the head, doctors providing emergency medical care, a paramedic, and a nurse. All specialists of the regional hospital and other institutions can be involved in the work of the department. The Department of Emergency and Planned Advisory Aid, as a rule, is the basic medical unit of the regional center for disaster medicine. In this case, the practical work on the implementation of sanitary tasks is carried out by teams of specialized medical care of constant readiness - BSMPP.
Organizational and methodological department
In contrast to the city hospital, the functions of the organizational and methodological department in the regional hospital are much wider. In fact, it serves as the scientific and methodological base of the state health management body for the implementation of advanced organizational forms and methods of medical services for the population into practice.
Functions of the organizational and methodological department:
Analysis of the activity of health care facilities of the region;
Organizational, methodological and advisory assistance to health authorities and institutions of the region;
Study of health indicators of the population of the region;
Organization of increasing the codification of personnel;
Work planning.
The organizational and methodological work of medical institutions of the region is attended by:
The main staff (chief surgeon, therapist, pediatrician, obstetrician-gynecologist) specialists of the state health authority.
Freelance specialists (most often heads of specialized and highly specialized departments) specialists of the state health management body.
Offsite forms of work
In order to bring specialized medical care closer to the rural population, the teams of outpatient medical care, which are created on the basis of the Central Regional Hospital and regional hospitals, are of great importance. The visiting team is formed by the chief physician of the hospital from the number of full-time doctors and secondary medical personnel. workers. It may include honey. workers of other medical institutions (city hospitals, family houses, dispensaries, etc.).
Planned field consultations of specialist doctors at the regional (regional) hospital are organized and carried out by the consultative polyclinic in conjunction with the emergency and planned consultative care department.
Types of on-site forms of medical care:
Mobile medical outpatient clinics,
Clinical diagnostic laboratories,
Fluorographic installations,
Dental offices.
The main tasks of mobile forms of medical care of the population:
Performing a large amount of preventive and curative work.
To bring the provision of medical care to rural residents closer, to make it more accessible and timely.
Implementation of advisory assistance.