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The system of organization of medical assistance to the population in Russia. "organization of medical assistance to the population"

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Ministry of Health Protection Russian Federation

Siberian State Medical University

Department of organization of health protection and public health

abstract

On the topic: Organization medical assistance Moscow and

the rural population

Vikonav: Ondar Tupten Mongun-oolovich

Revised: Obraztsova Olena Mykolaivna

Tomsk 2014

Entry

1. Principles of organizing medical assistance to the population of the Russian Federation

2. Revagation of medical care to help the practicing

3. Dispensary method

4. The principle of specialization of medical assistance

5. Organization of curative and preventive assistance to the rural population

Visnovok

List of victorious literature

ATvedennya

The organization of likuval-prophylactic assistance to the population is hoped for both in the city and in the countryside. The organization of curative and preventive assistance to help the local population consists of three stages:

1. The primary medical and sanitary assistance (PHC) is established by outpatient and polyclinic facilities, hospitals, medical aid services, feldsher-obstetric stations, health centers.

2. Stationary medical assistance is carried out for the minds of the hospital.

3. Vіdnovne lіkuvannya - in the minds of hospitals and outpatient clinics.

Primary medical and sanitary assistance is the main, available kind of medical service, which is free for a skin hulk, which includes: treatment of the most wide-spread ailments, as well as injuries, injuries and other inconvenient conditions; medical prevention of the most important diseases; sanitary and hygienic lighting; carrying out other visits related to tasks health care assistance people for a living (Fundamentals of the legislation of the Russian Federation on the protection of the health of the people, at the editorial office of the Federal Law No. 122 "" dated 22.08.2004)1

The provision of likuval-prophylactic assistance will be consistent with the following principles:

1) the availability and free of charge of guarantees for a cost-free medical assistance in addition to the program of sovereign guarantees. The program has been appointed to see, obsyagi, the order of that mind and free medical assistance to the population. The program of sovereign guarantees is scrutinized;

2) inconsistency of judicious justice and prevention;

3) the onset of the pledges of health protection;

4) superiority of the nativnі MP pracyuyuchim;

5) dilnicity;

6) dispensary method.

Meta work - look at the organization of medical assistance to the population in the Russian Federation and the Republic of Bashkortostan.

To reach the goal, it is necessary to complete the following tasks:

1. review of the literature from the researched problem;

2. Vivchiti the main ambush of the organization of medical assistance to the population;

3. look at the main stages of primary health care assistance to the rural population.

1. Principles of organizing medical assistance to the population of the Russian Federation

For the organization of the first medical aid, there is an offensive between the helper, the polyclinic, the hospital. Spadkoєmnіst reach a way exchange of information between doctors of likuvalno-prophylactic installations, holding spilnyh clinical conferences, consultations - ce allows you to improve the qualifications of medical staff, reduce the duplication of illness.

1) agreement of a polyclinic with a hospital for the hospitalization of a patient;

2) written epicrisis is transferred to the polyclinic;

3) organization at the polyclinic of an annual medical treatment (additional treatment)

4) physicians of polyclinics work according to their will at the hospital.

2. Help for the medical help of the practicing

The medical care of the working people is established at the specialized establishments - medical and sanitary parts (MSL), medical or feldsher health centers. MSCH can be of the same type - serve the working enterprises, their relatives and the population of the adjacent territory. Ninі such є yak MCh, i closed type (tіlki pratsivnіv tsgogo podpriєmstva). Health centers and paramedics work according to the work schedule. Feldsher's health centers can be resuspended.

The work of the guild service is assessed, before us, by the form No. 16 - for the results of the analysis of disease with timchasovoy vtratsezdatnosti. An important division of the work of the shop doctor with often ailments (1 illness, 4 illnesses and 40 days of temporal incompetence on the river). The guild doctor keeps lists of people who often get sick. The jubilation is carried out according to the weather from high specialists. At the enterprises of the sanatorium-prevention center. Medical and sanitary parts can function like:

2. Consolidated liquor.

Medical assistance to the working people is also hoped for by a chaotic measure of judicious and preventive installations, we are in front, at the peaks, if the medical and sanitary part is not possible, and the number of working people is lower by the established standards. (Vitaminny plant of attachments up to 5th polyclinic. Cable plant - up to 1st polyclinic). At the reception, there was an extra window for serving the attendants.

Dilnichny principle - ce attached to the dilnichny doctor of the singing contingent of the population.

3. dispensary method

Clinical examination - actively guarding the camp of healthy contingents of the population (healthy and ill), taking these groups of the population into shape with the method of early manifestation of sickness, dynamic guarding and complex treatment of ailments expansion of sickness, renewal of practice and continuation of the period of active life 3.

The following stages are seen in the organizational process of clinical examination:

1. selection of contingent in the way of active manifestation, registration.

2. carrying out a complex of merry and socially preventive visits, tobto. zdijsnennya in the dispensary guard; assessment of the results of the effectiveness of clinical examination.

Examination of special medical examinations, as a rule, is carried out in case of admission of ailments by a doctor at a polyclinic or at home and after various preventive examinations, when the early stages of illness are detected. medical dispensary

Dynamic care of the 1st group (healthy) is needed for the help of short-term preventive medical examinations. For this group of dispensary care, a deep plan of recreational and health-improving prophylactic and social approaches is being developed, which includes how to improve the minds of the workforce, how to sanitary and hygienic enlighten that propaganda. healthy way life.

Dynamic caution of the II group may be on the basis of a change or a change in the injection of risk factors, an increase in resistance and compensatory abilities of the body.

In this hour, the method is zastosovuetsya in robots with a very small contingent of the population:

1. - children up to 18 years old;

2. - vaginal women;

3. - students of full-time education;

4. - Invalid Vijn;

5. - athletes;

6. - okremi groups of the population, depending on the basic SGP;

7. - ailments, yakі pіdlyagayut dispensary care.

The clinic sees dispensary days before working with dispensary ailments. Medical examination is carried out at 2 stages. Stage 1 indications:

1. Povnota stunned by medical glances;

2. The contingent that is given to the shoemaker medical look. Approximately 80% of the population is guarded by dispensary supervision. In addition, additional medical examinations are being carried out within the framework of the National Health Project. For medical examinations, the doctor-therapist is a long-term one, the general practitioners rose up the population, as they passed the medical examination, after 5 groups I will become healthy:

I - "practically healthy",

II - "with a high risk of developing an illness that will require preventive visits",

III - "what will be required for that exuberance in outpatient minds",

IV - "what will be required for that exuberance in stationary minds",

V - "what will require high-tech types of medical assistance".

Gromadyans, vіdnesenі:

up to group I - do not require dispensary care, they are held prophylactic conversation about a healthy way of life;

up to the ІІ-ї groups - a program of preventive visits is being developed, which are included in this APU;

up to III group - are assigned supplements and, if necessary - exaltation in outpatient minds;

up to group IV - supplements are assigned, and if necessary - exaltation in stationary minds;

up to the V group - to be sent to the Commission to the governing body of the health protection of the subject of the Russian Federation for the selection to require high-tech medical assistance.

The standard of medical examination includes obstezhennia with offensive fahivtsy:

1. Fluorography, mammography (for the female population older than 40 years) or ultrasound examination of the milk duct, ECG (electrocardiogram), OAM ( hot analysis section), CBC (high blood test), high cholesterol and lipid profile, cucor, tumor markers (40 years and older)

2. look at the specialists: a doctor-therapist for a long-term practice, an obstetrician-gynecologist (for the female population), a urologist (for the human population), a neurologist, a surgeon, an ophthalmologist, an endocrinologist.

Якість додаткової диспансеризації: відсутність вперше виявлених, захворювань на пізніх стадіях, у тому числі - онкологічних, туберкульозу, важких форм цукрового діабету, інсульту, інфаркту та інших захворювань, що ведуть до тривалої та стійкої втрати працездатності (через три місяці після завершення диспансеризації)4 .

4. The principle of specialization of medical assistance

Specialized brigade of Swedish medical assistance,

Higher specialists of outpatient clinics,

At the departments of rich profile hospitals.

At dispensaries.

Dispensaries - tse spetsializovani kuvalno-prophylactic mortgages for the active manifestation of ailments, likuvannya, rehabilitation and prevention. All dispensaries of republican significance are financed from the budget of the Republic of Belarus

Tipi: cardiological, medical and physical culture, shkirno-venereal and other. Dispensaries include a polyclinic and a hospital. An important part of the work - tse advisory assistance to the global security measures of likuval-preventive pledges.

Yakіst nadannya medichnoї podpomoga at spetsіalіzovannykh stsіonarakh vishcha, nіzh i nіzh іn tsіnаrі zagalny profile. For example, a cardiodispensary is a cardiological service to a hospital or a therapeutic service. However, an expensive form of medical help.

5. Organization jubilantly- preventive assistance to the rural population

You will be at the quiet organizational ambushes themselves, like the city's population. The head of them is a dilnichiy and a dispensary. The authority of the organization of medical assistance is characterized by low officials: the population of rural residents is small; distance of the place of residence in the district centers; weakly secure with the help of a call; the specifics of the minds of the workers and pobutu - the seasonal nature of the agricultural work 5. Contact with creatures, chemical fertilizers and other.

Features of medical assistance:

1. up to 40% of the obligatory medical assistance is given by middle medical practitioners - (feldsher-midwife stations);

2. great service radius;

3. lower security of material, technical and human resources (medical and diagnostic equipment, doctors, lizhkami);

4. more important than medical care for those employed by a strong supporter.

Stage I of providing medical assistance to the rural population of the rural medical station (SVU). The qualifications of the dolikarska and the medical aid are shown. The radius of the dilyanka is 5-7 (up to 20) km. At the warehouse of a rural medical clinic, there are: a rural medical clinic (SUB), a rural medical outpatient clinic (SVA), a FAP (feldsher-midwife station), a children's nursery, feldsher health centers at the hospital, and a prophylactic office.

Medical assistance is available for 6-8 specialties: therapy, pediatrics, dentistry, surgery, obstetrics and gynecology. Silska likarska dilyanka, which is located in the central region district likarni, vvazhєtsya ascribe that її the population is born with her. On the complex therapeutic division - 2000 and more adults and children.

Stage II - qualified specialty medical assistance at district medical mortgages, at the warehouse of the central district clinic, the central district pharmacy, district clinics, inter-district dispensaries (for 10-20 specialties).

ІІІ stage - highly qualified university specialists, practical help for all specialties, can be found in republican institutions, dental clinics, advisory clinics, centers, including the Centers for SNID, medical prevention, etc.

The 1st stage of providing medical assistance to the rural population is the rural dispensary (SUB). In the Republic of Belarus (2006) - 53. Chotiri of the fallow category in the wild quantity of beds, in the amount of 25 to 100 beds. At SUB, there may be a flare-up of in-patient rebuking. At the SUB, outpatient and inpatient medical help is expected: therapeutic, dental, infectious diseases, help for a half hour with term fluctuations, surgical and traumatological help, help for children.

The main functions of the rural medical clinic: providing qualified medical assistance; prevention of illness and traumatism; organizational and methodological care and control over the activities of feldsher-midwife stations and other facilities of the 1st stage, planned supervision of doctors to the required facilities of the 1st stage.

1. close medical assistance to the pracіvnikіv silskogo gospodarstva pіd h masovyh polovih works.

2. current sanitary supervision of installations and facilities, water supply, purification of settlements.

The following features of the organization of outpatient and inpatient care in the SUB vary:

1. there is no clear exchange for an outpatient appointment;

2. the year of admission of sickness is confessed at a convenient hour for the population with the improvement of the seasonality of agricultural work;

3. the possibility of receiving patients as a paramedic for the presence of a doctor;

4. Home visits are serviced by a doctor only at the point village, dezashovana SUB, home visits in other settlements of the rural health care station are serviced by a paramedic;

5. calling at the hospital with the right to change at home and obov'yazkovoy іnformatsiєyu staff about their own medical expenses, in case of need for indispensable assistance;

6. seeing a doctor for one prophylactic day for a day to get around the business.

When you visit the FAP, the doctor will methodically help you with the robotic FAP, and you can do the same basic visits to the missions:

a. revise the correctness and reliability of the records for the reception of ailments, according to splinters, dispensary care for pregnant women, children and those seriously ill;

b. consult patients who returned to the FAP, independently or requested by the doctor and paramedic;

With. provide and consult women at home, children under 2 years old, seriously ill;

The rural medical outpatient clinic (SVA) is expected to provide outpatient care. Functions tі w, scho th for the rural lіlnichnoї likarni, prote nemає tіlodobovogo hospital

Feldsher-obstetric station (FAP). The Republic of Bashkortostan has 2464 (2011) feldsher-obstetric points. The manager is a paramedic. In this hour, we are continuing the regulations on FAP, confirmed by the order of the Ministry of Health of the SRSR No. 1000, dated 1981. According to the standards, the feldsher-obstetric point is organized for the number of residents at a distance of 700 and more at the distance to the nearest medical mortgage at a distance of 2 to 4 km, for a population of 300-700 - 4-6 km, less than 300 people over 6 km.

At the feldsher-midwife point, paramedics can be trained; paramedic and midwife; paramedic, midwife and patronage nurse. Order for hot meals administrator of the rural settlement, and for special ones - the head doctor of the local medical center. Functions of the feldsher-obstetric point:

1. pre-caring medical assistance,

2. vikonanny appointment of a doctor,

3. patronage of children and women, guarding the health of the disabled and specialists of the agricultural state,

4. conducting prophylactic, anti-epidemic, sanitary and hygienic visits, immunization,

5. clinical examination of healthy and sick people,

6. sanitary and hygienic education and training of the population,

7. implementation of medical supplies through pharmacies of the 2nd category,

8. appearance and soundness, analysis of indications. Schomisyachno - call to the organizational method office of the central district likarni,

9. participation in the examination of non-practice data with the permission of the head doctor of the district.

II stage of providing medical assistance to the rural population - the central district clinic (TsRL). For exhaustion, it is divided into 6 categories from 100 to 400 pounds. The structure of the central district clinic:

1. hospital with supervision of the main specialties (therapeutic, surgical, pediatric, obstetric, gynecological, infectious),

2. polyclinic,

3. accompaniment of medical assistance and indispensable medical assistance,

4. pathoanatomical examination,

5. organizational - methodical cabinet and additional updates.

The head office of the CRL (the head office of the district) is ordered: from the main meals - to the administration of the municipal district, from the special meals - to the Ministry of Health of the Republic of Belarus. Spiral with your robots on your intercessors:

1. from the medical service of the population of the Ministry of Education and Science - the head of the organizational and methodological cabinet;

2. on the basis of childhood and blanket support (for the population of over 70,000);

3. for the medical part (for work in the hospital);

4. polyclinic (head of the polyclinic);

5. from clinical and expert work (KER) - from the examination of timchasovy unpracticality,

6. for the administrative - gospodarskoy part (AHCh) and іn.

For operational care, the central district medical center has a functioning medical council. The warehouse includes the patrons of the head doctor, the head sanitary doctor of the district, the head of the polyclinic, the district pharmacy, the head of the district professional council, medical practitioners, the partnership of Chervony Khrest, the head fakhivtsi district 6.

Organizational and methodological care of the health care of the district will be provided by: regional post-employment specialists to the district and the organizational methodological office of the CRL (OMK); senior paramedic and midwife for the district; district medical statistician

Functions of the organizational and methodological office:

1. Rozrobka zahodіv shkodo podvishchennya askostі nadannya medіcheskoї to help the population of the area. Vision of the robot. Various types of emergency assistance - medical teams, emergency outpatient clinics, dental offices, dental laboratories.

2. Methodical maintenance of likuvalno-prophylactic regulations for the district;

3. Analysis of demonstrations of work, folding of river records;

4. Promotion of qualifications of medical practitioners.

Stage III of medical assistance to the rural population - the republican medical establishment. Center for organizational and methodical care by the likuval and preventive institutions of the republic, the base of specialization and advancement of the qualifications of doctors.

For the pressure of the republican clinics, the clinics are subdivided into 5 categories. Priority directly to the development of health care in the countryside is the promotion and thorough outpatient care, health care of mothers and children

From the beginning of the 90s of the 20th century, reforms were introduced in the protection of health in the countryside. New therapeutic and pediatric clinics are being organized, reorganization of rural medical clinics at medical outpatient clinics, SVA at the FAP, medical care, which have been called, and sometimes concentrated in the CRL. Per stay rocky growing wider and wider see different medical help. Zocrema, medical teams, clinical and diagnostic laboratories, fluorographic installations, transfer dental offices and denture laboratories and others are organized.

The main functions of the Republican Clinical Medicine:

1. highly qualified specialized consultative-diagnostic and judicious assistance to the population of the republic in polyclinics and inpatient minds due to the high-efficiency medical technologies;

2. advisory and organizational and methodological support to specialists of other judicious and preventive institutions of the republic, for example, in front of the silskoy lanka;

3. organization and provision of qualified emergency and planned consultative medical assistance for the best services of air ambulance and ground transport;

4. zdіysnennya ekspertisi yakostі lіkuvalno-diagnostic process in the medical institutions of the republic;

5. Implementation of other expert functions on a contractual basis with the Ministry of Health of the Republic of Belarus (MOH RB), the Republican Fund for Education medical insurance(RFOMS) and branches of CHI and in;

6. following the agreement with the Ministry of Health of the Republic of Belarus and the development of the funds for the implementation of targeted programs for the development of medical assistance;

7. Vykoristannya practice likuvalno-prophylactic institutions of the Republic modern technologies, economical methods of management and principles of medical insurance;

8. participation in training, retraining and advanced qualifications of medical practitioners;

9. ensuring the effectiveness of preventive visits, promoting the level of sanitary and hygienic culture and actively promoting a healthy way of life.

In this rank, the Republican (Craiova, Regional) likarnya is a liquor, scientific-organizational, methodical and primary center for the protection of health.

Іsnuє 5 categories of republican (regional, regional) likaren, from 300 to 800 and more lizhok, the largest dotsіlny є likarnі for 700-1000 lizhok with usma specializations. Однак у кожній республіканській (крайовій, обласній) лікарні незалежно від її потужності повинні бути такі структурні підрозділи: управління (адміністрація, бухгалтерія, канцелярія, архів, бібліотека та ін.), організаційно-економічний відділ, консультативна поліклініка, стаціонар із приймальним відділенням, діагностичний Viddіl, vіddіlennya ekstrenoї planned-advisory medical assistance (OEKMP), vіddіl ACS, pathological-anatomical vіddіlennya, AHCH (garch-block, garage, laundry room, boiler house, warehouse accommodation and other pіdrozdіli), boarding house for sick people during the period of medical treatment, catering.

Head of the Polyclinic of the Republican Clinical Medicine:

1. we give advisory assistance to help the sick;

2. conduct viznі consultations of specialists;

3. analysis of the quality of outpatient care (conjuncture look around, information sheets with an assessment of the level of medical and preventive care in the regions).

To plan the work of polyclinics in the districts, vouchers for consultations are provided. In the republican clinical clinic, there is an organizational and economic department (OEO), which viconizes the function of the organizational method, which is a structural part of the republican clinic, and without intermediary subordination to the head doctor. Before the structure vіddіlu enter:

1. organizational and economic support;

2. clinical expert opinion;

3. information and statistical analysis.

The main tasks of the organizational and economic activity are to promote the practice of modern medical and information technologies, economic management methods, principles of medical insurance, training and retraining of medical personnel.

Крім штатних головних спеціалістів, є позаштатні головні спеціалісти, що призначаються наказом МОЗ РБ у складі висококваліфікованих провідних фахівців республіканських лікарень, диспансерів та інших лікувально-профілактичних установ м. Уфи, а також фахівців науково-дослідних установ та професорсько-викладацького університету.

Regional leading regional specialists - organizers of the event specialized assistance in a rural area, a highly qualified doctor-fahivets, the head of the department of the central district medicine, which is the highest category, is assigned. The appointment of that department of the head district specialist is the head physician of the central district likarni.

Основні завдання головного районного спеціаліста: розробка та проведення заходів щодо профілактики захворювань, впровадження у практику лікувально-профілактичних установ новітніх методів профілактики, діагностики та лікування хворих, з метою зміцнення здоров'я населення, зниження захворюваності, у тому числі з тимчасовою втратою працездатності, інвалідності that . Follow the close link between the strong foundations of health protection and the territorial administrative bodies and large organizations at the right level of medical assistance to the rural population.

In judicious-prophylactic installations, there is a function of operational control and control of quality, responsibility for internal control of quality, for additional standards of medical assistance.

Wshutdown

The legislator is responsible for the realization of the rights of the people to a free, publicly accessible medical assistance to the most important social value of the state.

The improvement of the organization of medical assistance at the pre-hospital and hospital stages has led to significant changes in the structure of the outpatient and inpatient stages of providing medical assistance to the population. The reform of the management and financing of the health care of the Russian Federation, the provision of medical insurance for the population presented new help to the doctor, which is the first medical aid at the pre-hospital stage

At the current stage, the development of health care has a special organizational and methodological role, as well as a judicious and advisory role of head fahivtsiv, as they work with the staff of the Ministry of Health Care (therapist, surgeon, pediatrician, obstetrician-gynecologist).

Wlist of victorious literature

1. Anopchenko T.Yu., Maksimov D.A. Organization of stationary medical assistance to the population of the great place in modern minds // Economic aspects of the strategy of modernization of Russia. Collection of scientific works / Ed. prof. Aloshina V A, prof., Chernishov M.A., prof. Anopchenko T.Yu. - Rostov n / D .: View of "AkademLіt", 2011. - 208 p.

2. Zhilyaeva E.P. The role of the state in the current health care of France // Problems of social hygiene, health care and the history of medicine. - 2006. - No. 1. - P.51-54.

3. Maksimenko L.L., Bobrovskii I.M., Muravyova V.M. Organization of curative and preventive assistance to the population of the Russian Federation (instructional guide) // Successes of modern natural science. - 2010. - No. 9 - S. 31-33.

4. Organization and assessment of the quality of literal and preventive assistance to the population: Edited by V.Z. Kucherenko. - Moscow, GEOTAR-Media, 2008 – 560 p.

5. Starodubov V.I. Primary medical help: a perspective for development: monograph / V.I. Starodubov, A.A. Kalininska, S.I. Shlyafer. - M.: Medicine, 2007. - 264 p.

6. Stepanov V.V. The main directives of the strong health care / V.V. Stepanov, E.A. Finchenko, I.A. Tsitsorina, A.V. Ganina, M.I. Braslavets, M.V. Gusev / The main direct development of the health care system. - Novosibirsk: Vidavnicha company Lada. - 2003. - S. 8 - 67.

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The protection of health is like a system of preventive, preventive, pro-epidemic, rehabilitative medical approaches, establishing sovereignty and municipal authority as a Galuzev structure, and the continuity of activities of structures - the elements of the system. Vaughn includes galleys:

curative-prophylactic (ambulatory-polyclinic medical, dispensary and other);

medical assistance to women and children;

sanitary and protiepidemic;

medical - pharmaceutical industry, pharmacy establishments and enterprises;

medical education and medical science - high and medium medical and scientifically advanced establishments;

sanatorium-resort install;

pathoanatomical, ship-medical and ship-psychological examinations;

obov'yazkove medical insurance (ZMS). Appointed organizations (see installations) to form the basis

Primary medical and social assistance

The primary medical and social assistance (PHC) and the relevant establishments are the zone of the first contact of the population with health care services. These people can be seen:

outpatient clinics;

women's consultations;

sanitary and epidemiological stations;

install fasteners and emergency assistance;

install a floor aid.

The WHO developed the strategy "Health for all until the year 2000", as if it would give the skin people the opportunity to lead a healthy, productive, social and economic way of life. The implementation of this strategy is possible through the primary medical and social assistance in the state institutions.

Have 1978 r. in Alma-Ata, the largest international conference was held, at which the concept of PMSD was broken up and a final resolution was adopted - the Alma-Ata Declaration.

Naychisnіshi establish, in which one hopes for the first medical and social assistance, - outpatient-polyclinic; in them, PMSD is manifested by professional and guild doctors (therapists, pediatricians), doctors of general practice (family doctors), as well as middle medical practitioners at feldsher and feldsher-obstetric centers.

The PMSD system is responsible for providing not only lucrative, but also preventive work, as well as organizing medical assistance to the attached population.

Ninі in Ukraine the first importance belongs to outpatient clinics, where 80-90% of all services fall. Until 2005 PHC in Russia

Tsya strategіya i vіdpovіdnі programs prodovhenі WHO and in the 21st century.

they gave about 16,000 outpatient clinics, some of which had about 60,000 doctors, including over 45,000 long-term therapists and 30,000 long-term pediatricians; for the time being, there are only a few doctors of global practice - more than 4,000.

The number of operative interventions that occurred in polyclinics increased in 1990-2005. more lower by 20%, accounting for 6.0 million in 2005. The number of allowances for 1 sack per river (including a bag and a medical aid) decreased from 11.0 in 1985. up to 9.0 in 2005

The functions of a doctor of a private (family) practice are significantly wider than the duties of a long-term therapist, a pediatrician, and include some of the services that are provided by fahivtsy doctors. With the priority development of primary health care and the provision of a doctor of general practice, a thorough medical assistance was provided to the population of the Russian Federation. There is a subsequent increase in the number of GPs (up to 7.5 thousand in 2007).

Functions of the doctor's internship practice:

ensuring the obligatory duty and the quality of the duty to the population of the outpatient-polyclinic likuvalno and prophylactic assistance;

promotion of the availability of the most important services, which are included in the structure of specialized assistance;

the minds of the minds of the way of life of the members of this family.

Physicians of indirect practice (family physicians) of goiter zdiisnyuvat dynamic observation of all members of the family, regularly conduct preventive visits.

Up to 95% of the doctors' and patients' examinations depended on the hospitality of all members of the same doctor by one and the same doctor, and the responsibility of such a doctor is more effective than the work of a long-term doctor. With the work of a doctor of general practice (family doctor), the number of direct consultations to doctors of other specialties changes, the number of comforts, respect for the health of all members of the family, saving an hour of patients of that doctor.

For the full work of the doctors of the global practice (family) it is necessary to ensure such activity in the countries, where the traditional health care service (France, Great Britain, Cuba, etc.)

Organization of outpatient care

Амбулаторно-поліклінічна допомога надається амбулаторіями та поліклініками, що входять до складу лікарень, самостійними міськими поліклініками, сільськими лікарськими амбулаторіями, диспансерами, вузькоспеціалізованими поліклініками (стоматологічні, фізіотерапевтичні та ін.), жіночими консультаціями та здравпунктами. In the country, there are over 16,000 outpatient clinics, the number of outpatients in them is almost 1.0 billion. Mayzhe 80% of all those who have turned for medical assistance, repair and end the exaltation in the minds of the clinic.

Among the outpatient and polyclinic facilities, the polyclinic and outpatient clinics are responsible for establishing over 75% of mortgages of the indirect type, and the number of medical windows they have is close to 85%.

Polyclinic- tse specializations of the LPZ, in which we hope to receive medical assistance if we are ill, if we come, and also if we are ill at home, a complex of preventive and curative approaches is created for treatment and prevention of illness and complication. The city's polyclinic is of great help to the population of the city. If the polyclinic is recognized exclusively or more importantly for providing medical assistance to practitioners of industrial enterprises, public health organizations and transport enterprises, then they should be respected by the medical and sanitary part (or the main part of the medical and sanitary part).

Ambulatory depends on the type of polyclinic equal to specialization and general activity. In the outpatient clinic, conduct an appointment for one specialty or a small number of specialties: therapy, surgery, obstetrics and gynecology, pediatrics and other.

Polіklinіki Rozniyati according to the organized Roboti (Op'Dnani Zi Statzіonar Ta Neconnani - Samostiyni), for the Teritarian acquaintance (MISKI TO SILSKI), behind profiles (Zagalni Ta -Tycho Tikhoennya, School of Service. specializations: dentistry, physiology, health resorts and others).

What kind of polyclinic is regulated by the Order of the Minister of Health of the SRSR? 1000 "Come in to thoroughly organize the work of outpatient clinics" (1981) with upcoming changes.

The intensity of the set number of personnel is calculated on the basis of the number of people who are served, and the estimated number of arrivals. For the number of medical advice for a change of 1200 and more up to 250, 5 groups of polyclinic institutions are established, the staff is paid, the organizational structure is appointed, and the financial authorities are responsible for the planned commitment to work.

The main structural developments of the Moscow polyclinic:

kerіvnitstvo polyclinics (head doctor, yogo intercessors);

registry with a table of dovіdok;

therapeutic and preventive care: therapeutic, shop therapeutic, surgical, traumatological, stomatological, dentures, ophthalmological, otorhinolaryngological, neurological, physiotherapeutic departments (offices), rehabilitation and physiotherapy; cardiological, rheumatological, endocrinological cabinets, infectious diseases cabinet, women's consultation; medical and feldsher health centers, dispensaries, medical care and non-essential help and assistance;

additional diagnostic departments: x-ray department (office), laboratory, department (office) of functional diagnostics, endoscopy office, office of the form of medical statistics, administrative and state part of that іn.

According to the decisions of caregivers in polyclinics, they can organize other services: stationary replacements for short-term care (wards), the so-called hospitals, as well as health centers, in addition to non-traditional methods of treatment on the basis of paid medical services and state transparency activities and int.

The city polyclinic, which is organized in places, work settlements and settlements of the city type, will work according to dіlnichno-territorial principle. Attached practitioners of industrial enterprises, business organizations and enterprises

transport is served according to the guild (virobnichim) principle. Doctors and nurses are attached to the skin yard, like they are giving help to the population of the yard. Therapists, pediatricians, obstetricians-gynecologists, phthisiatrics, if possible, other fahivtsy will work according to the dіlnichnym principle.

The most important type of outpatient care is therapeutic, organized according to a separate principle. Medical therapeutic dilyanka- the most important lanka at the system of medical assistance, and the long-term therapist - is the most important to stand on the sidelines of the system of protecting the health of the population. The number of grown-up population of a therapeutic farm should be the average of 1700, of a workshop - 1600 people (at the bottom of the farms fallow and with the minds of the workshops - up to 2000 people and less than 1000 people).

Dilnichny likar- not only a clinician, but also an organizer of health protection at the stage of PMSD. A good doctor needs to know the basics of public health and health protection, clinical medicine, sociology and psychology of the sim's. The dilnichiy doctor is to blame for the health of the population of his business and the factors that they inject into him, he is guilty of improving diyalnist, provadzhuvati new methods of diagnostics and likuvannya, elements of scientific organization of practice.

A good dіlnichny likar is, in fact, a likar of the global practice.

Compliant with the regulation "About the doctor-therapist of the long-term polyclinic (outpatient clinic)"

self-qualified therapeutic assistance to the population of the village in the polyclinic (ambulatory) and in the house;

for emergency medical assistance we are ill regardless of the time of living at times of uninterrupted occasions in case of guilty hospital stays, injuries, poisoning;

timely hospitalization of therapeutic ailments with obov'yazkovym frontal obstezhenniya under the hour of planned hospitalization;

consultation of sick people, in case of necessary medical conditions, from the head of therapeutic care, doctors of other specialties of the polyclinic (outpatient clinic) and other pledges of health care;

victoria modern methods prevention, diagnostics and healing of ailments, including complex therapy and fundamental healing (medication, dietary therapy, physical therapy, massage, physiotherapy, etc.);

examination of timchasovoj inappropriateness of ailments is evidently up to a dignified position on the examination of timchasovoj inappropriateness;

organization and conduct of the complex of visits to the medical examination of the mature population of the village (revealing, taking on the appearance, dynamic guarding, jubilant and health-improving visits), analysis of the effectiveness and quality of the medical examination;

organization and conduct preventive chips that deworming of the population of the village;

раннє виявлення, діагностику та лікування інфекційних захворювань, негайне повідомлення завідувачу терапевтичного відділення та лікаря кабінету інфекційних захворювань про всі випадки інфекційних захворювань або підозрілих на інфекцію хворих, про харчові та професійні отруєння, про всі випадки невиконання протиепідемічних вимог інфекційними хворими, направлення екстреного повідомлення про інфекційне sickness;

systematically improve their qualifications and equal medical knowledge of a long-term nurse;

more actively and systematically carried out medical and educational work among the population of the village, the fight against shkidlivimi zvichkami.

A long-term therapist works on a schedule that confirms the supervision of an appointment, in which the fixing of the year of an outpatient reception of ailments is carried out, help at home, and that other work is preventive. I gave an hour to take that help at home to lie down due to the number and warehouse of the population of the village, due to the fact that it was different.

The work of the long-term therapist of the polyclinic department of the medical center will be behind the system of care (work in the clinic, outpatient clinics and hospitals).

To improve the qualifications of professional doctors, send them to the institutes (faculties) for post-graduate education, to advanced courses and specializations with medical higher initial pledges, scientific and advanced institutions at least 1 time for 5 years.

Preventive work is aimed at, for us, by a wide crowd of physicians of outpatient clinics, especially long-term therapists, dispensary method. This is an active method of dynamic vigilance for the camp of healthy contingents (healthy and ill) of the population with the method of early manifestation of illness, taking on the appearance of that complex treatment of ailments, conducting visits to the recovery of the minds of the workforce, forgetting the ability to develop a healthy, wide form of illness life.

In today’s minds, specializations that are developing, in medicine, a long-term doctor has more preparations for a “healthy” rose of the sick, a lower “high” specialist, to that the wine will be sick in the social environment: at home, in the future, in the future pobut, often pratsyu, vzaєmini, yakі know your budget, the atmosphere sіm'ї. In addition, the dilnichiy doctor makes a synthesis of fahivtsiv’s veneers, together with them he puts together a plan to treat the sick to the lot.

In this manner, we have created a development of the concept of a “family” doctor, who may know not only the pathology of internal organs, but also other specialties and the building of PMSD.

Registry- Structural follow-up of the polyclinic, in order to make an appointment with doctors. The practitioners of the registry can be individuals, as they may be able to light up the middle and prepare the installation for the wiping of their shoes. On the landing of the head of the registry, important individuals are assigned, as if they could provide an average medical education.

The registry can be centralized, if it is the only one for establishing, and decentralized, if the registry office is registered at the reception to pediatricians, dentists, obstetricians-gynecologists and others For whom, on special tables, lie vouchers for admission until different doctors at different days of the week and at different hours. The patient chooses an hour convenient for the new one, and he will come to the reception with an outpatient card, so that he can take care of the new house. You can give a voucher for a sick person to receive a medicine.

Specially seen by the registrars, they record to the doctors of the workshops, draw up the doctor's records for the doctors, register the doctors' wikis to the sick at the house. One of the registrars is assigned the functions of a preparatory worker.

The medical card of an outpatient sick person is a single document, they are ill, with the drive of such ailments they go to the clinic, which helps the doctor to correctly diagnose and recognize healing. For the familiarity of the doctor with the transferred illnesses, we write down the diagnoses on the first side outpatient card- at the list of clarified diagnoses.

In order from the registry in a prominent place on the stands, name the street that enters the warehouse for the service area of the clinic, name the office and the office from the designated top, room numbers, graphics of the skin doctor's work.

Medical help at home- one of the main types of polyclinic activity. Medical assistance at home is hoped for in a healthy way: from 9 to 19 years old - a long-term doctor, at the right time in case of emergency - a Swedish doctor and an indispensable help.

When the doctor’s call is issued, the camp of the ailing is brought home, and in emergency situations, the chergovy doctor (due to the busyness of the long-term doctor) is vizhzhzhaev to the ailing negaino. In emergency cases, if you require hospitalization, a doctor calls for help. Data about the wiki should be entered in the journal. The steps taken by a doctor in a sick home are called active, as if the stench is broken by the doctor's initiative, we are ill without a cure.

The doctor takes care of conducting clinical and diagnostic examinations, consulting the sick with doctors of other specialties.

In all cases, in which hospitalization is indicated, the sick should be sent to the hospital. For daily indications before hospitalization, or in case of organizational difficulties, a long-term doctor organizes an inspection for illnesses at home hospital at home. For help, members of the Association of the Red Cross - activists, sanitary upgrades and nurses can be found. At polyclinics, united with a hospital, it is possible to organize eating from the kitchen of the liquor, seeing at the timchas's hospitalization of the whiteness and the objects of observation for ailments.

When we get sick, we get sick, we rejoice in outpatient clinics and at home, we see recipes for the cost-free withdrawal of medicines. A special order appoints such a group of ailments. The appointment of a doctor for help at home is to open up at the skin deposit, going out of actual vitrates for an hour. For help, at home, clinics provide doctors with special medical bags with a set of accessories, tools and medicines. Such bags are taken care of by the nurses of the villagers. Nurses see ailments, which are considered to be juicy procedures, or which follow the method of dispensary care.

The activity of polyclinics has a great role to play head of departments. Vin is assigned no less than nіzh at 9 medical positions in the therapeutic and 8 - in the surgical department. For a smaller number of settlements, one of the fakhivtsiv vikonu functions of the superintendent.

The function of the head of the department includes the folding together with the doctors in the schedule and the plan of the cuval and preventive work, the core and control over the organization of the cuval and diagnostic process, its effectiveness and efficiency, the examination of the unpractical hours. Qiu work manager in charge of viconu, periodically taking part in the appointments of doctors, inspecting the necessary symptoms of illnesses at home to carry out together with the doctors an examination of the temporal incompetence of the sick, assessing the severity of the sickness of the medical assistance. Important functions of supervising and advancing the qualifications of medical personnel, holding conferences, taking up modern methods of diagnostics and improving the technique of various medical procedures, systematic examination of the quality and effectiveness of diagnostically-diagnostic

At polyclinics, operational-oblique documentation has come:

medical card of an outpatient patient;

Statistical coupon for registration of the final (specified) diagnosis;

Urgent information about infectious disease, eating, gostra, occupational disorders, non-inferior reaction to splintering;

Talon of acceptance to the doctor;

The book of the record of viklikiv of the doctor at home;

Worker of a doctor of a polyclinic (outpatient clinic), dispensary, consultations;

Control card of the dispensary guard;

List of osіb, yakі pіdlyagayut tsіlovogo medical examination;

It is known that people are ill, that they are sent to the dispensary guard;

Leaflet of inappropriateness;

Coupon for referral to hospitalization;

Directly for consultation and additional offices;

Medical certificate about death;

Journal of the treatment of infectious diseases;

Journal for the record of VKK;

book of registration of sheets of non-sales data;

Recipe (grown up, childish);

Recipe for the removal of faces to avenge narcotic speech;

Recipe for picking up lika free of charge, with payment of 50, 20% of the cost and others.

Due to the introduction of medical insurance in some polyclinics, a single coupon of an outpatient patient is issued, in which registration is made for medical services. The rest are encrypted with ICD.

On the rights of a structural support, the polyclinic organizes cabinets of medical statistics, which are ordered without delay to the head healer or to the intercessor of jubilant work, for:

Organizations of statistical appearance;

control over the maintenance of documentation and the reliability of information that should be kept in it;

Ordering of oblique documents;

Storage of periodic tariff statistical sound;

rozroblennya oblіkovih and zvіtnih statistical documents;

The participation in the analysis of activities is set on the basis of these distributions;

Rational organization of the collection of observable documents in every possible way.

The Cabinet of Medical Statistics works in close contact with the staff of the polyclinic and physicians.

The most important document is a statistical source, which in the established term is given to the highest body of health protection management.

Caregivers of the pledges of health protection have been given the right to draw up individual norms for the recruitment of doctors in outpatient clinics (pіdrozdіlіv) depending on specific minds (demographic stock of the population, disability, compactness of business, provision of transport, food). The Kerivnikov Mountains Zhoreni is healthy, Visidichi of the Neckodniki, to the blue, they are abusedly, they are not navigated for them with stagnant standards, for the rachon, there are a lot of installations of the settings of the settings. Posad at be-yakoy order.

Galuze normative acts of practice and recommendation, staff standards (11.0 plant a medicinal plant per 10,000 population) are vikoristovuyutsya as an additional help to the number of settlements of medical personnel.

Like a butt, you can bring such roses (the stinks of different ones at different installations, different plots). Rosrakhunkovy hour on the first meeting of a long-term therapist until the 22nd of the month, on the second meeting - the 16th of the month. Multiplicity of blows to become 2.5. The average time spent at the likuvalno-diagnostic examination at the polyclinic until about 18 min. The rate of recruitment (service) - the number of jobs that are counted in one hour (60 hours) for the doctors of the outpatient reception (a person for a year), become 3. The Program of State Guarantees of Cost-Free Medical Assistance determined “an indication of obligatory outpatient and polyclinic assistance” – the number of admissions per 1000 cases – 9000 admissions, including for the basic program of ZMS – 8000.

Doctors of polyclinics work 5 days a day out of two weekends. From a 6.5-year working day to an average of 0.5 years, it is spent on work, it does not lead to judicious and diagnostic and preventive activities (conferences, awards, service calls, necessary special hours). Otzhe, rozrahunok number of settlements likarіv outpatient priyom to go for obsyag work. The structure of the medical settlements is determined by the kerіvnitstvo of the polyclinic.

The number of middle and young staff in outpatient clinics is dependent on the number of medical staff. It is recommended to lay down according to the type of establishment at the average for Moscow polyclinics 1:2.2, and for outpatient and polyclinic subsets, spreading in towns and villages with a population of less than 25,000 people, 1:(3.5-3 ) and lie down due to the nature of the settlement.

In the rest of the hour, a contract system was adopted for the reception of specialists. The payment is carried out according to the tariff scale with improved qualifications (categories), in certain institutions - with improved obligations and performance. Workers and practitioners, cabinets, responsible for arranging planting orders.

Unfortunately, there is no single report card for equipping polyclinics (and hospitals). The plant is equipped with fallow equipment in terms of material and technical capabilities and initiatives of kerіvnitstv (spіvrobіtnikov).

Often the organization of the work of practitioners is determined by the care of the polyclinic with the improvement of legislation in practice: the polyclinic may work 5 days per week (on Saturday that week, the work is carried out without additional help).

In 2006, the coming fates of the national project "Health", will be adopted from the initiative of the President of the Russian Federation V.V. Putin, transferring significant supplements to the developmental programs and plans for the health care system, and ahead of the primary health care. The main directives of the national project "Health" are the development of primary medical assistance, preventive directing medical assistance, increasing the availability of high-tech (expensive) medical assistance, and other important inputs. Іstotniy-

In addition, the allocation for the project was increased, especially for the first medical assistance. For example, only for development for 2 years (2006, 2007) are seen to be over 68 billion rubles. Transferred zbіlshennya 3 yew. числа ВОП, скорочення коефіцієнта сумісництва (до 1,4 і нижче), підвищення рівня кваліфікації лікарів, зниження термінів очікування діагностичних досліджень, терміну зношування діагностичного обладнання, додаткове оснащення ЛПЗ медичним обладнанням, машинами «швидкої допомоги» (більше 12 тис. за 2 роки ). Dilnichni likar-therapists, pediatricians have become dodatkovo to their rates otrimuvati 10 thousand. rub., And young medical sisters for these programs - 3 yew. rub. at the month. Increased wages for medical practitioners and indispensable assistance, and the wages of other doctors and medical staff are raised to the plan. Medical examination and її financial security are being strengthened - since 2006 and in the coming years.

Organization of inpatient medical assistance

In the present hour (2005) in the health care system of the Russian Federation, there are about 8.0 thousand. (7835) medical establishments (1990 - 12.5 thousand), which may be 1672.1 thousand. lizhok. The provision of drug lizhki decreased from 130.5 per 10,000 population in 1990. up to 121.5 in 1992 and 108.2 in 1999, up to 95 in 2005.

The average duration of the stay of a sick person at the hospital practically did not change: 16.6 days in 1990, 17.0 days in 1992. that

15.8 days in 1999, 13.7 in 2005, but the average number of days of employment increased from 289 to 327. The rate of hospitalization decreased: in 1985. Vіn becoming 24.4 per 100 inhabitants, in 1999 p. .- 20.9, i in 2005 - 23.5.

Kriza protect your health, madly, slammed and likarnyany mortgage. Tse manifests itself in front of the fact that a significant part of the loan fund does not show signs of sanitary norms that rules, but the material and technical base does not allow conducting a judicious-diagnostic process clearly to the present day. Lіzhkovy fund in rich vipadkah vikoristovuєєt lacking and not recognized. Employment of the hospital during the rest of the years was significantly lower than the normative one and became on average 290-307 days on the hospital, 30-50% of the patients did not require hospitalization and could go through an obstezhennaya and receive treatment at the pre-hospital stage. At the same time, up to 70% of financial and material and technical resources are invested in the development of inpatient medical care.

In the implementation of economical methods of managing the health system, the HMS system and the need for increased competitiveness of judicious and preventive measures to adopt structural health care, including inpatient medical assistance. Tsya reorganization is obliged to follow such basic directives as far as the concept of the development of health protection and medical science (1997), which is the health intensity of the literal-diagnostic process.

Organization of medical care (independence) due to the high intensity of the liquor-diagnostic process. Mostly hospitals, in which one is expected to receive emergency medical assistance. Qi LPZ can be equipped with good medical facilities, mothers are significantly more secure with medical personnel, medical supplies, soft inventory and other equipment.

The number of lizhok in such hospitals to become up to 20% of severe lizhkovo natuzhnosti, the average term perebuvannya in them is small, it is necessary only for the adoption of hospitals, more than ailments of guilt are transferred to other likuvalnye mortgages.

Likarni (vіddіlennya), zorієntovanі likuvannya planned ailments mid-line perebuvannya, tobto. on the double glee. Vidpovidno standard equipment, staffing and

other care of such hospitals, otherwise, the middle term of rebuking the ailing person for a lie, otherwise the need for the staff. Approximately the number of lizhok in likarnyah mortgages of this type to become up to 50% of the total lizhkovo natuzhnosti.

Medical (additional) care and medical rehabilitation is important for those with chronic illnesses. The number of lizhok they have to become up to 20% due to severe lizhkovo natuzhnosti.

Medico-social likarnі (vіddіlennya) - likarnі nursing care, hospіsi. Organizations for the protection of health and social security can direct patients to such a setting. Such a setting can become up to 20% of the total pelvic pressure.

In whom are selected and developed federal, regional centers and specialized medical assistance of various profiles, in which new medical technologies and diagnostics are established.

The current system of providing medical assistance is responsible for ensuring the development of specializations and the promotion, as a rule, of the most expensive new technologies.

Сучасне реформування охорони здоров'я спрямоване на інтенсифікацію стаціонарної медичної допомоги, скорочення (на 20% і більше) числа ліжок, що неповно використовуються, зменшення термінів перебування хворих на ліжку, передачу частини стаціонарної допомоги амбулаторно-поліклінічним установам, стаціонарам вдома та іншим нестаціонарним ЛПУ abo hospitals, often of which reach more than 15% of all services, which are earlier obtained in day-to-day, so great, hospitals).

In this hour, the international standard sets the optimal size of the cavernous type of medicine at 600-800 pounds, and the allowable minimum size is 300-400 pounds, which gives the opportunity to open up the medicine for them for 5-7 main specialties and improve management.

Providna likarnyana installation - mіska likarnya- LPZ, which provides qualified services to the population on the basis of modern medical science and technology.

Behind the view, the nature of the given medical assistance and the organization of the work of the hospital can be:

for a profile - a rich profile or a special one;

from the organization - associations are not united from the polyclinic;

for an obligatory duty - different categories (lizhkovo natuzhnosti).

The main task of the Moscow likarni is a highly qualified likuval-preventive service to help the population.

An important division of activity - offensiveness in obstezhennі and likuvanni ailments between polyclinics and hospitals, yak reach:

Mutual information between the doctors of the polyclinic and the hospital about the camp of ailments, directing to hospitalization and prescription from the hospital (directly from the outpatient card to the hospital for hospitalization of planned illness and medical records from the history of the country);

Actively trained doctors in the hospital to participate in clinical examination and analysis of efficiency;

Specialists of the hospital came to improve the qualifications of doctors in polyclinics (spilny clinical conferences, analysis of pardons, consultations on a regular basis), participation in the promotion of qualifications of doctors (courses, doctors).

Behind the profile of the middle medical mortgages, rich professional and general hospitals, in some cases, are responsible for various medical specialties. Specialized hospitals, such as, for example, cardio-rheumatology, infectious diseases, gastroenterology, pulmonology, dermatovenereology, sloping booths, ophthalmology, sound roses at great places.

Like global, so and specialized hospitals can be clinical bases of medical universities, universities, academies, research institutes. For example, on the basis of Russian medicine? 15 i? 57 Moscow was given a low clinical department of the Russian State Medical University.

In the country, a low center of specialized medical assistance has been created as a scientific, organizational, methodological and literal-diagnostic association for important clinical specialties. They conduct a search for new effective methods of prevention, diagnosis and treatment of diseases, expand the rational organization of specialized medical assistance, prepare highly qualified personnel. It is also a center for oncology, surgery, cardiology, pulmonology, nephrology, gastroenterology, and the care of healthy mothers and children.

From the organization of work, the establishment of the protection of health is more important - the united librarian, on which the head likar stands. Vіn vydpovidaє for all likuvalno-prophylactic, administrative-government and financial activities establish. The head physician of the joint medical intercessors from medical, polyclinic and administrative-government work. Головний лікар організує та контролює правильність та своєчасність обстеження та лікування хворих, догляд за ними, диспансерне обслуговування, проведення профілактичних та протиепідемічних заходів у районі діяльності, підвищення кваліфікації медичного персоналу, правильність ведення історій хвороби, забезпеченість лікарні медичним та господарським обладнанням. Vіn systematically analyzes the indications of the work of the hospital, confirms the plans for the work and the cost of the hospital, controls the correctness of the staining of materials and medicines, vouches for the sanitary camp of the hospital, for the selection and placement of personnel.

The intercessor of the head doctor from the medical part of the vіdpovіdaє for the quality of the medical activity of the likarni bezporeddno cheruє likuvalno-prophylactic and sanitary-protiepidemic work of the likarni; reviewing the effectiveness of likuvalno-prophylactic approaches; analyze skin patterns of death in hospitals at home; ensure the correct organization of juicy meals and exercise therapy; organize consultative help for the sick.

The intercessor of the head physician at the polyclinic without intermediary care for the robot of the polyclinic and the organization of the polyclinic to help the population; rozroblyaє plans likuvalno-prophylactic and anti-epidemic visits to polyclinics and safety of their visits; appoint a control and expert commission and a keruє її work; organize a dispensary for the installed contingents of the population and control over yoga quality and efficiency; systematically fighting the disease of the population in the service area.

Заступник (помічник) головного лікаря з адміністративно-господарської частини керує всією адміністративно-господарською діяльністю лікарні, забезпечує постачання предметів господарського обладнання та інвентарю, продуктів харчування, палива, гарячої води, освітлення, організовує харчування хворих, опалення, проведення ремонту, протипожежні заходи, білизну government, transport, etc.

The main statistical appearances for the hospital:

Medical card of a stationary sick person (history of sickness);

A leaflet to the appearance of ailments and a lizhkovy fund;

Map of vibes to the hospital;

Liquor sheet.

Colors and other oblіkovі statistichnі forms wink at the folding of the river sound.

For the analysis of the duration of the hospital, the average employment of the patient, the turnover of the patient, the average duration of the stay of the sick at the hospital, mortality, the frequency of clinical and pathological anatomical diagnoses are considered.

Organization of medical assistance to the local

the rural population

1. Principles of organizing medical assistance to the population of the Russian Federation

2. Revagation of medical care to help the practicing

3. Dispensary method

4. The principle of specialization of medical assistance

5. Organization of curative and preventive assistance to the rural population

Entry

1. The primary medical and sanitary assistance (PHC) is established by outpatient and polyclinic facilities, hospitals, medical aid services, feldsher-obstetric stations, health centers.

2. Stationary medical assistance is carried out for the minds of the hospital.

3. Vіdnovne lіkuvannya - in the minds of hospitals and outpatient clinics.

Primary medical and sanitary assistance is the main, available kind of medical service, which is free for a skin hulk, which includes: treatment of the most wide-spread ailments, as well as injuries, injuries and other inconvenient conditions; medical prevention of the most important diseases; sanitary and hygienic lighting; carrying out other visits related to medical and sanitary assistance to the community for a living.

The provision of likuval-prophylactic assistance will be consistent with the following principles:

2) inconsistency of judicious justice and prevention;

3) the onset of the pledges of health protection;

4) superiority of the nativnі MP pracyuyuchim;

5) dilnicity;

6) dispensary method.

1. Principles of organizing medical assistance to the population of the Russian Federation

1) agreement of a polyclinic with a hospital for the hospitalization of a patient;

2) written epicrisis is transferred to the polyclinic;

3) organization at the polyclinic of an annual medical treatment (additional treatment)

4) physicians of polyclinics work according to their will at the hospital.

2. Help for the medical help of the practicing

1. APU

2. Consolidated liquor.

Dilnichny principle - ce attached to the dilnichny doctor of the singing contingent of the population.

3. dispensary method

The following stages are seen in the organizational process of clinical examination:

1. selection of contingent in the way of active manifestation, registration.

2. carrying out a complex of merry and socially preventive visits, tobto. zdijsnennya in the dispensary guard; assessment of the results of the effectiveness of clinical examination.

Dynamic care of the 1st group (healthy) is needed for the help of short-term preventive medical examinations. For this group of dispensaries, a comprehensive plan of recreational and health-improving prophylactic and social approaches is being developed, which includes how to improve the minds of the workforce, how to promote a healthy way of life.

Dynamic caution of the II group may be on the basis of a change or a change in the injection of risk factors, an increase in resistance and compensatory abilities of the body.

In this hour, the method is zastosovuetsya in robots with a very small contingent of the population:

1. - children up to 18 years old;

2. - vaginal women;

3. - students of full-time education;

4. - Invalid Vijn;

5. - athletes;

6. - okremi groups of the population, depending on the basic SGP;

7. - ailments, yakі pіdlyagayut dispensary care.

The clinic sees dispensary days before working with dispensary ailments. Medical examination is carried out at 2 stages.

Stage 1 indications:

1. Povnota stunned by medical glances;

2. The contingent that is subject to obov'yazkovomu medical examination. Approximately 80% of the population is guarded by dispensary supervision. In addition, additional medical examinations are being carried out within the framework of the National Health Project. For medical examinations, the doctor-therapist is a long-term one, the general practitioners rose up the population, as they passed the medical examination, after 5 groups I will become healthy:

I - "practically healthy",

II - "with a high risk of developing an illness that will require preventive visits",

III - "what will be required for that exuberance in outpatient minds",

IV - "what will be required for that exuberance in stationary minds",

V - "what will require high-tech types of medical assistance".

Gromadyans, vіdnesenі:

up to group I - do not require dispensary care, they are held prophylactic conversation about a healthy way of life;

up to the ІІ-ї groups - a program of preventive visits is being developed, which are included in this APU;

up to III group - are assigned supplements and, if necessary - exaltation in outpatient minds;

up to group IV - supplements are assigned, and if necessary - exaltation in stationary minds;

up to the V group - to be sent to the Commission to the governing body of the health protection of the subject of the Russian Federation for the selection to require high-tech medical assistance.

The standard of medical examination includes obstezhennia with offensive fahivtsy:

1. fluorography, mamography (for the female population over 40 years of age) or ultrasound examination of the breast, ECG (electrocardiogram), OAM (seminal analysis of the cross section), OAC (salt blood test), high cholesterol and lipid profile, tsukor, tumor markers ( 40 older and older)

4. The principle of specialization of medical assistance

For the okremo ї category of ailments, special medical assistance is organized, which we hope:

Specialized brigade of Swedish medical assistance,

Higher specialists of outpatient clinics,

At the departments of rich profile hospitals.

At dispensaries.

dispensary - tse spetsializovanie likuvalno-prophylactic pledge for the active manifestation of ailments, likuvannya, rehabilitation and prevention. All dispensaries of republican significance are financed from the budget of the Republic of Belarus

Tipi: cardiological, medical and physical culture, shkirno-venereal and other. Dispensaries include a polyclinic and a hospital. An important part of the work - tse advisory assistance to the global security measures of likuval-preventive pledges.

5. Organization of curative and preventive assistance to the rural population

Features of medical assistance:

1. up to 40% of the obligatory medical assistance is given by middle medical practitioners - (feldsher-midwife stations);

2. great service radius;

3. lower security of material, technical and human resources (medical and diagnostic equipment, doctors, lizhkami);

4. more important than medical care for those employed by a strong supporter.

Medical assistance is available for 6-8 specialties: therapy, pediatrics, dentistry, surgery, obstetrics and gynecology. Sіl'ska likarska dіlyanka, which is located in the area of the central raion likarnі, is respected by the ascribed that її the population goes straight to it. On the complex therapeutic division - 2000 and more adults and children.

Stage I of medical assistance to the rural population - Silska dilnichna likarnya (SUB). In the Republic of Belarus (2006) - 53. Chotiri of the fallow category in the wild quantity of beds, in the amount of 25 to 100 beds. At SUB, there may be a flare-up of in-patient rebuking. At the SUB, outpatient and inpatient medical help is expected: therapeutic, dental, infectious diseases, help for a half hour with term fluctuations, surgical and traumatological help, help for children.