Organization of medical assistance to the rural population. Organization of medical care for the rural population

WHAT IS THE CITIZEN CONCERNING? Demography Efficiency of resource use Public opinion Increasing the competitiveness of the region (okrug) Salary Professional development Career growth Working conditions High living standards Quality of medical services Payable Queues Insecurity Priorities WHAT ARE THE MINISTRY OF HEALTH CARE? WHAT ARE WORKERS OF HEALTHCARE?

Health care rural population it is provided on general principles, however, the implementation of therapeutic and preventive measures in the optimal volume and at a sufficient level is complicated by a number of circumstances that must be taken into account when organizing it: socio-economic conditions; medical and demographic characteristics; the state of morbidity and disability; natural conditions; development of infrastructure in general and the network of medical institutions

DEVELOPMENT OF RURAL HEALTH IN UKRAINE CHARACTERISTICS DEMOGRAPHIC INDICATORS OF RURAL POPULATION RURAL POPULATION Mortality from external causes of death on 43.6% higher than the urban mortality rural population 19.3% higher than the birth rate URBAN RURAL POPULATION BY 16.7% HIGHER THAN URBAN POPULATION RURAL POPULATION MORTALITY FROM NEW ROCATIONS IS 11.9% LOWER THAN URBAN POPULATION INFANT RURAL POPULATION MORTALITY IS 31.9% HIGHER THAN URBAN POPULATION MORTALITY IS 31.9% ABOVE OVER THE CITY POPULATION. THAN THE URBAN POPULATION MORTALITY OF THE RURAL POPULATION FROM DISEASES OF THE DIGESTIVE ORGANS IS 4.5% LOWER THAN IN THE URBAN POPULATION THE MORTALITY OF THE RURAL POPULATION FROM DISEASES OF THE RESPIRATORY POPULATION IS 56.1% HIGHER

Stages of rendering medical care to the rural population: Stage II (district medical institutions - CRH, RB, NRB) Stage I (SVU, AOPSM, FAP) Stage III (regional medical institutions - regional hospital, specialized dispensary) Stage IV (state specialized centers, clinics of research institutes)

Gradually, to the extent of the restructuring of the network and the increase in the provision of medical personnel, the principle of stages entered into its formation: Stage I - the rural medical section provides primary health care. Stage II - regional medical institutions provide mainly secondary (specialized) care (primary care at this stage is provided only to residents of the regional center and adjacent villages - the assigned area). Stage III - regional hospitals and dispensaries provide highly specialized care. In modern conditions, stage IV has also formed, which is represented by interregional and state specialized centers. In addition, urban health care facilities are also significantly involved in the provision of medical care to the rural population.

The main tasks of the district hospital: providing the population of the district with outpatient and inpatient medical care; implementation of medical and preventive and general health-improving measures for the health care of mothers and children; organization and implementation of measures to prevent and reduce morbidity and injuries; introduction of modern methods of prevention, diagnosis and treatment; organizational and methodological guidance and control of the activities of health care institutions of the medical area.

The rural outpatient clinic carries out: early detection of diseases and risk factors; timely treatment of patients in the outpatient clinic and at home; selection of persons who need dispensary observation, their timely examination, treatment and recovery; organization of ambulance and emergency care; referral for consultations and preparation for examination by doctors-specialists of regional institutions during their planned visit to a rural medical area; timely hospitalization of patients; examination of temporary disability; referral to the medical and social expert commission (MSEC) of patients with signs of persistent disability; dynamic monitoring of the health status of women and children; scheduling and conducting consultative appointments of patients in the territory of FAPs; carrying out health-improving and anti-epidemic measures.

Responsibilities of the head of the FAP conduct outpatient reception and service calls; fulfilling the prescription of doctors, carrying out certain physiotherapy procedures and laboratory research; participation in the organization of preventive medical examinations, in the selection of persons for dispensary observation; organization of transportation of patients to the appropriate medical institutions, while accompanying sick children under the age of one year; early detection of infectious patients; provision of isolation, and, if necessary, hospitalization of these patients; the implementation of patronage of patients with tuberculosis, mental disorders; participating in their outpatient care;

Vaccinations; anti-epidemic measures in the cells of infectious diseases; carrying out the current sanitary supervision over the proper facilities and the territory of the settlement; carrying out measures for the prevention of agricultural injuries; implementation of medical and hygienic education of the population; drawing up FAP work plans; filling out accounting documents and drawing up a report of the feldsher-obstetric station (form 024); issuance of certificates of incapacity for work (in accordance with the relevant order of the regional department (department) of health).

Responsibilities of the FAP midwife: annual census of children under 15 years of age; outpatient reception of children, pregnant women, gynecological patients and the provision of medical care at home; organization of consultations with a local doctor (pediatrician) in case of diseases of children (especially young children), timely admission to the appropriate hospital; conducting preventive examinations of all women; patronage of pregnant women and children;

Referral, if necessary, of women to an obstetrician-gynecologist; fulfillment of doctors' prescriptions for children, pregnant women and gynecological patients; conducting certain physiotherapy procedures and laboratory tests; provision of emergency care for acute illnesses and accidents; vaccinations; medical and hygienic study of women and children.

Settlement of less than 100 inhabitants Settlement of less than 100 inhabitants Improvement of medical care for the rural population, including first aid Departments of the general public health department Central district hospital Inter-municipal centers Inter-territorial polyclinics (from 100 to 200 thousand inhabitants) Inter-municipal centers Inter-territorial polyclinics (from 100 to 200 thousand inhabitants) Feldsher's FAP stations First aid households Settlement from 100 to 300 inhabitants Settlement from 100 to 300 inhabitants Settlement from 300 to 700 inhabitants Settlement from 300 to 700 inhabitants Settlement of 1500 inhabitants Settlement of 1500 inhabitants Settlement of about 3000 inhabitants and more Settlement facility with about 3000 inhabitants and more Outpatient clinics Complex area Mobile medical teams Developed infrastructure: roads, communications, telephone communications First aid to the population Subdivisions and branches District hospital Settlement 1700 residents Settlement 1700 residents "20

Implementation of modern methods of diagnostics and treatment into the practice of the district's health care facilities; Providing emergency and emergency medical care;

Organization of advisory assistance; organizational and methodological management of the work of all health care facilities of the district, as well as control of their activities; development and implementation of measures aimed at improving the quality of medical care; development, organization and implementation of measures to improve the qualifications of medical personnel and the rational use of medical personnel and material and technical resources; planning, financing and organization of material technical support health care institutions of the region.

Areas of organizational and methodological work analysis of population health indicators; analysis of performance indicators of health care facilities of the district; study and dissemination of best practices; planning and organizing visits of CRH specialists to rural areas for advice to the population and doctors; planning and ensuring the conduct of preventive medical examinations; planning and organizing advanced training of medical workers of district and district health care facilities; development of measures to improve medical support for the population of the region.

Functions of the district pediatrician consultative assistance to workers of the health care facilities of the district center, rural medical districts on the organization of medical care for children; visiting FAPs and rural hospitals (outpatient clinics), examining healthy children and consulting sick children, checking the timeliness of preventive vaccinations and sanitary and anti-epidemic measures; control over the conduct of dispensary supervision over children, primarily in the first year of life; for carrying out preventive vaccinations for children; drawing up, together with the sanitary-epidemiological station (SES), a plan of anti-epidemic measures aimed at combating childhood infectious diseases, participation in its implementation;

Provision of advanced training in pediatrics for doctors in rural areas, medical workers of preschool institutions and schools, patronage nurses, medical personnel of FAPs; visiting preschool institutions, monitoring their activities; analysis of reports of children's health care institutions, study and assessment of the health status of children in the rural area and the activities of health care facilities, generalization of the data obtained and the development of specific measures to improve the quality of medical care; involvement of representatives of local authorities, public organizations, and Red Cross Society activists in activities aimed at improving medical care for children.

Scheme of financing the levels of medical care to the population in the city hospital 25 Donetsk 1 LEVEL: Family medical outpatient clinic Family doctor - holder and distributor of finances 2 LEVEL: CRH, RB, NB, Consultative and diagnostic centers 3 LEVEL: Oblast hospital, Specialized inpatient care Budget financing per capita Extra-budgetary funds Funds raised through Insurance companies Payment from the family doctor's fund for each patient on a completed visit without a family doctor's referral Consultation of narrow specialists by purchasing insurance policies for patients Diagnostic tests are carried out by purchasing insurance policies Payment from the family doctor's fund for clinical-cost groups of diseases Finances attracted by insurance companies a sample Scheme of financing the levels of health care for the rural population Click for larger picture

The main tasks of the regional hospital: providing the population of the region in full with highly specialized inpatient and consultative polyclinic care; organization and provision of emergency and advisory medical care in the region; introduction of modern methods and means of diagnostics, treatment, work experience of the best medical institutions into the practice of the hospital; advanced training of doctors and nurses of medical institutions in the region; organization, management and control of statistical accounting and reporting, preparation of consolidated reports, analysis of performance indicators of medical institutions in the region; development of measures aimed at improving the quality of medical care and improving the health of the population.

Satisfaction of the population with the quality of medical care in 2011 56.3% - upon receipt of inpatient medical care 41.8% - upon receipt of outpatient care 68.4% - upon receipt of inpatient-substituting medical care Satisfied with the quality of medical care according to a sociological survey 50.8 % of respondents Satisfied with the quality of medical care according to a sociological survey 50.8% of respondents The number of complaints from the population about: the quality of food in hospitals, the sanitary condition of the premises of medical institutions, drug provision has decreased. The possibilities of making an appointment have been expanded, which gives the patient the right to choose a method that is convenient for him personally

Financial resources for the implementation of the health care modernization program in UKRAINE in years All funds 6.5% of GDP Strengthening the material and technical base of medical institutions Implementation of modern information systems in healthcare Implementation of standards of medical care, increasing the availability of outpatient medical care, including that provided by medical specialists

Implementation of modern information systems in health care in 81 health care facilities Implementation of 52 standards of medical care, increasing the availability of outpatient medical care, including that provided by medical specialists (63 health care facilities are involved), medical examination of adolescents in 34 health care facilities, opening 6 centers of medical and social support for pregnant women in base of interdistrict obstetrics and childhood centers Strengthening MTB: - continued construction construction (acquisition) of 15 FAPs - purchase of 233 units of equipment for 32 health care facilities (including 1 CT scan, 1 angiograph, 9 units of vehicles, 2 neonatal resuscitation vehicles, 2 mobile complex) - the creation of an emergency department on the basis of GBUZ JSC "First City Clinical Hospital" - the opening of 55 general medical practices in rural areas - the creation of 47 households III. II. I.I.I.I. Measures to implement the healthcare modernization program

Provision of doctors for residents The industry employs people, doctors of paramedics Provision: -doctors - 40.3 per population; medical staff 93% - Coefficient of combination of doctors - 1.48, -wed. staff - 1.23

City 968 units Village 102 units. City 850 units Village 90 units. Social expectations of students (motivation to work in the countryside) a set of social measures: state support provided in the form of social payments for the construction or purchase of housing, cultural leisure and modern infrastructure, computerization of the village, the possibility of consulting with more experienced colleagues, professional retraining, the availability of medical literature, high salaries , including surcharge for work in rural areas The total number of vacancies for secondary medical. staff 940 units The total number of medical vacancies is 1070. Functions of an advisory polyclinic: Providing highly specialized counseling to patients in the areas of medical and prophylactic institutions of the region; solution of questions about the subsequent treatment of consulted patients with the definition of medical technology and place; involvement of highly qualified doctors-specialists of hospitals and other health care facilities, as well as workers of research institutes and medical universities in consultation; referral to medical institutions that sent patients for consultation, conclusions indicating the diagnosis established in the polyclinic, performed and recommended treatment; development of proposals (leaflets) for the health care facilities of the region on the procedure and indications for referring patients to consultative polyclinics;

Organization and holding (together with the department of emergency and planned consultative care) field consultations of specialist doctors in the regions, as well as correspondence consultations for doctors of regional healthcare facilities; a systematic analysis by rayons of the oblast of cases of disagreement in diagnoses between health care facilities, which sent patients for consultation, and a consultative polyclinic; analysis of mistakes made by doctors of health care facilities during examination and treatment of patients before sending them to an advisory clinic; preparation of status and level overviews and fact sheets treatment and diagnostic work in districts and health care facilities of the region.

DEVELOPMENT OF RURAL HEALTH IN UKRAINE IN THE REGIONAL PROGRAM OF MODERNIZATION OF HEALTH ENTITIES IN UKRAINE IS A COMPLEX OF MEASURES TO IMPROVE THE PROVISION OF HEALTH CARE RURAL POPULATION, INCLUDING: increasing the availability of medicinal aid rural population Intensifying prevention PRIMARY HEALTH NETWORK DEVELOPMENT OF MEDICAL ORGANIZATIONS IN RURAL DEVELOPMENT OF HUMAN RESOURCES POTENTIAL HEALTH INSTITUTIONS IN RURAL AREAS Optimization of hospital beds in rural areas and improving its performance strengthening material-technical base of medical ORGANIZATIONS IN RURAL AREAS IMPLEMENTATION IN THE WORK OF PRIMARY HEALTH MOBILE MEDICAL CENTER (mobile outpatient clinics, MOBILE HEALTH CENTERS)

Organization of medical care for the city and

rural population

1. Principles of organizing medical care for the population in the Russian Federation

2. The advantage of providing medical care to workers

3. Dispensary method

4. The principle of specialization of medical care

5. Organization of medical and preventive care for the rural population

Introduction

The organization of medical and preventive care for the population is provided both in the city and in the countryside. The organization of medical and preventive care for the urban population consists of 3 stages:

1. primary health care (PHC) is carried out by outpatient clinics, hospitals, ambulance services, feldsher-obstetric posts, health centers.

2. inpatient medical care is carried out in a hospital environment.

3. rehabilitation treatment - in hospitals and outpatient clinics.

Primary health care is a basic, affordable and free type for every citizen health care including: treatment of the most common diseases, as well as injuries, poisoning and other urgent conditions; medical prevention of major diseases; sanitary and hygienic education; carrying out other activities related to the provision of health care to citizens at the place of residence.

The provision of medical and preventive care is built in accordance with certain principles:

1) availability and free of charge guaranteed volume of free medical care in accordance with the program state guarantees... The program defines the types, volumes, procedure and conditions for the provision of free medical care to the population. The state guarantees program is reviewed annually;

2) the continuity of medical care and prevention;

3) the continuity of health care institutions;

4) an advantage in providing MT to employees;

5) district;

6) dispensary method.

1. Principles of organizing medical care for the population in the Russian Federation

For the organization of high-quality medical care, continuity is carried out between the ambulance, the clinic, the hospital. Continuity is achieved through the exchange of information between doctors of medical and prophylactic institutions, holding joint clinical conferences, consultations - this allows you to improve the qualifications of medical personnel, reduce duplication of patient treatment.

1) an agreement between a polyclinic and a hospital for hospitalization of a patient;

2) the discharge report is sent to the clinic;

3) organization of rehabilitation treatment departments in polyclinics (follow-up care)

4) the doctors of the polyclinic must take turns working in the hospital.

2. The advantage of providing health care to workers

Medical support of workers is carried out in specialized institutions - medical and sanitary units (MSU), medical or paramedic health posts. Medical units can be of both open type - they serve working enterprises, their relatives and the population of the adjacent territory. Currently, such are all medical units, and of a closed type (only employees of this enterprise). Medical and paramedic health posts work according to the work schedule of the enterprise. Feldsher's health posts can be mobile.

The work of the shop service is assessed, first of all, according to the form No. 16 - according to the results of the analysis of the incidence of temporary disability. An important section is the work of a workshop doctor with often long-term illnesses (1 disease 4 cases and 40 days of temporary disability per year). The shop doctor makes lists of people who are often ill for a long time. Treatment is carried out in consultation with narrow specialists. There are sanatoriums at the enterprises. Medical and sanitary units can function as:

1. APU

2. United Hospital.

Medical assistance to workers is also provided by a general network of medical and preventive institutions, primarily in cases where enterprises do not have a medical and sanitary unit and the number of employees is below the established standards. (The vitamin plant is attached to the 5th polyclinic. The cable plant is attached to the 1st polyclinic). The reception has a separate window for servicing workers.

The district principle is the attachment of a certain contingent of the population to the district doctor.

3. Dispensary method

Clinical examination - active monitoring of the health of certain population groups (healthy and sick), registration of these population groups for the purpose of early detection of diseases, dynamic observation and comprehensive treatment of sick people, taking measures to improve their working and living conditions, prevent the development and spread of diseases , restoration of working capacity and prolongation of the period of active life 3.

In the organizational process of clinical examination, the following stages are distinguished:

1. selection of contingents through active identification and registration.

2. carrying out a complex of medical and social-preventive measures, i.e. implementation of the actual dispensary observation, assessment of the results of the effectiveness of dispensary examination.

Identification of persons subject to prophylactic medical examination is carried out, as a rule, when patients are admitted by a doctor in a polyclinic or at home and as a result of various preventive examinations, where the earliest stages of diseases are detected. medical dispensary treatment

Dynamic observation of group I (healthy) is carried out through annual preventive medical examinations. For this group of dispensary observation, a general plan of medical and health-improving preventive and social events, which includes measures to improve working and living conditions, sanitary and hygienic education and propaganda healthy way life.

Dynamic observation of group II is aimed at eliminating or reducing the influence of risk factors, increasing resistance and compensatory capabilities of the organism.

Currently, the method is used in work with a certain contingent of the population:

1. - children under 18;

2. - pregnant women;

3. - pupils and students of the full-time department;

4. - invalids of wars;

5. - athletes;

6. - certain groups of the population in accordance with the base SGBP;

7. - patients subject to dispensary observation.

Dispensary days are allocated in the polyclinic to work with dispensary patients. Clinical examination is carried out in 2 stages.

Stage 1 indicators:

1. Completeness of coverage of medical examinations;

2. The contingent undergoing compulsory medical examination. Approximately 80% of the population is covered by dispensary supervision. In addition, additional medical examination is carried out within the framework of the National Project "Health". Based on the results of the clinical examination, the district general practitioner, GP distributes citizens who have passed the medical examination into 5 groups of health status:

I - "practically healthy",

II - "with a high risk of developing the disease, requiring preventive measures",

III - "in need of further examination and treatment on an outpatient basis",

IV - "in need of further examination and treatment in inpatient conditions",

V - "in need of high-tech types of medical care."

Citizens classified:

to group I - they do not need dispensary supervision, they are given a preventive conversation on a healthy lifestyle;

to the II-nd group - a program of preventive measures carried out in this APU is drawn up;

to group III - additional examinations are prescribed and, if necessary, treatment on an outpatient basis;

to group IV - additional examinations are prescribed and, if necessary, treatment in stationary conditions;

to group V - sent to the Commission of the health management body of the subject Russian Federation on the selection of those in need of high-tech medical care.

The standard of clinical examination includes examination by the following specialists:

1.fluorography, mammography (for the female population over the age of 40) or ultrasound examination of the mammary gland, ECG (electrocardiogram), OAM ( general analysis urine), CBC (complete blood count), total cholesterol and lipid profile, sugar, tumor markers (40 years and older)

2. examinations by specialists: a local general practitioner or general practitioner, obstetrician-gynecologist (for the female population), urologist (for the male population), neurologist, surgeon, ophthalmologist, endocrinologist.

The quality of additional medical examination: the absence of newly diagnosed diseases at the later stages, including oncological, tuberculosis, severe forms diabetes mellitus, stroke, heart attack, and other diseases leading to long-term and persistent disability (three months after the completion of medical examination) 4.

4. The principle of specialization of medical care

For a certain category of patients, specialized medical care is organized, provided:

Specialized ambulance team,

Narrow specialists of outpatient clinics,

In the departments of multidisciplinary hospitals.

In dispensaries.

Dispensaries - these are specialized medical and preventive institutions for the active identification of patients, treatment, rehabilitation and prevention. All dispensaries of republican significance and are financed from the budget of the Republic of Belarus

Types: cardiological, physical therapy, skin-venereal, etc. Dispensaries include a polyclinic and a hospital. An important section of the work is advisory assistance to the general network of medical and prophylactic institutions.

The quality of medical care in specialized hospitals is higher than in a general hospital. For example, a cardiac dispensary is a cardiology department of a hospital or a therapeutic department. However, this is an expensive form of medical care.

5. Organization of medical and preventive care for the rural population

It is built on the same organizational principles as for the urban population. The main ones are the district and dispensary. Differences in the organization of medical care are determined by a number of factors: low population density of rural residents; remoteness of the place of residence from the regional centers; poor provision of communications; specificity of working and living conditions - seasonal nature of agricultural work 5. Contact with animals, chemical fertilizers, etc.

Features of the provision of medical care:

1.up to 40% of the volume of medical care is provided by paramedics - (feldsher-obstetric stations);

2. large radius of service;

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

4. preferential medical provision of persons engaged in agricultural labor.

Stage I of rendering medical assistance to the rural population is a rural medical area (SVU). We provide qualified first aid and medical assistance. The radius of the site is 5-7 (up to 20) km. As part of the rural medical area, there are: a rural district hospital (SUB), a rural medical outpatient clinic (SVA), a FAP (feldsher-obstetric station), nurseries, medical assistant health centers at enterprises, dispensaries.

Medical assistance is provided in 6 - 8 specialties: therapy, pediatrics, dentistry, surgery, obstetrics and gynecology. A rural medical area located in the area of the central regional hospital is considered to be registered and its population applies directly to it. At the complex therapeutic area there are 2,000 or more adults and children.

Stage II - qualified specialized medical care in district medical institutions, as part of the central district hospital, the central district pharmacy, district hospitals, inter-district dispensaries (for 10-20 specialties).

Stage III - highly qualified highly specialized care in almost all specialties is provided in republican institutions, dental clinics, consultative clinics, centers, including AIDS Centers, Medical Prevention Centers, etc.

Stage I of providing medical care to the rural population - rural district hospital (SUB). In RB (2006) - 53. Four categories depending on the total number of beds, from 25 to 100 beds. Day hospitals can be deployed in the SUB. The SUB provides outpatient and inpatient medical care: therapeutic, dental, infectious patients, assistance in childbirth in urgent cases, emergency surgical and traumatological care, assistance to children.

The main functions of a rural district hospital: provision of qualified medical care; prevention of morbidity and injury; organizational and methodological guidance and control over the activities of feldsher-obstetric points and other institutions of the 1st stage, scheduled visits of doctors to subordinate institutions of the 1st stage.

1. the approximation of medical care to agricultural workers during the period of massive field work.

2. current sanitary supervision of institutions and facilities, water supply, cleaning of settlements.

The following features are distinguished in the organization of outpatient and inpatient care in the SMS:

1. there is no clear time limit for outpatient appointments;

2. the hours of reception of patients should be appointed at a time more convenient for the population, taking into account the seasonality of agricultural work;

3. the possibility of receiving patients by a paramedic in the absence of a doctor;

4. home calls are served by a doctor only in the village where the SMS is located, home calls in other settlements of the rural medical district are served by a paramedic;

5. on duty in a hospital with the right to stay at home and obligatory information of the staff about their location, in case of need for emergency assistance;

6. Allocation of one preventive day a week at the doctor's office for a detour of the site.

When visiting the FAP, the district doctor provides methodological assistance in the work of the FAP and must carry out the following main activities in the field:

a. check the correctness and reliability of records on the admission of patients, on the vaccinations carried out, dispensary observation of pregnant women, children and seriously ill patients;

b. advise patients who have applied to the FAP on their own or invited by a doctor and paramedic;

c. visit and consult at home pregnant women, children under 2 years of age, seriously ill patients;

Outpatient and polyclinic care is provided in the rural medical outpatient clinic (SVA). The functions are the same as for a rural district hospital, but there is no round-the-clock hospital

According to the standards, a feldsher-obstetric center is organized with a number of residents from 700 or more at a distance to the nearest medical institution from 2 to 4 km., With a population of 300-700 - 4-6 km, less than 300 people over 6 km.

A paramedic may work at the feldsher-obstetric station; paramedic and midwife; paramedic, midwife and health visitor. Subordinates on general issues to the administration of a rural settlement, and on special issues - to the chief physician of the local hospital.

Functions of the feldsher-obstetric station:

1.provision of first aid medical aid,

2. fulfillment of doctor's prescriptions,

3.Patronage of children and pregnant women, monitoring the health of people with disabilities and agricultural specialists,

4.carrying out preventive, anti-epidemic, sanitary and hygienic measures under the supervision of a doctor, immunization,

5. prophylactic medical examination of healthy and sick,

6.sanitary training and education of the population,

7.the sale of medicines through pharmacies of the 2nd category,

8. accounting and reporting, analysis of indicators. Monthly - reports to the organizational and methodological office of the central regional hospital,

9. participation in the examination of incapacity for work with the permission of the chief physician of the district.

II stage of providing medical care to the rural population - Central District Hospital (CRH). In terms of capacity, it is divided into 6 categories from 100 to 400 beds. The structure of the central district hospital:

1.inpatient hospital with departments in the main specialties (therapeutic, surgical, pediatric, obstetric, gynecological, infectious diseases),

2. polyclinic,

3.the department of ambulance and emergency medical care,

4.pathological department,

5. organizational - methodical office and auxiliary units.

The chief physician of the CRH (chief physician of the district) is subordinate to: on general issues - to the administration of the municipal district, on special issues - to the Ministry of Health of the Republic of Belarus. It relies on its deputies in its work:

1. for medical care of the population of the Ministry of Education and Science - head of the organizational and methodological office;

2. for childhood and obstetrics (with a population of over 70,000);

3. on the medical side (responsible for the work of the hospital);

4. in the polyclinic (head of the polyclinic);

5. for clinical expert work (CEP) - for the examination of temporary disability,

6. for the administrative - economic part (AHP), etc.

A medical council functions for operational management in the central district hospital. It includes the deputy chief physician, the chief sanitary doctor of the region, the head of the polyclinic, the regional pharmacy, the chairman of the regional committee of trade unions, medical workers, the Red Cross society, and the chief specialists of the region 6.

Organizational and methodological management of the district health care is provided by: district freelance specialists of the district and the organizational and methodological cabinet of the Central Regional Hospital (OMK); senior paramedic and midwife of the area; district medical statistician

Functions of the organizational and methodological office:

1. Development of measures to improve the quality of medical care to the population of the district. Field work. Various types of mobile care - mobile medical teams, mobile outpatient clinics, dental offices, dental laboratories.

2. Methodical management of the district medical institutions;

3. Analysis of performance indicators, preparation of annual reports;

4. Professional development of medical workers.

III stage of providing medical care to the rural population - republican medical institutions. Center for organizational and methodological management of medical and preventive institutions of the republic, base of specialization and advanced training of doctors.

In terms of capacity, republican clinical hospitals are divided into 5 categories. Priority area in the development of health care in the countryside is the strengthening and improvement of outpatient care, protection of maternal and child health

Since the beginning of the 90s of the twentieth century, reforms have been taking place in health care in the countryside. New assigned therapeutic and pediatric sections are being organized, rural district hospitals are being reorganized into medical outpatient clinics, SVA into FAPs, and the vacated beds are sometimes concentrated in the Central District Hospital. Per last years are developing more and more different kinds mobile medical care. In particular, visiting medical teams, clinical diagnostic laboratories, fluorographic units, mobile dental offices and dental laboratories, etc. are organized.

The main functions of the republican clinical hospital:

1.provision of highly qualified specialized consultative, diagnostic and medical assistance to the population of the republic in a polyclinic and in stationary conditions using highly effective medical technologies;

2. Provision of advisory and organizational and methodological assistance to specialists from other medical and preventive institutions of the republic, primarily at the rural level;

3. organization and provision of qualified emergency and planned consultative medical care using medical aircraft and ground transport;

4. implementation of the examination of the quality of the treatment and diagnostic process in 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 (MH RB), the republican fund of compulsory health insurance(RFOMS) and branches of OMS, etc.;

6. Implementation under an agreement with the Ministry of Health of the Republic of Bashkortostan and development of measures for the implementation of targeted programs for the development of medical care;

7.implementation of medical institutions of the republic into practice modern technologies, economic methods management and principles of health insurance;

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

9. ensuring the effectiveness of preventive measures, increasing the level of sanitary and hygienic culture and actively promoting a healthy lifestyle.

Thus, the republican (regional, regional) hospital is a medical, scientific-organizational, methodological and educational center of public health.

There are 5 categories of republican (regional, regional) hospitals , from 300 to 800 or more beds, the most appropriate are hospitals with 700-1000 beds with all specialized departments. However, in each republican (regional, regional) hospital, regardless of its capacity, there should be the following structural divisions: management (administration, accounting, office, archive, library, etc.), organizational and economic department, consultative clinic, hospital with an admission department, diagnostic Department, Department of Emergency Planned Advisory Medical Aid (OEPKMP), Department of ACS, Pathological and Anatomical Department, AHC (catering unit, garage, laundry, boiler room, warehouse and other departments), boarding house for patients for the period of examination, dormitory for medical workers.

Tasks of the polyclinic of the republican clinical hospital:

1. Provides advice to patients;

2. Conducts field consultations of specialists;

3. analysis of the quality of outpatient care, (market surveys, information letters assessing the level of medical and preventive care in the districts).

To plan the work of the polyclinic, vouchers for consultation are sent to the districts. The republican clinical hospital has an organizational and economic department (OEE), which performs the function of an organizational and methodological department, which is a structural part of the republican hospital and is directly subordinate to the chief physician. The structure of the department includes:

1. organizational and economic department;

2. clinical expert department;

3. information and statistical department.

The main tasks of the organizational and economic department are introduction into practice of modern medical and information technologies, economic management methods, principles of medical insurance, training and retraining of medical personnel.

Freelance chief regional specialists - the organizers of the relevant specialized care in the rural area, a highly qualified specialist doctor is appointed, the head of the department of the central regional hospital, having a category. The appointment and dismissal of the chief regional specialist is carried out by the chief physician of the central regional hospital.

The main tasks of the chief district specialist: development and implementation of measures for the prevention of diseases, the introduction of the latest methods of prevention, diagnosis and treatment of patients into the practice of medical institutions in order to improve the health of the population, reduce morbidity, including those with temporary disability, disability and mortality ... It should be emphasized the importance of close communication of rural health care institutions with territorial administrative bodies and public organizations in the further improvement of medical care for the rural population.

In medical institutions there is an operational department and quality management departments responsible for intradepartmental quality control, for compliance with the standards of medical care.

Conclusion

The legislative definition and implementation of the rights of citizens to free public health care is the most important social value of the state.

Improving the organization of medical care at the prehospital and hospital stages has led to significant changes in the structure of the outpatient and inpatient stages of providing medical care to the population. The reform of the management and financing of health care in the Russian Federation, the introduction of health insurance for citizens have presented new requirements for a doctor who provides primary health care at the prehospital stage of treatment, regardless of the form of ownership, territorial subordination and departmental affiliation.

On the the present stage In the development of health care, a special role is played by the organizational-methodological and medical-advisory role of the main specialists on the staff of the Ministry of Health (therapist, surgeon, pediatrician, obstetrician-gynecologist).

LECTURE: ORGANIZATION OF MEDICAL ASSISTANCE TO THE RURAL POPULATION Compiled by: senior lecturer, Ph.D. Badoeva Zaira Aslanbekovna Vladikavkaz 2013

Plan 1. Unity of principles of providing curative and 2. preventive care to urban and 3. rural population. 2. Features of the organization of rural 3. medical care. 3. Stages of providing medical and preventive care to the rural population and the main organizations.

The health care of the villagers is part of all health care. Therefore, the basic principles inherent in health care in general are also characteristic of rural health care.

However, in rural conditions, the concept of the availability of medical care should not be equated with territorial approximation, since this is not always possible. In this connection, we are talking about a system in which it would be possible to provide or organize the provision of timely, adequate and full medical care.

The unity of the principles of providing therapeutic and prophylactic assistance to the urban and rural population: the preventive nature of the distribution of the mass character of the specialization of medical care is generally available.

At present, the level of inpatient medical care for the villagers has practically reached the level of the townspeople. At the same time, the level of outpatient and polyclinic medical care among the rural and urban population differs significantly. The same applies to the quality of medical services.

The existing differences in the organization of medical services for the rural population are due to: a kind of population settlement system; low population density; seasonality of agricultural labor; significant remoteness of settlements from each other; decrease in the proportion of people of working age; increase specific gravity elderly and old in the countryside; insufficient development of transport links;

The level and quality of medical care for the rural population is also affected by: deterioration of the material and technical base of rural health care; high turnover of medical personnel; low level of provision of rural healthcare organizations with modern medical equipment;

One of the main features of the provision of medical care to the rural population is its staging. At the first stage, medical assistance is provided by a rural medical station. The second stage is the district medical institutions: the central district hospital, the sanitary-epidemiological station and other medical institutions.

Stage I - earlier - a rural medical district (SVU), which includes 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-midwife station (FAP) c) health centers (if there is an industrial enterprise in the served area). Currently, there are no IEDs, SVA and local 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 the FAP there are: 1 position of a paramedic or midwife or nurse and 0, 5 positions of a nurse. The cost of FAPs - 1, 5 -2, 0% of the district budget.

Functions of the FAP: - provision of first-aid medical care and timely fulfillment of doctor's prescriptions; - Carrying out preventive and anti-epidemic work; - organization of patronage of pregnant women, children; - implementation of measures to reduce infant and maternal mortality; - hygienic training and education of the population.

The rural medical station (SVU) served 7-9 thousand people within a radius of 7-9 km. The district hospital is the main institution at the SVU, it 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. The local hospital provides all types of qualified medical and preventive care.

All types of medical and preventive care for pregnant women, mothers and children are provided by the doctor of the local hospital. If there are several doctors, then one of them is responsible for the health of children and women in this area.

When district hospitals are unprofitable, they are closed or re-profiled into rehabilitation departments of district hospitals, and independent rural medical outpatient clinics (SVA) are opened for medical care of the population, in the staff of which should be: a general practitioner, dentist, obstetrician-gynecologist, pediatrician.

From staffing standards medical personnel of district hospitals: 1. The positions of doctors for the provision of outpatient polyclinic care to the population are established per 10,000 population: Adult Child population Physician-therapist 4, 0 Pediatrician - Obstetrician-gynecologist 0, 6 Surgeon 0, 4 - 8, 0 - 0, 3 2, 5 Dentist

2. The positions of doctors of the inpatient departments are established on the basis of 1 position: - general practitioner - for 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 work of the SUB: - 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.

organizing and carrying out a set of preventive measures among the population of the site - carrying out therapeutic and prophylactic measures to protect the health of mothers and children - studying the causes of general morbidity and morbidity with temporary disability and developing 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; fight against alcohol consumption, smoking and other bad habits.

Stage II - Territorial Medical Association (TMO). The TMO is supervised by the Chief Physician of the TMO (he is also the chief doctor of the Central District Hospital) and his deputies: - Deputy for public health services (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 administrative and business affairs.

TMO is a complex of health care facilities, functionally and organizationally interconnected. The TMO may include: polyclinics (adults, children, dental); antenatal clinics, dispensaries, hospitals, maternity hospitals; ambulance stations; children's sanatoriums and other institutions.

Principles for the formation of TMT: 1. A certain population size - 2. The optimal size of TMO - 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.

Functions of the TMO: 1. Organization of medical and preventive care for the attached population, as well as for 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.

At this stage, the district pediatrician and the district obstetrician-gynecologist are responsible for the organization of medical and preventive care for women and children. 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.

Stage III - regional hospital and medical institutions of the region. The regional hospital is a large multidisciplinary medical and prophylactic institution that fully provides highly qualified highly specialized care 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.

The structure of the regional hospital: 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 consultancy, etc. The bed capacity of the regional hospital for adults - 1000 -1100 beds, for children - 400 beds.

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.

RUSSIAN PEOPLES FRIENDSHIP UNIVERSITY

DEPARTMENT OF PUBLIC HEALTH, HEALTH CARE AND HYGIENE.

ABSTRACT ON THE TOPIC:

"Organization of medical and preventive care for the rural population."

Lecturer Kicha D.I.

completed by a 5th year student

Shadrunova Ksenia

ML 508 group

MOSCOW 2014

Medical care for the rural population is based on the basic principles of healthcare organization. However, there are factors that influence the organizational forms and methods of work of rural medical institutions:

The nature of the settlement of rural residents, the average number of residents in one settlement

Service radius, distance and condition of roads, transport

The nature of agricultural work and living conditions

National characteristics and customs of some nationalities

Medical staff turnover

Economy and cultural level

Geographic and climatic conditions

In this regard, a number of features of the organization of medical care in the countryside are distinguished, the main of which are:

· Stages

· Continuity

The presence of special medical institutions in the countryside

Application of special organizational forms and working methods

Stages of providing medical care to the rural population and types of rural health care institutions

1st stage - rural medical area.

Includes 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).

The main function of the stage: provision of first aid, first qualified medical aid with possible elements of specialized medical aid.

Feldsher-obstetric station (FAP)- the nearest medical institution to the place of residence, which provides medical assistance to rural residents. The presence of a FAP is one of the features of rural health care, due to the need to bring medical care closer to the population in the conditions of a large service radius of the district hospital and a low density of rural residents. The recommended standard for the number of residents for the organization of FAP is 700 and more with a distance of at least 5 km to the nearest medical institution.

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.

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. The local hospital provides all types of qualified medical and preventive care. Medical assistance to the population during the 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 local hospital doctor... If there are several doctors, then one of them is responsible for the health of children and women in this area.

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 treatment and prophylactic 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 the current sanitary supervision over the condition of production and communal facilities, water supply sources, children's institutions, public catering establishments;

· Carrying out treatment 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

2nd stage - regional health care institutions.

The leading place is central district hospital (CRH). The CRH carries out 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 in its composition depend on the population size, structure and level of morbidity, other medical and organizational factors and are determined by the administrations. municipalities... As a rule, CRHs have a capacity of 100 to 400 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 chief physician of the central district hospital is the head of health care of the municipal district, appointed and dismissed by the administration of the municipal district.

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas, paramedics of FAPs is carried out by specialists from central regional hospitals. 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 this municipal district 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 paramedics of FAPs, 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 central regional hospitals. Preventive and curative work of children's polyclinics and children's departments of regional hospitals 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 hospitals.

3rd stage - regional healthcare institutions.

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.

Outpatient qualified specialized dental care for patients is provided in regional dental clinics, inpatient - in dental departments of regional hospitals.