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Features of the organization of medical care for the rural population. Lecture organization of medical care for rural population compiled by senior. Family planning center: tasks of function structure

The main feature of providing medical care to the villagers is its stages. Conventionally, there are three stages in the organization of medical care for the rural population (Fig. 17.1).

First step- healthcare institutions of a rural settlement, which are part of integrated therapeutic site. At this stage, rural residents receive first aid, as well as the main types of medical care: therapeutic, pediatric, surgical, obstetric, gynecological, and dental.

The first medical institution that a villager usually turns to is feldsher-obstetric station (FAP). It functions as a structural subdivision of a local or central district hospital. It is advisable to organize FAPs in settlements with a population of 700 or more with a distance to the nearest medical institution over 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.

The FAP is responsible for solving a large complex of medical and sanitary tasks:

Carrying out activities aimed at preventing and reducing morbidity, injuries and poisoning among the rural population;

Reducing mortality, especially infant, maternal, working age;

Providing the population with pre-hospital medical care;

Participation in the current sanitary supervision of preschool and school educational institutions, utilities, food, industrial and other facilities, water supply and cleaning of populated areas;

Carrying out door-to-door rounds according to epidemiological indications in order to identify infectious patients, persons in contact with them and those suspected of infectious diseases;

Improving the sanitary and hygienic culture of the population. Thus, FAP is a health care institution

more of a prophylactic focus. At FAP

Rice. 17.1. Stages of providing medical care to the rural population

entrust the functions of a pharmacy for the sale of finished dosage forms and other pharmaceutical goods to the population.

The FAP is headed by head of FAP, the main tasks of which are:

Organization of treatment-and-prophylactic and sanitary-epidemiological work;

Outpatient reception and treatment of patients at home;

Provision of emergency and emergency medical care in case of acute diseases and accidents (injuries, bleeding, poisoning, etc.) with the subsequent referral of the patient to the nearest medical and preventive institution;

Preparing patients for admission to a physician at a FAP, conducting clinical examinations of the population and preventive vaccinations;

Carrying out anti-epidemic measures, in particular household rounds for epidemiological indications in order to identify infectious patients, persons in contact with them and suspected of infectious diseases;

Provision of medical care to children in preschool and school educational institutions located in the territory of FAP activities and do not have corresponding nurses in their states;

Conducting sanitary and educational work among the population. A person who has received secondary medical education in the specialty "General Medicine" and has a certificate in the specialty "General Medicine" is appointed to the position of the head of the FAP.

In addition to the head of the FAP, there is a midwife and a visiting nurse.

FAP midwife is responsible for the provision and level of pre-medical care for pregnant and gynecological patients, as well as for health education among the population on the protection of mothers and children.

The midwife is directly subordinate to the head of the FAP, and the methodological guidance of her work is carried out by the obstetrician-gynecologist of the medical-prophylactic institution, who is responsible for providing obstetric and gynecological care to the population in the territory of the FAP.

Patronage nurse carries out preventive measures to improve the health of the child population. To this end, it solves the following tasks:

Carries out patronage of healthy children under the age of 1 year, including newborns at home, monitors the rational feeding of the child;

Carries out measures for the prevention of rickets and malnutrition;

Carries out preventive vaccinations and diagnostic tests;

Carries out preventive work in preschool and school educational institutions (located in the territory of FAP and does not have the corresponding nurses in their states);

Prepares sick children for admission to FAP by a pediatrician;

Conducts household visits according to epidemiological indications in order to identify infectious patients, persons in contact with them and suspected of infectious diseases, etc.

In the absence of a patronage nurse in the staffing table, the midwife, in addition to her duties, monitors the health and development of children of the 1st year of life. In the absence of a midwife and a visiting nurse on the staff of the FAP, their duties are performed by the head.

Despite the important role of the FAP, the leading medical institution at the first stage of providing medical care to the villagers is district hospital, which may include a hospital and a medical outpatient clinic. The types and volume of medical care in the district hospital, its capacity, equipment, staffing with medical personnel largely depend on the profile and capacity of other medical institutions that are part of the health care system of the municipal district (rural settlement). The main task of the district hospital is to provide the population with primary health care.

Outpatient and polyclinic care for the population is the most important section of the work of the local hospital. She may turn out outpatient clinic, included in the structure of the hospital, or an independent outpatient clinic. The main task of the outpatient clinic is to carry out preventive measures to prevent and reduce morbidity, disability, mortality among the population, early detection of diseases, and clinical examination of patients. Doctors of the outpatient clinic provide appointments for adults and children, make home calls and emergency care. Paramedics can also take part in the reception of patients, however, medical care in an outpatient clinic should mainly be provided by doctors. In the local hospital, an examination of temporary disability is carried out, and, if necessary, patients are referred to the ITU.

In order to bring specialized medical care closer to the residents of the village, the doctors of the central district hospital, according to the

On a divided schedule, they go to the outpatient clinic to receive patients and select them, if necessary, for hospitalization in specialized institutions. Recently, in many constituent entities of the Russian Federation, there is a reorganization of district hospitals and outpatient clinics into centers of general medical (family) practice.

The second stage the provision of medical care to the rural population is the health care institutions of the municipal district, and among them the leading place is taken by central district hospital (CRH). The central district hospital provides the main types of specialized medical care and at the same time performs the functions of a health management body in the territory of the municipal district.

The capacity of the CRH, the profile of specialized departments in its composition depend on the population size, structure and level of morbidity, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, CRHs have a capacity of 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatric, infectious and obstetric-gynecological (if there is no maternity hospital in the area).

The head physician of the CRH is the head of the health care of the municipal district, appointed and dismissed by the administration of the municipal district.

An approximate organizational structure of the CRH is shown in Fig. 17.2.

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas, FAP paramedics is carried out by specialists from the Central Regional Hospital. Each of them, according to the approved schedule, travels to the integrated therapeutic area for medical examinations, analysis of dispensary work, and selection of patients for hospitalization.

In order to bring specialized medical care closer to the rural population, interdistrict medical centers. The functions of such centers are performed by large CRHs (with a capacity of 500-700 beds), capable of providing the population of the nearest municipal districts with the missing types of specialized inpatient and outpatient medical care.

The structure of the CRH has polyclinic, which provides primary health care to the rural population in the direction of

Rice. 17.2. Approximate organizational structure of the CRH

medical assistants of FAP, doctors of outpatient clinics, centers of general medical (family) practice.

The provision of out-of-hospital and inpatient medical and preventive care to children in the municipal district is entrusted to children's consultations (polyclinics) and children's departments of the Central District Hospital. Preventive and curative work of children's polyclinics and children's departments of the Central District Hospital is carried out on the same principles as in city children's polyclinics.

The provision of obstetric and gynecological care to women in the municipal area is entrusted to antenatal clinics, maternity and gynecological departments of the Central District Hospital.

The functional responsibilities of medical personnel, accounting and reporting documentation, the calculation of statistical indicators of the CRH's activities do not fundamentally differ from those in city hospitals and APUs.

The third stage Providing the rural population with medical care are healthcare institutions of the constituent entity of the Russian Federation, and among them the main role is played by regional (regional, district, republican) hospitals. At this stage, specialized medical care is provided in all major specialties.

Regional (regional, district, republican) hospital - a large multidisciplinary medical and prophylactic institution, designed to provide full specialized assistance not only to rural people, but also to all residents of the constituent entity of the Russian Federation. It is the center of organizational and methodological management of medical institutions located on the territory of the region (region, district, republic), the base of specialization and advanced training of doctors and nurses.

The approximate organizational structure of the regional (regional, district, republican) hospital is shown in Fig. 17.3.

The functional responsibilities of medical personnel, the method of calculating statistical indicators, accounting and reporting documentation of the regional (regional, district, republican) hospital do not fundamentally differ from those in city or central regional hospitals. At the same time, the organization of the work of the regional (regional, district, republican) hospital has its own characteristics, one of which is the presence in the hospital consultative clinic, where people come for help

Rice. 17.3. Approximate organizational structure of a regional (regional, district, republican) hospital

whether all municipal districts (urban districts) of a constituent entity of the Russian Federation. To accommodate them, a boarding house or hotel for patients is organized at the hospital.

As a rule, patients are referred to an advisory polyclinic after preliminary consultation and examination by regional (city) specialist doctors.

Another feature of the regional (regional, district, republican) hospital is the presence in its composition departments of emergency and planned consulting assistance, which, using the means of medical aviation or ground vehicles, provides emergency and advisory assistance with travel to remote settlements. In addition, the department ensures the delivery of patients to specialized regional and federal medical centers.

The Department of Emergency and Planned Advisory Aid works in close connection with regional center for disaster medicine.

In cases of emergencies, practical work on the fulfillment of sanitary assignments is carried out by teams of specialized medical care of constant readiness.

Unlike the CRH in the regional (regional, district, republican) hospital functions organizational and methodological department much wider. In fact, it serves as an analytical center and scientific and methodological base of the healthcare management body of the constituent entity of the Russian Federation for the introduction of modern medical and organizational technologies into practice.

The organizational activities of the department include holding regional feldsher (nursing) conferences, generalizing and disseminating best practices of healthcare institutions, organizing medical examinations of the population, scheduled visits of specialists, publishing instructional and methodological materials, etc.

The territory of Russia exceeds 17 million km2. Rural territories - 23.4% of the total territory - have a powerful natural, demographic, economic, historical and cultural potential, which, if used efficiently and effectively, can provide sustainable diversified development, employment, and a high standard of living for the rural population.

The demographic resource of rural areas is 38 million people (27% of the total population), including the labor force - 23.6 million people. The population density is low - 2.3 people per 1 km2. The settlement potential totals 155.3 thousand rural settlements, of which 142.2 thousand have permanent residents. 72% of rural settlements have less than 200 inhabitants, villages with more than 2 thousand people make up only 2%.

In the past 10 years, positive trends in the demographic situation in the countryside have been outlined. Natural population decline decreased from 281 thousand people in 2000 (-7.3 per 1000 people) to 82 thousand people at the beginning of 2010 (-2.1). The birth rate of the rural population is higher than the national average - 14 per 1000 people (compared to 12.6). This has a positive effect on the overall fertility rate.

However, the high birth rate in the countryside is accompanied by a high mortality rate. In 2010, with infant mortality and Russia, 7.5 babies per 1000 births

living in rural areas and in the city, the indicators were, respectively, UD and 6.9 babies per 1000 live births. The overall mortality rate per 1000 rural residents is 16.1, which is 6% lower than in 2000, but 19% higher than the mortality rate for the urban population. All this negatively affects the health indicators of the country's population as a whole.

The life expectancy of citizens in the countryside at the beginning of 2010 increased by 2.7 years compared to 2000 and amounted to 66.7 years against 69.4 in the city.

Rural areas are characterized by low population density, large remoteness of small settlements from each other. As a result, the average radius of the service area is 60 km, and often the remoteness of settlements from the regional center exceeds 100 km. The service shoulder of a general practitioner can reach 10 km or more.

The seasonality of work in the countryside creates tension in the spring-summer and autumn periods, when workers are mainly in the open air, which leads to overheating or hypothermia of the body. At the same time, the regime and quality of food are often not respected. The frequency of injuries, joint diseases, vibration disease is high. Contact with animals is associated with the risk of specific diseases.

As a result, rural residents are characterized by a large number of chronic diseases for which patients practically do not seek medical help, specific diseases associated with the peculiarities of agricultural production (injuries, diseases of the peripheral nervous system, eye damage, vibration disease).

Medical assistance to rural residents based on the principles of protecting the health of the country's population. One of the important organizational principles of public health is the observance of the unity and continuity of medical care for the population in urban and rural areas.

However, the factors determining the differences between urban and rural areas affect the organizational forms and methods of operation of rural health facilities.

The main factors contributing to the differences in health care between urban and rural populations are:

Peculiarities of the settlement of inhabitants in comparison with the city - low density, scattering and remoteness of settlements;

Peculiarities of agricultural labor - seasonality, high proportion of manual labor, often considerable remoteness of the place of residence from the place of work;

The outflow of young people and people of working age to the city;

Aging of the rural population;

Lower living standards in villages;

Poor road and transport condition:

Insufficiency or inaccessibility of new information technologies;

Low staffing with medical personnel;

Socio-economic and everyday difficulties.

In general, the health care system of the rural population is characterized by limited availability of medical care and low efficiency of medical, social and preventive measures. The task of converging the levels of medical care for the urban and rural population remains urgent.

Rural residents' turnover for medical care is significantly lower than urban residents. At the same time, the farther from a medical institution a settlement is, the less often residents turn to medical workers. The bulk of medical care is provided by nurses. A villager spends on visiting a medical facility

much more time than urban. The equipment of rural medical institutions is much worse than urban ones, the qualifications of personnel are lower than the average in health care.

The peculiarities of the organization of medical care for the villagers are a significant decentralization of outpatient care and a pronounced centralization of inpatient care. The main human resource in the countryside is paramedical workers. The medical staff is mostly concentrated in the district hospitals. carrying out reception of the population at the place of main work and on the road to remote rural settlements as part of special teams according to a specific plan.

In accordance with the Federal Law "On the Basics of Health Protection of Citizens in the Russian Federation" dated November 21, 2011 N-323-FZ (Article 5. Clause 2). the state provides citizens with health protection regardless of place of residence and any other circumstances. For residents of rural areas, it is also necessary to comply with the principles of health protection:

Ensuring the rights of citizens to health protection and related state guarantees:

The priority of the patient's interests in the provision of medical care;

Children's health priority;

Social security in case of disability;

Responsibility of public authorities and local self-government bodies, officials for ensuring the rights of citizens to health protection;

Availability and high KMP;

Inadmissibility of refusal to provide medical care;

Priority of prevention and preservation of medical confidentiality.

Organizational basis for the provision of medical care to ruralpopulation laid down in the XIX century. zemstvo doctors. The system of zemstvo medicine was formed in Russia during the existence of zemstvo self-government and operated in 1864-1917. There were new and progressive methods of providing medical care to the population in it, which have not lost their relevance to this day:

Orientation not at the paramedic center, but at the medical level of the provision of primary health care;

Local service for the rural population with the organization of several medical assistant points and a pharmacy on the site, in the center of each site there are hospitals with an outpatient clinic;

Keeping "card" records for outpatient admission of patients, which allows you to collect valuable material for statistical analysis of morbidity;

Combination of medical and sanitary-preventive work;

Active promotion of a healthy lifestyle;

Free medical care.

These principles were also implemented in the organization of primary health care for the population in the Soviet health care system (1918-1991). By the beginning of the first Soviet five-year plan in Russia (1929-1932), the rural population was served by 4677 medical stations and 3413 paramedic stations. There were 18,200 residents per medical area. Over the five-year period, the network of medical stations has grown to 7962, i.e. more than 70%; the number of rural hospital beds increased from 43,600 to 82,000. Expenditures on health care in the USSR in the years of the first five-year plan increased in comparison with the Russian Empire (1913) by almost 4 times. As a consequence of the efforts made. the life expectancy of Soviet people from 1926 to 1972 increased by an average of 26 years. Health care in general in the RSFSR can be judged by the data of the 3rd edition of the Great Soviet Encyclopedia (1969-1978; Table 5.20).

A typical rural medical institution - FAP - is a primary pre-medical structural unit that provides prophylactic, curative, health-improving. sanitary and antiepidemic, sanitary and educational, hygienic medical and sanitary care.

In subsequent years, the main feature of the organization of medical care for the rural population was the staging of its provision. 3 stages of providing medical and preventive care to the population are conditionally identified.

The first stage is a rural medical area - a local hospital, a paramedic station and a FAP, health centers, medical centers of educational institutions. At the first stage, rural residents receive pre-medical, primary and qualified medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).

The second stage - health care institutions of the municipal district: district and central district hospitals (CRH). which provide basic types of specialized medical care.

The third stage is the healthcare institutions of the constituent entity of the Russian Federation. among which the leading place is occupied by regional (regional, republican, district) hospitals. At this stage, specialized, including high-tech, medical care is provided in all major specialties.

In modern conditions, this approach is being revised. In the course of the implementation of the healthcare modernization program, a unified system of medical care is being built for both urban and rural populations.

Primary health care for the rural population will consist of three levels. At the 3rd level, all outpatient medical institutions are concentrated: at the 2nd - inter-municipal centers providing qualified specialized outpatient and inpatient medical care in the most demanded profiles in accordance with the procedures for the provision of specialized medical care: at the 1st - consultative and diagnostic specialized assistance in regional CDC.

In rural areas of the Russian Federation, there are 1349 hospital medical institutions, including 727 central regional ones. 79 district and 382 district hospitals, with a total number of beds 153.4 thousand. The provision of beds per 10 thousand rural residents is 40.9, which is 2.7 times less than the provision of hospital beds for the urban population (Table 5.21).

In 2010, 40,650 doctors (7.6% of the total number of doctors) and 207,497 paramedical workers (15.7% of the total number of paramedical personnel) worked in rural medical institutions in the Russian Federation. The provision of doctors in rural areas in 2010 amounted to 12.2 per 10 thousand of the population, with paramedical personnel - 54.3 per 10 thousand of the population. In all constituent entities of the Russian Federation in rural areas, there was a shortage of doctors and nurses.

The emerging trend of a decrease in the number of district and rural district hospitals and an increase in the number of central district hospitals is due to the proven economic inexpediency of the existence of hospital medical institutions of small bed capacity. In large medical institutions (central district, regional, regional, republican, district hospitals) spend less funds per bed for economic and technical needs, heating, maintenance of service personnel, food. engineering and technical service. In addition, on their basis, they effectively use diagnostic equipment, qualified medical personnel, introduce modern medical technologies and thereby provide the population with better quality qualified medical care. In this regard, rural district hospitals in a number of regions of the Russian Federation will be re-profiled into medical outpatient clinics, TsOPP.

Often the regions, in favor of the development of central district hospitals, curtail FAPs, leaving the rural population without medical care and drug provision.

District hospitals need to be rebuilt taking into account local conditions: population density, transport accessibility, provision of hospital beds in general, etc.

PHC- the basis of the system for providing medical care to the rural population - includes prevention, diagnosis, treatment of diseases and conditions. medical rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle and health education of the population.

Primary health care providers to approach the territory of residence are organized according to the territorial-district principle, which provides for the formation of groups of the population served at the place of residence. Primary pre-medical health care is provided by feldshers, obstetricians and other paramedics in FAP.

FAPs are organized in rural areas with a population of 700 people or more, with a distance of more than 2 km to the nearest medical facility. If this

distance exceeds 7 km, then the FAP will be organized in a village with a population of up to 700 people. Functions of the FAP in accordance with the current regulatory framework:

Provision of first aid medical care:

Providing the population with medicines (according to the approved nomenclature);

Timely and in full compliance with the doctor's prescriptions;

Patronage of children and pregnant women, dynamic monitoring of the health of certain categories of citizens;

Carrying out measures to reduce child and maternal mortality;

Educating the population on a healthy lifestyle,

FAP also plays a significant role in the implementation of preventive vaccinations according to the National Vaccination Calendar, which takes into account the age and sex composition of the population.

The main task of the FAP in working with children is timely and high-quality patronage. providing a full range of preventive measures. The procedure for prenatal care and medical examination of children is the same for the city and countryside.

In addition, the duties of a paramedic include systematic monitoring of the work of children's educational institutions, their sanitary condition, physical education in them; organization of preventive examinations. instilling hygienic skills in children, conducting a wide educational work among parents, children, educators and teachers.

There are 37.8 thousand FAPs in the Russian Federation with a steady trend of network reduction. Compared to 2000, their number was reduced by 12.8%, while a number of GP offices were organized in rural areas. When closing a FAP, it is necessary to first comprehensively assess the availability of medical care, especially in sparsely populated areas, where the FAP is the only available health care unit. This is especially important when the FAP provides the population with drugs, monitors the intake of anti-tuberculosis drugs, carries out a set of preventive measures to form a healthy lifestyle, and patronage of the elderly. Accordingly, the attitude towards the paramedic in the countryside needs to be changed and his working conditions revised.

The leading link in the provision of primary health care should be a general practitioner (family). Its goal is to provide PHC to the population in a volume that partially replaces narrow specialists of the polyclinic, and subject to the maximum proximity to the place of residence of the attached citizens.

The GP can work individually or in a group. In individual practice, a doctor works independently, independently of other doctors and specialists, using the help of nursing staff working with him. Individual practice is mainly used in rural areas, where

a small number of people live and the involvement of other doctors is unreasonable in terms of the volume of assistance provided and financial support.

Group practice involves combining the efforts of several doctors to ensure interchangeability, mutual assistance in the provision of medical services to the population and to increase the economic efficiency of organizing GP offices.

Group practice has several advantages:

The possibility of interchangeability during the day and for the period of illness. vacation, training of one of the doctors:

The best office equipment, including diagnostic and treatment equipment, the creation of a day hospital;

Possibility of professional communication, consultation;

The possibility of a certain specialization in narrow specialties for each of the doctors (ophthalmology, endocrinology, cardiology);

Reducing administrative costs;

More efficient use of nursing staff.

The location of the GP office is determined by the size of the locality;!, The ability of the healthcare facility to provide a room, the OPPORTUNITIES of the settlement administration to provide a room for the office as close as possible to the place of residence of the attached population (more often on the first floor of a multi-storey residential building or in a specially erected building). Particularly convenient is the location of the GP office in new micro-districts of settlements, where there is usually no developed social infrastructure. The number of serviced citizens per GP is established on the basis of the norm of 1500 people. It has been established in practice; a smaller number of attached residents will not ensure the economic feasibility of work, and a larger number will not allow the doctor to provide them with the full range of services in a quality manner and on time. The specific number of residents is determined for each doctor by the chief physician of the polyclinic to which the GP belongs, based on the number of residents and the provision of the institution with personnel. The radius of service can reach 1.5 km in the city, up to 12 km in the countryside,

Attachment to a GP is carried out in the presence of a compulsory medical insurance policy and a document. the identity of the citizen. Every citizen has the right to choose a doctor attending, including a GP. However, in most cases, the GP serves the population living in the immediate vicinity of his site: for example, in a multi-storey multi-entrance building - residents of this one building. This approach allows you to provide assistance at home and at night.

The GP's work schedule is determined by the location of the office, the number and composition of the attached population, the radius of service and the availability of vehicles. Tasks of the GP:

Outpatient reception of the population, including the simplest studies (electrocardiography, clinical examination of blood and urine, determination of blood sugar levels, visual acuity, etc.);

Providing emergency care;

Providing care in a day hospital;

Home visits to patients;

Visiting your patients in the hospital:

Consultations of patients with narrow specialists:

Interaction with social protection authorities.

The workload for a doctor is 4-5 thousand visits per year. Narrow specialists in the polyclinic accept only in the direction of a GP.

Despite the important place of FAP in the primary health care system for the rural population, the leading health facility at the first stage of rural health care is the rural district hospital (SCH) or the corresponding subdivision of the CRH. which and

they have a hospital and a medical outpatient clinic. Primary medical care is provided here by general practitioners, district therapists, pediatricians, district pediatricians and GPs (family doctors).

The nature and volume of medical care in a rural district hospital is determined by the capacity, equipment, and availability of specialist doctors. Regardless of the capacity, the SUB provides outpatient care for therapeutic and infectious patients, assistance in childbirth, and medical and prophylactic care for children. emergency surgical and trauma care. The SUB staff includes doctors in the main specialties: therapy, pediatrics, dentistry, obstetrics and gynecology, surgery. SMS tasks:

Providing the population of the assigned territory with qualified medical care (outpatient and inpatient):

Planning and implementation of measures for the prevention and reduction of morbidity and injuries among various groups of the rural population;

Treatment and prophylactic health care for mothers and children:

Introduction of modern methods of prevention, diagnosis and treatment, advanced forms and methods of organizing medical care;

Organizational and methodological guidance and control of the FAP and other medical institutions that are part of the rural medical district.

Organization of outpatient and polyclinic care for the population is the most important section of the work of rural district hospitals. In rural areas, there are 2,979 outpatient clinics for 436 thousand visits per shift. These include rural medical outpatient clinics(polyclinics), both included in the structure of other medical organizations, and independent. Their main tasks are: carrying out extensive preventive measures to prevent and reduce morbidity, early detection of patients, clinical examination. provision of qualified medical care to the population, Doctors consult adults and children, make home calls and provide emergency medical care, paramedics can also take part in the reception of patients, however, outpatient care in a rural medical outpatient clinic should be provided by doctors.

In addition, the functions of a rural outpatient clinic include:

Bringing outpatient medical care closer to rural residents;

Carrying out a complex of sanitary and anti-epidemic measures (preventive vaccinations, current sanitary supervision of institutions and facilities, water supply and cleaning of populated areas);

Scheduled visits of doctors to subordinate FAPs and children's educational institutions to provide practical assistance and control their work.

An important place in the work of the rural medical hospital is occupied by the protection of the health of mothers and children. Medical care for children in a rural medical area provided by doctors and nurses under the guidance of the chief physician of the local hospital. If there is a pediatrician in a rural medical area, he is responsible for organizing medical care for children (as a rule, by the chief physician). In the absence of a pediatrician, the chief physician of a rural district hospital has the right to assign responsibility for medical care to children to one of the general practitioners, having allocated him a certain time to work with children.

The main duties of the doctor responsible for the medical care of children in the rural medical area:

Constant preventive monitoring of children in the villages assigned to the district hospital;

Periodic medical examination of all children on the site, especially those of the 1st year of life;

Active identification of sick and weakened children, taking them to the dispensary for regular observation and recovery:

Timely and complete coverage of children with preventive vaccinations;

Regular observation of children in organized groups, observation of the correct neuropsychic and physical development of children. carrying out the necessary recreational activities;

Active identification of sick children, timely provision of qualified medical care to them and provision of hospitalization if necessary;

Constant study of the conditions and way of life of children in the family, identification and assistance in the elimination of unfavorable environmental factors;

Monitoring the work of FAPs by regular (according to the schedule) field visits, providing them with the necessary organizational and methodological assistance;

Extensive educational work among parents, children, teachers, educators on the protection of children's health.

Doctors of rural outpatient clinics go on a certain schedule to the FAN of their site for a consultative appointment. At the same time, they should strive to improve the qualifications of their assistants, transferring knowledge and experience to them. The population is notified of the departure schedule.

Pediatricians from central district hospitals should travel to rural district hospitals on schedule to improve medical care for children in the countryside. The population is notified about the arrival of the pediatrician in advance.

Materials of inspections of the work of rural district hospitals and FAPs for medical care of children are summarized by district pediatricians and organizational and methodological offices of the Central District Hospital. are periodically heard at district conferences and medical councils. Based on the results of the discussion, appropriate organizational measures are taken.

In accordance with these tasks, the main responsibilities of the doctor (doctors) of the rural medical district have been determined;

Outpatient reception of the population;

Inpatient treatment of patients in a rural district hospital:

Home assistance;

Provision of medical care in case of acute illnesses and accidents;

Referral of patients to other health care facilities for medical reasons;

Examination of temporary incapacity for work and issuance of certificates of incapacity for work:

Organization and conduct of preventive examinations;

Timely registration of patients with dispensary registration:

Carrying out a complex of medical and health-improving measures, ensuring control of medical examination;

Active patronage of children and pregnant women;

Carrying out a complex of sanitary and anti-epidemic measures;

Sanitary and educational work, promotion of a healthy lifestyle;

Scheduled visits to FAP.

The structure of a rural medical area is formed depending on the size of the population served, the radius of service, the distance to the central district hospital and the condition of the roads. The number of people served in a rural medical area can reach 2.5 thousand people.

Primary specialized health care is provided by specialist doctors, including specialist doctors of medical institutions that provide specialized, including high-tech, medical care. Primary care is provided on an outpatient basis and in a day hospital.

To provide citizens with primary health care in acute diseases, conditions, exacerbation of chronic diseases that are not accompanied by a threat to the patient's life and who require emergency medical care, medical care units are created in the structure of medical institutions that provide it in an urgent form.

The organization of medical care for rural residents, its volume and quality depend on the remoteness of medical institutions from the place of residence of patients, staffing with qualified personnel, equipment, the possibility of obtaining specialized medical care, implementation of standards of medical and social security at the regional and federal levels.

Central District Hospital(CRH) is the main medical institution for the provision of qualified medical care to the rural population. At the same time, the CRH is the center for organizational and methodological management of the health care of the municipal district, which is responsible for organizing medical care for the population, increasing the efficiency, quality and availability of this care.

In different regions of the country, there are CRHs of different capacity, which depends on the population size, the availability of hospital facilities and other factors. The optimal capacity of the Central District Hospital is at least 250 beds. The CRH includes:

A hospital with departments in the main specialties;

Polyclinic with treatment and diagnostic rooms and a laboratory:

Emergency and Emergency Medicine Departments:

Pathological department:

Organizational and methodological office;

Auxiliary structural units (pharmacy, kitchen, medical archive, etc.).

The profile and the number of specialized departments of the CRH depend on its capacity, but their optimal number should be at least 5: therapeutic, surgical with traumatology, pediatric, infectious, obstetric and gynecological (if there is no maternity hospital in the area).

The main tasks of the Central District Hospital:

Providing the population of the district and the district center with qualified specialized inpatient and polyclinic medical care;

Operational and organizational and methodological assistance to medical organizations of the region;

Organization of material and technical support for the units of the Central District Hospital:

Development and implementation of measures aimed at increasing the population's medical care, reducing morbidity, infant and general mortality, health promotion;

Placement, rational use, professional development of medical personnel;

Implementation of measures for the formation of a healthy lifestyle.

The head physician of the CRH has deputies for the main areas of activity: for the medical part, outpatient work, organizational and methodological work (head of the organizational and methodological department), administrative work, security, and in areas with a population of 70 thousand and more - for childhood and obstetrics.

To provide methodological, organizational and advisory assistance to doctors of rural medical districts, the CRH allocates regional specialists who, within the framework of their specialty, organizationally and methodically manage all medical institutions of the district - often heads of departments of the CRH or the most experienced doctors. Each of them leads medical work in the district in their specialty, travels for consultations, conducts demonstration operations, examinations and treatment of patients, sends teams of specialist doctors to medical institutions of rural medical districts, hears reports from district hospitals, heads of FAPs, analyzes their work, statistical reports, conducts scientific conferences, seminars, professional development in the workplace.

To bring specialized medical care closer to the rural population in regional centers, they create interdistrict specialized departments(centers, medical districts) equipped with modern equipment. The functions of interdistrict centers are performed by health facilities. able to provide the population with specialized highly qualified inpatient or outpatient-polyclinic care, if the CRH of neighboring districts is not able to provide specialized care or its volume in each health facility is minimal, and the necessary specialists are not available. Along with performing the functions of a structural unit of a health care facility, interdistrict specialized! -Centers (departments) carry out:

Consultative appointments in the outpatient clinic of patients in the direction of the doctors of the hospitals of the attached districts;

Hospitalization of patients from the assigned areas:

Organizational, methodological and advisory assistance (including an examination of the ability to work) to doctors of health care facilities in the attached areas, including planned visits:

Introduction of modern means and methods of prevention, diagnosis and treatment of patients in the relevant specialty into the work of health care institutions;

Analysis of the results of the provision of medical care to residents of the attached districts, presentation of information on the work of the interdistrict medical center;

Conducting joint thematic conferences, seminars. Medical facilities of the attached districts transport patients

and pregnant women to the interdistrict center (by agreement), refer patients for consultation only on condition of a full examination in accordance with the standards of medical care, inform the population about the working hours of the center's specialists. To coordinate the work of interdistrict medical centers and assigned districts, interdistrict medical councils are created.

Polyclinic Central District Hospital provides qualified medical care to the rural population in 8-10 medical specialties. The tasks of the polyclinic include:

Provision of qualified outpatient and polyclinic care for the attached population of the district and the district center;

Organizational and methodological management of outpatient and polyclinic divisions of the district;

Planning and implementation of activities aimed at preventing and reducing morbidity and disability;

Implementation of modern methods and means of prevention and treatment of diseases in the work of all outpatient and polyclinic institutions of the region, advanced experience in providing outpatient care;

Implementation of measures for the formation of a healthy lifestyle.

Rural residents apply to the district polyclinic for referrals from medical institutions of rural medical districts to receive specialized medical care, functional examinations, and consultations of specialist doctors.

To bring specialized medical care closer to the place of residence, on the basis of the CRH, out of the number of full-time doctors and nurses, mobile medical care teams are created.

An important role in the organization of medical care for the population of rural areas is played by the organizational and methodological office of the Central District Hospital. which is staffed by the most experienced doctors. It has data on the economy and sanitary condition of the region, the network and staffing of medical institutions, on the provision of the population with various types of medical and social security, etc. The head of the organizational and methodological office is the head, who at the same time can be the deputy chief physician of the CRH.

Outpatient and inpatient medical care for children in rural areas, they are assigned to children's polyclinics, children's hospitals and children's departments of the Central District Hospital.

Children's health protection in the district is carried out according to a single plan approved by the chief physician, who is responsible for the quality of medical care for children. However, he assigns direct responsibility to his deputy for pediatrics and obstetrics, or (in the absence of one) to the district pediatrician, who directs the medical care of children in the rural area.

The position of a district pediatrician is established in the staff of each district hospital, which includes a children's consultation-polyclinic, in addition to the medical positions provided for by the standard staff of a children's polyclinic.

The main healthcare facility providing medical care to children at the regional level RF.- children's regional (regional, district, republican) hospital. and in its absence - a regional (regional, republican, district) hospital with a children's department and an advisory clinic for children.

In the area, except for the Central District Hospital. organize specialized dispensaries (anti-tuberculosis, dermatovenerologic, narcological), which work as interdistrict medical institutions, serving the population of neighboring districts.

Highly qualified specialized medical care for the rural population in all major specialties is provided by regional (regional, republican district) medical institutions. The main one is regional (regional, republican, district) hospital, which provides medical care in full, not only to rural people, but also to all residents of the constituent entity of the Russian Federation. It is the center of organizational and methodological management of medical institutions located on the territory of the region (region, republic, district), a clinical base for specialization and advanced training of doctors and nurses.

The capacity and staff of the hospital are determined by the size of the population of the administrative territory. The optimal capacity of a regional (regional, republican, district) hospital is 700-1000 beds.

The tasks of the regional hospital:

Highly qualified specialized consultative, diagnostic and therapeutic assistance to the population of the administrative territory in outpatient and inpatient conditions with the use of highly effective medical technologies,

Advisory and organizational and methodological assistance to specialists from other medical institutions of the administrative territory;

Qualified emergency and planned consultative medical assistance using medical aircraft and ground transport;

Development and implementation of targeted programs to improve medical care:

Implementation of modern medical technologies, effective management methods and principles of medical insurance into the practice of medical institutions of the administrative territory:

Participation in training, professional retraining and advanced training of medical workers;

Formation of a healthy lifestyle.

Organizational and Methodological Department;

Consultative and diagnostic polyclinic:

A hospital with an admission department;

Department of Expert and Planned Consulting;

Medical Library;

Other structural units required for the operation of the hospital (catering department, accounting department, medical archive, garage, etc.).

The work of the regional hospital is in many ways similar to the work of the city hospital. but it also has its own characteristics. One of them is the presence in the hospital of the regional consultative and diagnostic polyclinic.

The main tasks of the consultative and diagnostic polyclinic: providing patients sent from medical institutions of the district or district level with specialized qualified consultative assistance in the diagnosis of diseases, recommending the volume and methods of treatment, if necessary, inpatient care in the departments of the regional hospital. Consultative and diagnostic polyclinics not only perform an advisory and medical function, but also assess the quality of work of rural doctors, district, city and district hospitals.

As a rule, patients are referred to the regional consultative polyclinic after preliminary consultation and examination by regional specialist doctors. To evenly distribute the flow of patients, the specialists of the consultative and diagnostic polyclinic regularly inform about the availability of free places in the hospital departments or appointments for examinations, agree on the dates of admission of patients from medical institutions in rural areas, organize and conduct field consultations of specialist doctors, give a medical opinion for each patient. in which the diagnosis is indicated. treatment performed and further recommendations. In the polyclinic, a quality examination is systematically carried out: congestion and discrepancies in diagnoses, mistakes made by doctors of regional medical institutions during the examination and treatment of patients on the spot, etc. are considered.

A feature of the regional hospital is the presence in its composition departments of emergency and planned counseling, which provides emergency and advisory assistance with a trip to a remote settlement. The department transports the patient to the medical organization, dispatches call specialists from the districts and liaises with the teams dispatched to provide medical care. The emergency department organizes the delivery of patients accompanied by medical personnel to specialized institutions outside the region, the urgent delivery of medicines and funds necessary to save the lives of patients.

This branch usually has a fleet of vehicles for driving into the countryside. Its staff includes, in addition to the head, doctors, specialized

emergency medical assistants, paramedics, nurses. All specialists of the regional hospital and other medical institutions can be involved in the work of the department. The department of emergency and planning and advisory assistance in some regions is the basic medical unit of the regional center for disaster medicine. In this case, the teams of specialized medical care work almost in constant readiness.

To bring medical care closer to the villagers, specialists from regional institutions practice scheduled visits of complex teams to consult pre-selected patients who need to clarify the diagnosis. correction of the prescribed treatment, determination of the need for hospitalization in regional medical institutions. This work is carried out by the specialists of the central regional hospitals.

Research work- one of the activities of the regional (regional, republican, district) hospital: conducting scientific research, introducing the results of new developments and methods into the practice of medical institutions, organizing scientific conferences and seminars, the work of scientific societies of doctors.

In the regional hospital, in contrast to the city, the functions organizational and methodological department much wider. In fact, it serves as a scientific and medical basis for the state health management body of the region for the introduction into practice of advanced organizational forms and methods of medical assistance to the population. Its main functions:

Analysis of the activities of medical institutions in the region:

Organizational, methodological and advisory assistance:

Study and analysis of population health indicators:

Organization of professional development of personnel;

Work planning.

The organizational and methodological work of regional medical institutions involves the main staff (chief surgeon, therapist, pediatrician, obstetrician-gynecologist) and freelance (often heads of specialized and highly specialized departments) specialists.

Ambulance in rural areas at the level of FAP, SUB. family medical outpatient clinics are provided by the medical staff of these institutions at any time of the day.

The most important issues of organizing emergency medical care for the rural population:

The schedule and procedure for the provision of emergency medical care in all rural medical organizations;

Availability of styling, bags and their necessary equipment;

Ambulance Standards;

Registration of incoming calls and measures taken;

Continuity (based on the principle of feedback) between the ambulance service, outpatient clinic service, dispatching services of farms and enterprises:

Preparing the population for the provision of self and mutual assistance, improving the health literacy of the population;

Development and availability of incentives for participation in this type of assistance of all health workers, including nursing staff, including their training, equipment and material incentives;

Training of medical personnel for the provision of emergency and emergency medical care;

Priority of medicinal and logistical support.

To improve medical care for the rural population, a lot of work is being done within the framework of the health care modernization program. which includes organization of households, further strengthening of the material and technical base of medical institutions in rural areas, advanced training, training and retraining of personnel.

The modernization program provides for the opening of more than 3,800 households in settlements with a population of less than 100 people.

Housekeeping means a local resident who has agreed to provide first aid to sick or injured residents of the settlement. To do this, experts in the field of disaster medicine will teach such a resident the basic skills and techniques of first aid, and the local authorities will equip him with a telephone connection for an operational call to a paramedic, a doctor, an ambulance brigade and packing first aid. Such work is already being actively carried out in some constituent entities of the Russian Federation.

In rural areas, it is planned to open 1,093 FAPs and paramedic points. 226 medical outpatient clinics, 1381 GP offices.

The situation with medical personnel, working in rural areas has been deteriorating in recent years. In 2005-2010 the number of doctors in rural areas decreased by 1653 people (from 42.2 thousand to 40.6 thousand doctors), the coefficient of doctors' combination increased by 6.7%.

Since January 1, 2012 by the Decree of the Government of the Russian Federation of October 17, 2011 No. 39 to medical and pharmaceutical workers living and working under an employment contract in rural settlements, workers' settlements (urban-type settlements), being staffed at the main place of work in federal state institutions subordinate to federal executive bodies, as a measure of social support, a monthly cash payment is established to compensate for the costs of paying for housing, heating and lighting in the amount of 1,200 rubles.

In order to reduce the shortage of medical personnel in rural areas, it was proposed to create additional incentives for doctors who will transfer to work in rural areas, in the form of one-time payments in the amount of 1 million rubles for the arrangement, solution of housing and other domestic problems.

It is planned to carry out one-time compensation payments to medical workers under the age of 35 years. arriving in 2011-2012 after graduating from a higher educational institution to work in a rural settlement or moving from another settlement.

The condition for receiving these payments is the conclusion between the doctor and the authorized executive body of the constituent entity of the Russian Federation of an agreement on moving to work in a rural settlement for a period of at least 5 years.

The executive authorities of the constituent entity of the Russian Federation have the right to provide payments for nursing personnel at the expense of the constituent entity of the Russian Federation.

Federal target program "Social development of the village until 2013" (as amended by decrees of the Government of the Russian Federation of April 29, 2005 No. 271 and of April 28, 2011 No. 336) provides for the implementation of additional measures for the development of a network of PHC institutions:

Strengthening the material and technical base of health care facilities in rural areas, taking into account the creation of field units, centers, departments of general medical (family) practice;

Improving primary health care for the rural population by introducing general medical (family) practice;

Providing the rural population with emergency medical care by improving the regulatory, material and technical and personnel support;

Improvement of advisory, diagnostic and medical assistance by the introduction of field forms of medical care;

Staffing of healthcare institutions mainly with specialists from general medical (family) practice:

Development of the GP (family doctor) institute.

As a result of the implementation of the measures, the rural population's access to the services of medical institutions and their subdivisions will be expanded.

To increase the efficiency of the implementation of the Concept of the demographic policy of the Russian Federation for the period up to 2025, approved by the decree of the President of the Russian Federation of October 9, 2007 No. 1351. in relation to rural areas, additional measures are needed in order to:

Reducing the mortality rate, especially in the working age:

Reducing the level of infant mortality;

Preserving and strengthening the health of the rural population: increasing life expectancy;

Creation of conditions for a healthy lifestyle;

Reducing the incidence of socially significant diseases,

Reduction of the migration flask of the rural population. In this regard, in the regions it is necessary to provide:

Strengthening primary health care in rural areas:

Increasing the availability of medicines for rural residents;

Formation of motivation for a healthy lifestyle, including programs to reduce the consumption of alcohol and tobacco products, non-medical consumption of drugs and psychotropic substances, prevention of alcoholism, drug addiction, cardiovascular and other diseases;

Ensuring the operation of health centers in rural settlements.

In the field of medical care, it is planned to expand the access of the rural population to qualified primary health care. ambulance and specialized medical care based on strengthening the FAP network. district hospitals, the creation of outpatient clinics for general medical practice, taking into account the territorial characteristics. strengthening the material and technical base of district, central district hospitals and interdistrict centers using telemedicine, ensuring transport accessibility for the rural population of interdistrict centers, regional, republican and federal medical institutions. It is planned to expand the ambulance service, pharmacy network, mobile forms of specialized medical care and the use of remote forms of diagnostics in the countryside. The entire rural population should be covered by dispensary supervision.

To popularize a healthy lifestyle and attract rural residents to engage in physical culture and sports, it is planned to expand the network of sports facilities and grounds.

All measures proposed and carried out by the Government and health authorities at the local level should really change the existing health care system in the countryside and bring it to a new, higher quality level that meets the modern requirements of medicine.

Unity of principles of providing medical and preventive care urban and rural population: 1) preventive nature; 2) district; 3) mass character; 4) specialization of medical care 5) general availability.

The peculiarity of the provision of medical and preventive care to the rural population:

1) stages of assistance

2) mobile types of medical care (mobile medical teams).

Features of the organization of rural medical care:

1) low population density - the number of rural population in 2004 2.803.600, 2005 2.744.200, 2006 2.691.500. Compared to 2002, the rural population decreased by 118 thousand. In 2005, 90.307 people were born, of which 24.205 (26.8%) were in the countryside. The birth rate in 2005 was 9.2 in the Republic of Belarus, in the countryside - 8.9. The mortality rate in the countryside is 2.2 times higher than in the city. Infant mortality in general is 6.4, in rural areas - 9.3. Life expectancy in the countryside is 64.52, in the city 70.53.

Population - the number of people in a locality. The average rural population is 200 people.

2) the scattering of settlements over a large territory - rural settlements 24 thousand. The average population density in the Republic of Belarus is 48 people per km2, in the village - 10 people per km2. Proximity is the distance between settlements, the radius of service is the distance from a settlement where there are medical institutions to the most remote settlement, whose residents are attached to this institution for medical care. This value is manageable and varies with population.

3) poor quality of roads

4) the specifics of agricultural labor: seasonality, dependence on the weather

5) conditions, lifestyle, traditions

6) low availability of specialists

Stages of providing medical and preventive care to the rural population and the main organizations:

Stage I - earlier - a rural medical district (SVU), including a complex of medical institutions:

A) a rural district hospital (SUB, provides both outpatient and inpatient care) or a rural medical outpatient clinic (SVA, provides only outpatient care)

B) feldsher-obstetric station (FAP)

C) health centers (if there is an industrial enterprise in the served area).

Currently There are no IEDs, SVA and district hospitals are branches of the Central District Hospital, FAPs are branches of SVA.

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

FAPs- are created for medical care of 400 people or more at a distance of 2 km or more from a medical institution. When serving more than 400 people. in the states of FAP there are: 1 position of a paramedic or midwife or nurse and 0.5 positions of a nurse. The cost of FAPs is 1.5-2.0% of the budget of the ZO district.

FAP functions:

- provision of first aid medical care and timely fulfillment of doctor's prescriptions;

- Carrying out preventive work and anti-epidemic work;

- organization of patronage for pregnant women, children,

- Carrying out measures to reduce infant and maternal mortality;

- hygienic training and education of the population.

Rural medical station (SVU)- served 7-9 thousand people within a radius of 7-9 km.

District hospital- This is the main institution on the SVU, consists of a hospital and an outpatient clinic. Depending on the number of beds, there can be category I - for 75-100 beds, II - 50-75 beds, III - 35-50, IV - 25-35 beds. At the local hospital All types of qualified medical and preventive care are provided... Medical assistance to the population during field work is of great importance. Considerable work is being done to protect the health of women and children, to introduce modern methods of prevention, diagnosis, and treatment.

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

At Unprofitable activities of local hospitals, they are closed or repurposed into branches Rehabilitation of district hospitals, and for medical care of the population, Independent rural medical outpatient clinics(SVA), the staff of which should be: a general practitioner, dentist, obstetrician-gynecologist, pediatrician. A dentist (dentist) provides medical assistance to patients with dental diseases in a local hospital or in a rural medical outpatient clinic.

From the standard standards of the medical personnel of local hospitals:

1. The positions of doctors for the provision of outpatient care to the population are established on the basis of 10,000 of the population:

2. The positions of doctors of the hospital departments are established at the rate of 1 position:

- therapist - 25 beds;

- pediatrician - for 20 beds;

- surgeon - 25 beds;

- dentist - for 20 beds.

The bed capacity of the rural district hospital is 27-29 beds.

Organization of SMS work:

- provision of medical and preventive care to the population

- introduction into practice of modern methods of prevention, diagnosis and treatment of patients

- development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care

- organization and implementation of a set of preventive measures among the population of the site

- carrying out medical and preventive measures to protect the health of mothers and children

- study of the causes of general morbidity and morbidity with temporary disability and the development of measures to reduce it

- organization and implementation of medical examination of the population, especially children, adolescents

- implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.)

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

- Carrying out therapeutic and prophylactic measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms

- organization and implementation of measures for sanitary and hygienic education of the population, promotion of a healthy lifestyle, including rational nutrition, increased physical activity; combating alcohol consumption, smoking and other bad habits

- wide involvement of the public in the development and implementation of measures to protect public health

Stage II - Territorial Medical Association (TMO).

Managed by TMO Chief physician of the TMO(he is also the chief physician of the Central District Hospital) and his deputies:

- Deputy for medical care of the population (he is also the head of the organizational and methodological office);

- Deputy for the medical department (with the number of beds 100 or more);

- Deputy for Medical and Social Expertise and Rehabilitation (if the number of the served population is at least 30,000 people);

- Deputy for obstetrics and childhood (if the number of the served population is at least 70,000 people);

- Deputy for Economic Affairs;

- Deputy for the administrative part.

The medical council includes: chief physician, his deputies, chief physician of the Center for Hygiene and Epidemiology, head of the central regional pharmacy, leading specialists of the region, chairman of the regional committee of the trade union of medical workers, chairman of the Red Cross and Red Crescent Society.

The decision to create a TMO is taken by the higher health management body. In small towns and rural areas, TMO usually unites all medical institutions and replaces the city health department and the central district hospital. In large cities with a population of more than 100,000, there may be several TMOs, one of them is the head one.

TMO Is a complex of health care facilities, functionally and organizationally related to each other. The TMO may include:

polyclinics (adults, children, dental);

antenatal clinics, dispensaries, hospitals, maternity hospitals;

ambulance stations;

children's sanatoriums and other institutions.

Consolidation of institutions should be expedient, not mandatory. Institutions that are not included in the TMO act independently. As a rule, these are health centers and centers of hygiene and epidemiology, forensic medical examination bureaus, blood transfusion stations.

Principles of TMO formation:

1. A certain size of the population - the optimal size of TMT is 100-150 thousand population.

2. Organizational and financial separation of outpatient and inpatient institutions.

3. Coincidence of the boundaries of the TMO service area with the administrative boundaries of the region (city).

4. Rational association of institutions - an association of institutions that provide medical care to adults and children.

The tasks of the TMO- provision of affordable and qualified medical and preventive care to the population.

Functions of TMO:

1. Organization of medical and preventive care for the attached population, as well as any citizen who seeks medical help.

2. Carrying out preventive measures.

3. Provision of ambulance to the sick.

4. Timely provision of medical assistance at the reception, at home.

5. Timely hospitalization.

6. Clinical examination of the population.

7. Carrying out medical and social expertise.

8. Carrying out hygienic training and education.

9. Analysis of the activities of health care facilities.

The main medical institutions Stage II is the central district hospital (CRH) and other institutions of the district (see question 102).

For organizing Medical and preventive care for women and children at this stage, the district pediatrician and the district obstetrician-gynecologist are responsible. With a population of more than 70,000 people, the position of deputy chief physician for childhood and obstetrics is appointed - an experienced pediatrician or obstetrician-gynecologist.

Outpatient dental care at the second stage, it can be provided in dental clinics and dental departments of the Central District Hospital. Inpatient dental care in the dental department of the Central District Hospital or on special beds for dental patients in the surgical department.

Stage III - regional hospital and medical institutions of the region.

Regional Hospital Is a large multidisciplinary medical and prophylactic institution that fully provides highly qualified highly specialized assistance to residents of the region. This is the center for organizational and methodological management of medical institutions located in the region, a base for specialization and advanced training of doctors and nurses.

Regional hospital structure:

1. Hospital.

2. Consultative clinic.

3. Other units (kitchen, pharmacy, morgue).

4. Organizational and methodological department with a department of medical statistics.

5. Department of emergency and planned consulting assistance, etc. (see question 104).

The bed capacity of the regional hospital for adults is 1000-1100 beds, for children - 400 beds.

Consultative clinic provides the population with highly qualified, highly specialized medical care, provides field consultations, by phone - correspondence consultations, analyzes the activities of medical and preventive institutions, the discrepancy between the diagnoses of the sending institutions and the polyclinic, diagnoses of the polyclinic and the hospital, error analysis. Does not have the right to issue sick leave.

Children and women in the region receive all kinds of qualified specialized medical care in the consultative polyclinic. Inpatient care for women is provided in regional maternity hospitals, regional dispensaries and other medical institutions in the region.

Outpatient qualified specialized dental care patients are in the regional dental clinics, inpatient - in the dental departments of regional hospitals.

The number of hospital organizations in the countryside in 2005 was 274, of which there were 184 district hospitals, 90 nursing hospitals. The number of outpatient clinics was 3326. In 2005, there were 253 independent medical outpatient clinics, and 336 general practitioners outpatient clinics in 2005. FAPs in 2005 - 2524.

IVstage: republican level(Republican Scientific and Practical Center, republican hospitals).

The peculiarity of the provision of medical and preventive care to the rural population:

1) stages of assistance

2) mobile types of medical care (mobile medical teams).

Features of the organization of rural medical care:

Population - the number of people in a locality. The average rural population is 200 people.

2) the scattering of settlements over a large territory - rural settlements 24 thousand. The average population density in the Republic of Belarus is 48 people per km 2, in a village - 10 people per km 2. Proximity is the distance between settlements, the radius of service is the distance from a settlement where there are medical institutions to the most remote settlement, whose residents are attached to this institution for medical care. This value is manageable and varies with population.

3) poor quality of roads

4) the specifics of agricultural labor: seasonality, dependence on the weather

5) conditions, lifestyle, traditions

6) low availability of specialists

Stages of providing medical and preventive care to the rural population and the main organizations:

Stage I - earlier - a rural medical district (SVU), including a complex of medical institutions:

a) a rural district hospital (SUB, provides both outpatient and inpatient care) or a rural medical outpatient clinic (SVA, provides only outpatient care)

b) feldsher-obstetric station (FAP)

c) health centers (if there is an industrial enterprise on the served territory).

Currently There are no IEDs, SVA and district hospitals are branches of the Central District Hospital, FAPs are branches of SVA.

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

FAP functions:

Providing first-aid medical care and timely fulfillment of doctor's prescriptions;

Carrying out preventive work and anti-epidemic work;

Organization of patronage for pregnant women, children,

Carrying out measures to reduce infant and maternal mortality;

Hygienic training and education of the population.

Rural medical station (SVU)- served 7-9 thousand people within a radius of 7-9 km.

District hospital- This is the main institution on the SVU, consists of a hospital and an outpatient clinic. Depending on the number of beds, there can be category I - for 75-100 beds, II - 50-75 beds, III - 35-50, IV - 25-35 beds. At the local hospital all types of qualified medical and preventive care are provided... Medical assistance to the population during field work is of great importance. Considerable work is being done to protect the health of women and children, to introduce modern methods of prevention, diagnosis, and treatment.

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

At unprofitable activities of local hospitals, they are closed or repurposed into branches rehabilitation of district hospitals, and for medical care of the population, independent rural medical outpatient clinics(SVA), the staff of which should be: a general practitioner, dentist, obstetrician-gynecologist, pediatrician. A dentist (dentist) provides medical assistance to patients with dental diseases in a local hospital or in a rural medical outpatient clinic.

From the standard standards of the medical personnel of local hospitals:

1. The positions of doctors for the provision of outpatient care to the population are established on the basis of 10,000 of the population:

2. The positions of doctors of the hospital departments are established at the rate of 1 position:

Physician-therapist - 25 beds;

Pediatrician - 20 beds;

Surgeon - 25 beds;

Dentist - 20 beds.

The bed capacity of the rural district hospital is 27-29 beds.

Organization of SMS work:

Provision of medical and preventive care to the population

Introduction into practice of modern methods of prevention, diagnosis and treatment of patients

Development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care

Organization and implementation of a complex 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 current sanitary supervision over the condition of industrial and communal premises, water supply sources, children's institutions, public catering establishments;

Carrying out therapeutic and prophylactic measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms

Organization and implementation of measures for sanitary and hygienic education of the population, promotion of a healthy lifestyle, including rational nutrition, increased physical activity; combating alcohol consumption, smoking and other bad habits

Wide involvement of the public in the development and implementation of measures to protect public health

Stage II - Territorial Medical Association (TMO).

Managed by TMO chief physician of the TMO(he is also the chief physician of the Central District Hospital) and his deputies:

Deputy for 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 the administrative part.

TMO Is a complex of health care facilities, functionally and organizationally related to each other. The TMO may include:

polyclinics (adults, children, dental);

antenatal clinics, dispensaries, hospitals, maternity hospitals;

ambulance stations;

children's sanatoriums and other institutions.

Principles of TMO formation:

1. A certain size of the population - the optimal size of TMT is 100-150 thousand population.

2. Organizational and financial separation of outpatient and inpatient institutions.

3. Coincidence of the boundaries of the TMO service area with the administrative boundaries of the region (city).

4. Rational association of institutions - an association of institutions that provide medical care to adults and children.

The tasks of the TMO- provision of affordable and qualified medical and preventive care to the population.

Functions of TMO:

1. Organization of medical and preventive care for the attached population, as well as any citizen who seeks medical help.

2. Carrying out preventive measures.

3. Provision of ambulance to the sick.

4. Timely provision of medical assistance at the reception, at home.

5. Timely hospitalization.

6. Clinical examination of the population.

7. Carrying out medical and social expertise.

8. Carrying out hygienic training and education.

9. Analysis of the activities of health care facilities.

The main medical institutions Stage II is the central district hospital (CRH) and other institutions of the district (see question 102).

For organizing medical and preventive care for women and children at this stage, the district pediatrician and the district obstetrician-gynecologist are responsible. With a population of more than 70,000 people, the position of deputy chief physician for childhood and obstetrics is appointed - an experienced pediatrician or obstetrician-gynecologist.

Stage III - regional hospital and medical institutions of the region.

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.

Outpatient qualified specialized dental care patients are in the regional dental clinics, inpatient - in the dental departments of regional hospitals.

Stage IV: republican level(Republican Scientific and Practical Center, republican hospitals).

31. Clinical examination of the population. Definition, tasks. Organization and maintenance of medical examination in medical and preventive organizations. Indicators for assessing dispensary work - see question 67.

Medical and social expertise (MSE), definition, content, basic concepts. Management of the service of medical and social examination and rehabilitation in the Republic of Belarus.

Medical and social expertise (ITU) Is an independent area of scientific knowledge and a sphere of practical activity that studies the state of human life and his ability to work, reveals the degree of their violation and pursues the goal of their restoration through a complex of therapeutic and rehabilitation measures. The subject of medical and social expertise is the determination, in accordance with the established procedure, of the needs of the examined person in measures of social protection, including rehabilitation.

Medical and social expertise (MSE) is a relatively new concept that replaced “medical and labor expertise” after the adoption in 1991 of the law “On social protection of disabled people in the Republic of Belarus”. According to this law, it is determined following ITU structure:

1) VTEK were transferred to the health care system with their subsequent reorganization into medical and rehabilitation expert commissions (MEDEC)

2) under the management of the Ministry of ZO, a scientific and practical system of medical and social expertise began to function, including

a) a republican scientific and practical center in the form of the Scientific Research Institute of Medical and Social Expertise and Rehabilitation (SRI MSEiR)

b) regional, city, interdistrict medical and rehabilitation expert commissions (MEDEC)

c) individual services and specialists dealing with MSU and rehabilitation issues in inpatient and outpatient organizations of the republic.

Main tasks of ITU:

1.scientific assessment of the state of work ability

2.determining the causes of disability

4.systematic observation and control over the working capacity of disabled persons

5.Promoting the prevention and treatment of diseases, prevention of disability

6.expert control over long-term patients

7.determination and study of the economic and social causes of disability

8.determination of the degree of disability by workers and employees who have received an injury or other damage to health associated with their work

Basic ITU concepts:

1) ability to work- such a state of the organism, in which the combination of physical and spiritual capabilities allows a person to fulfill his professional duties (work of a certain volume and quality). When assessing the ability to work, the following criteria are taken into account:

a) medical- the influence of biological, medical factors (disease state of the body); when assessing the state of working capacity, the diagnosis, stage and course of the disease, the presence and nature of complications, the degree of functional disorders, and clinical prognosis are taken into account. Many diseases, especially in the initial period, do not lead to the need to stop work; in this case, if work is not contraindicated for the patient, and the disease does not harm others, disability is not determined.

b) social- include the characteristics of the profession, position, the degree of predominance of physical or neuropsychic stress, the length of the working day, the shift pattern of work, working conditions, labor prognosis, social status of a person, marital status, etc. Disability can be determined by social indications, i.e. in cases where there is no disease, but the legislation establishes the possibility of temporary release from work due to various circumstances (for example, caring for a sick family member, in connection with quarantine, etc.).

2) incapacity for work divided by:

a) temporary- the functional state of the body caused by illness, injury or other reason, in which the dysfunction that prevents the continuation of professional work is temporary, reversible and the patient may return to work. The main criterion for temporary disability is the reversibility of functional disorders, a favorable clinical and work prognosis. This means a complete recovery or significant improvement of the impaired body functions with the restoration of working capacity in a relatively short time.

b) persistent- arises if the impairment of functions that prevents the performance of professional work, despite treatment, has acquired a stable and long-term nature, in connection with which the performance of professional work becomes impossible or requires a significant change.

Temporary and permanent disability can:

1. complete- the impossibility of continuing professional work, in connection with which the patient is relieved of his obligations to work and society takes care of his material support.

2. partial(disability) - the inability to perform their professional work, while the patient is able to perform other, easier work without damage to health.

Aspects of the examination of incapacity for work:

1) medical - a study of the nature of the disease;

2) social - the ability to perform professional work, change it or stop;

3) legal - the examination is regulated by documents, the doctor is responsible;

4) statistical - at the state level, statistical accounting of the time of incapacity for work, permanent incapacity for work is carried out;

5) economic - according to documents, the state pays benefits or pensions.

33. Rehabilitation: medical, professional, social. Definition of concepts. Organization of the rehabilitation system for sick and disabled people in the Republic of Belarus. Law of the Republic of Belarus "On the prevention of disability and rehabilitation of disabled people."

Rehabilitation is a set of measures of a different nature aimed at reducing the impact of disabling factors and conditions leading to physical and other defects, as well as providing opportunities for a disabled person to achieve social integration. This is an interdepartmental concept (not only doctors should be involved in rehabilitation).

The main types of rehabilitation:

a) medical rehabilitation- a process aimed at restoring and compensating by medical and other methods of the functional capabilities of the human body, impaired as a result of a congenital defect, past diseases or injuries

b) medical and professional rehabilitation- the process of restoration of working capacity, combining medical rehabilitation with the definition and training of professionally significant functions, the selection of a profession and adaptation to it;

c) vocational rehabilitation- a system of measures that provide a disabled person with the opportunity to get a suitable job or keep the previous one and advance in the service (job), thereby contributing to his social integration or reintegration;

d) labor rehabilitation- the process of employment and adaptation of a disabled person to a specific workplace;

e) social rehabilitation- a system of measures to improve the standard of living of people with disabilities, create equal opportunities for them to fully participate in the life of society

Rehabilitation directions:

1) rehabilitation of patients - aimed at preventing a defect, preventing disability

2) rehabilitation of disabled people - reducing the severity of disability, adaptation of a disabled person to the domestic and work environment.

Disability prevention levels

a) primary prevention of disability- a decrease in the incidence of impaired functions that impede life and limiting the ability to work.

b) secondary prevention of disability- limiting the degree of dysfunction or reverse development with existing diseases, congenital or acquired defects.

c) tertiary prevention of disability- prevention of the transition of emerging or congenital functional disorders at the level of disability into permanent defects, leading to an aggravation of disability and incapacity for work.

In 1994 the law was adopted "On the prevention of disability and rehabilitation of disabled people"... On its basis, the state program for the prevention of disability and the rehabilitation of persons with disabilities operates.

Article 4. Tasks of the legislation of the Republic of Belarus in the field of disability prevention and rehabilitation of disabled people:

Creation of legal guarantees for the organization and development of a system for the prevention of disability and rehabilitation of disabled people;

Ensuring and protecting the rights of citizens of the Republic of Belarus to medical, professional and social rehabilitation;

Participation of public organizations of people with disabilities in state programs for the rehabilitation of people with disabilities.

Article 5. The state program for the prevention of disability includes:

Study of the causes of disability;

Development of measures to prevent or limit the incidence of health loss, including immunization programs;

Development of measures to prevent congenital defects, chronic and occupational diseases, accidents, injuries, as well as the restructuring of the human psyche with the help of

external influence;

Creation of a system for early detection and prevention of disability;

Creation of special programs to reduce injuries

Development of programs for certification and rationalization of workplaces and working conditions as measures for the prevention of occupational and other diseases

Medical examination and health improvement of children;

Analysis of all cases of injuries caused by emergency and environmental circumstances or the risk of such circumstances;

Control over the excessive use of medicines, drugs, alcohol, tobacco and other stimulants;

Creation of special programs to reduce the frequency and severity of hereditary pathology, endocrine, mental diseases leading to disability, as well as alcoholism;

Measures of education, explanatory work about the dangers of smoking and alcoholism, overweight, insufficient physical activity as risk factors for cancer, cardiovascular and

other chronic diseases;

Scientific support of the developed programs, personnel training, educational, educational and other measures.

34. Sanitary and Epidemiological Service in the Republic of Belarus, structure, functions, management. Branches of sanitary activities. Law of the Republic of Belarus "On the Sanitary and Epidemic Welfare of the Population".

Sanitary and Epidemic Service- the system of state institutions carrying out state sanitary supervision, development and implementation of sanitary-preventive and anti-epidemic measures.

Tasks of the Sanepid Service:

1) ensuring a timely hygienic assessment of everything new that is being introduced into the national economy

2) development and implementation, regulation of maximum permissible concentrations of harmful substances and methods of control over them

3) organization and control over the implementation of measures and recommendations for improving working conditions, life, recreation of the population

The organization of the Sanitary and Epidemiological Service is based on:

1.state nature of sanitary and epidemic activities

2.scientific planning basis for sanitary-prophylactic and anti-epidemic measures

3. the unity of the management of sanitary-prophylactic and anti-epidemic activities, consisting in the fact that this work is concentrated in a single complex institution - the TsGiE.

4.participation of all medical organizations in sanitary-preventive and anti-epidemic work with the organizing role of the Sanitary and Epidemiological Service

5.participation of the population in sanitary and recreational work and the promotion of hygienic knowledge

The main task is the state sanitary supervision; control over the implementation of sanitary-preventive and anti-epidemic measures.

1) prevention and liquidation of environmental pollution

2) improvement of working conditions in agricultural and industrial production to reduce general and occupational morbidity

3) creation of the most favorable conditions for the normal development and education of children and adolescents

4) improving the nutrition of the population - rational nutrition, prevention of food poisoning

State sanitary supervision is carried out by the Sanitary and Epidemiological Service (SES) in the form of preventive and current supervision over the conduct of sanitary and anti-epidemic measures, over the observance of sanitary and hygienic and anti-epidemic norms and rules by ministries, departments, enterprises, institutions, organizations, officials, individual citizens.

Organizational structure of SES RB:

a) republican level: headed by the deputy minister of the ZO - the chief state sanitary doctor of the Republic of Belarus, he has 4 deputies, heads the sanitary-epidemic department. There is a republican TsGiE, which is engaged in scientific and practical activities.

b) the regional level: the regional CGiE, its chief doctor is the chief state sanitary doctor of the region, he is also the deputy head of the department of the ZO region

c) district level: district CGiE - chief physician - chief state sanitary doctor of the district, deputy chief physician of the district

Scientific research organizations of SES: Scientific Practical Center for Hygiene (formerly Research Institute of Hygiene), Research Institute of Microbiology and Epidemiology.

There are 146 total CH&E in the Republic of Bashkortostan, in addition to them there are disinsection and deratization centers, disinfection stations, sanitary control points.

Organizational structure of the CH&E (for example):

1. Organizational department - coordinates all the work of the SES on the scale of the service area, consists of departments: computerization, information support, metrology and standardization, epidemic analysis and forecasting

2. Sanitary and hygienic department - departments of communal hygiene, labor hygiene, food hygiene, hygiene of children and adolescents, toxicological.

4. Radiation hygiene.

5. Department of hospital hygiene and disinfection

6. Department of especially dangerous infections

7. Department of AIDS Prevention.

The legal basis for the activities of the CH&E is determined by:

a) the constitution of the Republic of Belarus

b) the law on ZO

c) the law "On Sanitary and Epidemic Welfare"

d) a set of sanitary and hygienic and sanitary and preventive standards, norms, rules, individual government decrees, decisions of the Council of People's Deputies on sanitary and anti-epidemic issues.

State sanitary supervision by the bodies and institutions of the SES carried out in 2 forms:

a) preventive - for construction, planning, development of settlements, planning the location of industry

b) current - sanitary inspection of public utilities, industrial events, food facilities, preschool and school institutions, sources of infection, etc.

Officials of the TsGiE, in the implementation of state sanitary supervision, perform control and organizational functions. Among health workers, only the sanitary doctor has the right to coercion.

Law of the Republic of Belarus "On Sanitary and Epidemic Welfare of the Population"(1993) regulates public relations in the field of ensuring the sanitary and epidemic well-being of the population of the Republic of Belarus, maintaining and strengthening health, physical, spiritual development and long-term active life of people; the law defines the competence of the republican and local bodies of state power and administration in the field of ensuring the sanitary and epidemic well-being of the population; obligations of enterprises, institutions, organizations and other business entities, public associations, officials and citizens to comply with sanitary standards, rules, hygienic standards and conduct sanitary and hygienic, preventive, anti-epidemic and anti-radiation measures; the system of state control and supervision; types of responsibility for violations of sanitary legislation.

The main sections of the law:

General Provisions

The rights and obligations of citizens, enterprises, institutions and organizations to ensure the sanitary and epidemic well-being of the population

Powers of the highest bodies of state power and administration in the field of ensuring the sanitary and epidemic well-being of the population

General requirements for ensuring the sanitary and epidemic well-being of the population

State control and supervision over compliance with the sanitary legislation of the Republic of Belarus

Departmental sanitary supervision, industrial and public sanitary control

Responsibility for violation of sanitary legislation.

Medical care for the rural population is based on the same principles as for the urban population, but the peculiarities of the life of the rural population (the nature of settlement, low population density, specific conditions of the labor process, household activities and everyday life, poor quality or lack of roads) require the creation of a special system organization of medical and preventive care. The organization of medical care in the countryside, its volume and quality depend on the remoteness of medical institutions from the place of residence of patients, the staffing of medical institutions with qualified personnel and equipment, and the possibility of obtaining specialized medical care. A feature of medical care for the rural population is the staging of medical care. There are three stages of providing medical care to rural residents:

1. Rural medical area - unites a rural district hospital, a medical outpatient clinic, feldsher-obstetric posts, feldsher posts, preschool institutions, feldsher health posts at enterprises, a dispensary. At this stage, the rural population can receive qualified medical care. Qualified medical care - medical medical care provided to citizens for diseases that do not require specialized diagnostic methods, treatment and the use of complex medical technologies.

2. District medical institutions - CRH, district hospitals, district centers of state sanitary and epidemiological surveillance. At this stage, rural residents receive specialized medical care.

3. Republican (regional, regional) medical institutions: Republican (regional, regional) - hospitals, dispensaries, polyclinics, centers of state sanitary and epidemiological surveillance. At this stage, highly qualified and highly specialized medical care is provided.

102 First stage. Rural medical area includes the following medical institutions: a local hospital with an outpatient clinic (polyclinic) or an independent hospital (a medical outpatient clinic, FAP, state farm (collective farm) medical dispensaries, pharmacies, dairy kitchens. primary health care to the rural population and contribute to the successful solution of the problems of providing this care in conditions of considerable remoteness of settlements from district and central district hospitals.

The first stage is a rural medical area, where patients receive qualified medical care; the second stage - regional medical institutions and the leading institution at this stage is the central regional hospital, which provides specialized medical care for its main types; the third stage - regional institutions and, in particular, the regional hospital, which provides highly qualified specialized medical care in almost all specialties.

The rural medical area is the first link in the system of medical care for the rural population. In addition to a rural district hospital or an independent medical outpatient clinic, the rural medical district includes feldsher-obstetric points, seasonal and permanent nurseries, and medical assistant health centers at industrial enterprises and trades. The network of these institutions is built depending on the location and size of settlements, the radius of service, the economy of the region and the condition of the roads. The average population in a medical area fluctuates between 5-7 thousand inhabitants with an optimal radius of a site of 7-10 km (the distance from the settlement village where the SUB is located to the most remote settlement of the rural medical area). Depending on natural and economic-geographical factors, the size of the medical areas, the population on them may be different.

All medical institutions that are part of the medical department are organizationally united and work according to a single plan under the leadership of the chief physician of the local hospital.

The nearest medical institution to which rural residents apply for medical help is a feldsher-obstetric center (FAP). The presence of feldsher-obstetric points is one of the features of rural health care, due to the need to bring medical care closer to the population in the conditions of a large service radius of the district hospital and low density rural residents.

The recommended standard for the number of residents when organizing FAP-700 and more with a distance to the nearest medical institution of at least 5 km. If the distance to the nearest medical institution exceeds 7 km, then FAP is organized in settlements with 300-500 inhabitants.

The main tasks of the FAP are:

Providing first aid;

Conducting sanitary and health-improving and anti-epidemic measures to prevent and reduce morbidity and injuries;

Timely and in full compliance with the doctor's prescriptions;

Organization of patronage for children and pregnant women;

Systematic monitoring of the health status of war invalids and leading agricultural specialists;

Implementation of measures to reduce infant and maternal mortality.

The main medical institution in a rural medical area is a local hospital or an independent medical outpatient clinic (polyclinic).

Regardless of the capacity in any district hospital, outpatient and inpatient care should be provided to therapeutic and infectious patients, assistance in childbirth, treatment and prophylactic care for children, emergency surgical and traumatological care, and dental care.

There are four categories of rural district hospitals: I - 75-100 beds, II - 50-75 beds, III - 35-50 beds, IV - 25-35 beds. The specialization of beds in the SC depends on their number. Thus, category I hospitals (75-100 beds) should have specialized beds for therapy, surgery, obstetrics, pediatrics, infectious diseases, and tuberculosis. As a rule, such hospitals are equipped with clinical diagnostic equipment. Category IV hospitals (25-35 beds) should have beds for therapy, surgery and obstetrics.

At a rural district hospital, as a department, there should be a mobile outpatient clinic for the approximation of medical care.

The main functions of the rural medical area are:

Provision of medical and preventive care to the population;

Conducting sanitary and anti-epidemic work.

Outpatient medical care is provided to the population of the rural medical district in the local hospital and at the feldsher-obstetric stations. SUB doctors conduct outpatient appointments for adults and children, provide home assistance and emergency care. A rural doctor must be a general practitioner (family doctor), he must continue the traditions of a rural doctor.

In the organization of medical care in the SMS, the following features can be distinguished:

There is no clear time limit for outpatient appointments;

Hours of admission to patients should be appointed at the most milking time for the population, taking into account the seasonality of agricultural work;

The possibility of receiving a patient by a paramedic in the absence of a doctor for one reason or another;

House calls are made by a doctor only in a village center, house calls in another settlement of a rural medical district are made by a paramedic;

Duty in a hospital with the right to stay at home and obligatory information of the staff about their location in case of emergency.

103 Second stage. District medical institutions : the central district and the so-called zonal district hospitals with polyclinics and departments of ambulance and emergency medical care located in the district, district dispensaries and other medical institutions

The second stage of medical care for rural uniforms:

Regional healthcare institutions: central regional hospital, numbered regional hospitals, regional center of state sanitary inspection, dispensaries, medical and sanitary units, etc.

The main link in the system of organizing medical care for rural residents is the central district hospital (CRH), which provides specialized care for its main types to residents of the entire district, respectively, of all rural medical districts.

The main tasks of the Central District Hospital:

Providing the population of the district and the district center with qualified specialized medical care;

Operational and organizational methodological management of health care institutions in the region;

Planning, financing and organization of material and technical supply of the district health care institutions;

Development and implementation of measures to improve the quality of medical care and improve the health of the population.

In addition to the CRH, located in the district center, in the territory of the district there may be other district hospitals, the so-called "numbered" hospitals, which can function as a branch of the CRH or specialize in one or another type of medical care. On the so-called attributed area, i.e. on the site located around the Central District Hospital, there is no rural district hospital, its functions are performed by the Central District Hospital itself.

The chief physician of the Central District Hospital is also the chief physician of the district. In his work on the management of the district health care and the central district hospital, the chief doctor of the CRH relies on his deputies;

For organizational and methodological work (usually he is in charge of the organizational and methodological room of the Central District Hospital);

Childhood and obstetrics;

On the medical side;

Organizational forms of leadership:

1. Work of the Medical Council under the head physician of the Central District Hospital.

2. Activity of the organizational and methodological office of the Central District Hospital.

3. Activities of regional specialists.

The head physician uses the organizational and methodological room and the doctors of the CRH specialists for the organizational and methodological guidance of the district health care institutions, which is carried out by:

Organization of planned visits of doctors - specialists to rural district hospitals for consultation and practical assistance to doctors of these institutions on the issues of medical, diagnostic and preventive work;

The systematic study of the main qualitative indicators of the work of the district medical institutions by the employees of the organizational and methodological office is the development on this basis of measures to improve the qualifications of medical personnel.

To improve the qualifications of doctors on the basis of the central regional hospital, clinical and analytical conferences, seminars, meetings, lectures and reports are organized and held by regional and regional specialists, at which doctors get acquainted with new methods of work of the best medical and preventive institutions of the region, the region. Specialization and advanced training of paramedical workers of FAP also takes place on the basis of the Central Regional Hospital.

Currently, the priority direction in the development of rural health care is the strengthening and improvement of outpatient and polyclinic care: new assigned therapeutic and pediatric sections are being organized, various types of mobile medical care are being developed, in particular, mobile medical teams, mobile dental offices and prosthetic laboratories. Much attention is paid to emergency and emergency medical care in rural areas, staffing them with doctors and nurses, equipping them with modern diagnostic and medical equipment.

104 Third stage. Regional medical institutions : regional hospital with an advisory clinic and an air ambulance department, dispensaries, a dental clinic, a psychiatric hospital, etc.

Third stage medical assistance to rural residents - regional health care institutions located in the regional center. The regional hospital is the main institution at this stage. It is a medical, scientific-organizational, methodological and educational center of the region's healthcare. The regional hospital performs the following main functions:

Providing the population of the region in full with highly qualified specialized consultative polyclinic and inpatient medical care;

Organizational and methodological assistance to medical and diagnostic institutions of the region in their activities;

Coordination of treatment-and-prophylactic and organizational-methodical work carried out by all specialized medical institutions of the region;

Provision of emergency medical care by means of air ambulance and ground transport with the involvement of specialist doctors from various institutions;

Management and control over statistical accounting and reporting of health care facilities of the region;

Analysis and management of the quality of medical care provided in the regional hospital itself and in all medical institutions of the region;

Study and analysis of morbidity, disability, general and infant mortality of the region's population;

Participation in the development of measures aimed at reducing them;

Generalization and dissemination of advanced experience in the work of medical institutions in the region on the introduction of new organizational forms of providing medical care to the population, the use of modern methods of diagnosis and treatment;

Carrying out activities for the specialization and improvement of doctors and nurses of medical institutions in the region;

Structural departments of the regional hospital: in-patient department, consultative polyclinic, treatment and diagnostic departments, offices and laboratories, an organizational and methodological department with a department of medical statistics, a department of emergency and planned consultative care.

The regional hospital should have a boarding house for patients coming from the regions of the region, and a hostel for medical workers who come to various types of specialization.

Department of Emergency and Planned Advisory Medical Aid:

Provides emergency and planning consultative assistance on the spot on calls from the districts;

Provides transportation of patients to specialized medical institutions of the region and outside the region, urgent delivery of various medications and means necessary to save the lives of patients, as well as to carry out urgent anti-epidemic measures;

Maintains constant communication with teams sent to provide medical care;

Organizational and methodological work is an integral part of the activities of all departments of the hospital. Each department plays the role of an organizational and methodological center for medical institutions in the region. This work is coordinated by the organizational and methodological department of the region. hospital, which performs the functions:

Examines the volume and nature of the activities of medical institutions in the region;

Provides organizational, methodological and medical advice to health authorities and institutions of the region;

Studying the health indicators of the region's population;

Organizes professional development of personnel;

Specialization and improvement of medical personnel is carried out in the regional hospital:

At regional seminars, conferences, ten days;

In workplaces with complete separation from work;

On intermittent part-time courses;

With the participation of specialists from the regional hospital on the basis of city and central regional hospitals.

Currently, the following tasks of rural health care and ways of solving them can be distinguished:

1. Approaching city health care facilities and improving the quality of outpatient care by:

Construction of rural medical outpatient clinics, work of general practitioners, family doctors;

Development of a network of assigned therapeutic and pediatric sites;

Expansion of mobile health care.

2. Approximation of specialized care by:

Strengthening the Central District Hospital;

Creation of interdistrict specialized departments;

Creation of mobile dental offices and dental laboratories.

105 MATERNITY AND CHILD SECURITY SYSTEM. state program "generic certificates" (see question 106)

Protection of mothers and children (OMID) is a system of state social and medical measures that ensure the birth of a healthy child, the correct and comprehensive development of the younger generation, the prevention and treatment of diseases of women and children. Tasks: rational nutrition and physical development. Group 6 - school age. tasks - accustoming children to health-improving procedures, conducting sanitary and hygienic training, promoting a healthy lifestyle. Principles of organizing medical care for mothers and children. 1. The principle of a single pediatrician - that is, one doctor serves children from 0 to 14 years old 11 months. 29 days. Since 1993, the child population under the contract can be served by two pediatricians. 2. The principle of precinct. The size of the pediatric site is 800 children. The central figure of the outpatient network is the district pediatrician; now the responsibility of the district pediatrician within the framework of compulsory medical insurance (MHI) is being increased and criteria for individual responsibility (or personification) are being sought. 3. Dispensary method of work. All children, regardless of age, health status, place of residence and attendance at organized preschool and school institutions, must be examined as part of preventive examinations, which, as vaccine prophylaxis, is free of charge. 4. The principle of association, that is, antenatal clinics are combined with maternity hospitals, children's polyclinics are combined with hospitals. 5. The principle of alternation of medical care: at home, in a polyclinic, in a day hospital. Only healthy children or convalescents come to the outpatient clinic at the outpatient clinic, patients are served at home. 6. The principle of continuity. It is carried out between the antenatal clinic, the maternity hospital and the children's clinic in the form of · antenatal care · visits to the newborn within 3 days after discharge from the hospital · monthly examinations of the baby in the children's clinic for 1 year of life 7. for the antenatal clinic - the principle of early dispensary registration ( up to 12 months) 8.the principle of social and legal assistance, that is, there is a lawyer's office in the children's clinic and antenatal clinic 3. Establishments of OMID. Child welfare institutions. 1. Outpatient polyclinic: · children's polyclinic · children's dental clinic · children's consultation 2. inpatient: · children's somatic hospital · children's infectious diseases hospital · children's department in the structure of general somatic adult hospitals 3. Specialized · children's homes · children's sanatoriums · nurseries · nurseries dairy kitchens for developmentally retarded children Maternity protection· Maternity clinics · maternity hospitals · obstetric and gynecological departments of somatic hospitals · departments of pathology of pregnant women in general hospitals. All OMID institutions are divided into categories and types. Let's take a look at the categories of maternity hospitals as an example. 1 category (high) 150 - 200 beds 2 category - 101 - 150 beds 3 category 81 - 100 beds 4 category - 60-80 beds

106 Women's consultation, maternity hospital: their tasks, structure, performance indicators, state program "birth certificates"

Women's consultation. Objectives: 1. Carrying out preventive measures in order to reduce complications in pregnancy 2. Carrying out preventive examinations of all women 3. Dispensary registration of pregnant women, as well as patients with chronic gynecological diseases. 4. Organizational and methodological work 5. sanitary and hygienic education, promotion of a healthy lifestyle. The structure of the antenatal clinic: registration office · offices of district specialists (the size of the area is 3400-3800 women aged 15 and older). 6. Treatment room. 7. Office of psycho-preparation for childbirth. 8. Lawyer's office 9. Dentist's office 10. Venereologist's office Accounting documentation for antenatal clinics 1. Individual card of a pregnant woman and woman in labor 2. Static coupon 3. Disability certificate 4. Exchange card 5. Emergency notice 6. Dispensary observation checklist 7. Polyclinic doctor's diary Reporting forms of antenatal clinic... · Form 30 · Form 16 VN · Report on pregnant women and women in labor (Form No. 32, insurance indicators of the antenatal clinic). Quantitative indicators - see the Adult Clinic. Qualitative: 1. The proportion of late registration in dispensary registration 2. The proportion of pathology in pregnant women 3. The proportion of premature babies 4. Maternal mortality (per 1000 population) 5. Ante- and intranatal mortality 6. Perinatal mortality 7. Indicators of examination for Rh- factor 8.the incidence of gynecological diseases (general and with VUT)

A maternity hospital is a stationary type institution that provides medical care for women in labor, it can be independent or combined with an antenatal clinic. Structural subdivisions of the maternity hospital: 1. An admission and access block, operating as a sanitary inspection, an examination room, sanitation 2. Physiological department 3. Observation department 4. Department of pregnancy pathology one bed, this is both a reporting and a planned indicator. Maternity hospital records:· Birth history · pregnancy termination card · hospital exit card · newborn development history · medical certificate of perinatal mortality Reporting documents of the maternity hospital: · form No. 14 (hospital report), according to it the following indicators are calculated: 1. bed turnover - the number of patients treated on one bed in 1 year 2. average bed occupancy - the average number of days the bed was occupied (the ratio of the total number of bed-days to the total number of beds. For a maternity hospital, this figure is 310 days. 3. Average length of stay of a patient in bed (6 days in the physiological department) 4. maternal mortality 5. still fertility 6. Perinatal mortality 7. frequency of caesarean section 8. expert analysis of each case of maternal mortality

Generic Certificate Program

The program of generic certificates has been in effect since January 1, 2006 in all regions of Russia within the framework of the priority national project "Health", which provides for a number of measures to improve the demographic situation. This program aims to increase the interest of medical organizations in providing quality medical care. The main purpose of birth certificates is to improve the quality of medical care for women during pregnancy, during childbirth and in the postpartum period, as well as during preventive medical examinations of a child during the first year of life in medical organizations.

A birth certificate is a document of additional financial support for the activities of medical organizations, which gives the right to pay for medical care services provided by medical organizations to women during pregnancy, during childbirth and in the postpartum period, as well as during preventive medical examinations of a child during the first year of life. ... The certificate is issued to a pregnant woman registered for pregnancy from 30 weeks in singleton pregnancies and from 28 weeks in multiple pregnancies.

The generic certificate consists of six parts: registration (stub), four coupons and the certificate itself:

· The back of the birth certificate is intended to confirm its issuance, it remains in the medical institution that issued the certificate.

· Coupon No. 1 of the birth certificate is intended to pay for medical services provided by antenatal clinics during pregnancy (3 thousand rubles for each woman who received the appropriate services). Transferred from the consultation to the regional branch of the Social Insurance Fund for payment.

· Coupon No. 2 of the birth certificate is used to pay for medical care provided to women during childbirth in obstetric facilities (6 thousand rubles for each woman who received the appropriate services). Transferred from the maternity hospital or maternity ward to the regional branch of the Social Insurance Fund for payment.

· Ticket number 3 consists of two parts. Coupon No. 3-1 of the generic certificate is intended for payment of services to health care institutions for the first six months of dispensary observation of a child (1 thousand rubles for each child placed in dispensary registration during the first year of life under 3 months and received within the next 6 months from the date of registration of the relevant services). Coupon No. 3-2 of the birth certificate is intended to pay health care institutions for services for the second six months of the child's dispensary observation (1,000 rubles for each child who received the appropriate services). Coupons No. 3 are transferred from children's clinics to the regional branch of the Social Insurance Fund for payment.

· The birth certificate serves as a confirmation of the provision of medical care to a woman during pregnancy and childbirth by health care institutions. A birth certificate (without coupons), which records the date of birth, weight and height of the baby, is issued to the woman upon discharge from the maternity hospital. The birth certificate is accompanied by a Memo containing information on the rights and obligations of women within the framework of the “Birth certificate” program.

The regional branch of the Social Insurance Fund of the Russian Federation transfers funds to pay for the services of a medical organization on the basis of the concluded agreement and submitted coupons of generic certificates confirming the provision of medical care services to women during pregnancy (coupon No. 1), medical assistance to women and newborns during childbirth and postpartum period (coupon number 2), as well as dispensary (preventive) supervision of the child during the first year of life (coupons number 3-1 and 3-2);

107 Center family planning: tasks of the function of the structure

The Family Planning and Reproduction Center provides specialized consultative and therapeutic and diagnostic assistance for reproductive health disorders associated with endocrinopathies in various age and gender groups ranging from 14 to 60 years old due to an integrated approach, clear specialization, standardization of modern technologies, prevention, diagnosis and treatment of reproductive disorders ...

The main tasks of the Family Planning Reproduction Center are:

· Ensuring the state policy in the field of reproductive health protection of the population of Omsk;

· Carrying out a set of measures to prevent reproductive health disorders of the population of Omsk;

· Reduction of the terms of restoration of lost health through the introduction of modern technologies, prevention, diagnosis and treatment into practice;

· Providing a set of measures to protect the reproductive health of adolescents in Omsk.

The main function is to provide specialized outpatient medical diagnostic and consulting assistance on a wide range of problems related to the protection of the reproductive health of the population:

· Preconceptional preparation of pregnancy in women with endocrinopathies;

· Providing advice on family planning, contraception, prevention of unwanted pregnancies in women of fertile age suffering from endocrinopathies;

· Medical, psychological and psychotherapeutic assistance to adolescents with impaired reproductive function;

· Diagnostics and treatment of infertile marriage;

· Rendering assistance to women and men of transitional age in order to preserve and prolong their social functioning and improve the quality of life;

· Identification of breast pathology;

· Organizational and methodological work with antenatal clinics on reproductive health, analysis of the prevalence of abortion and contraception, development of proposals for improving this work;

· Professional development of specialists in health care facilities and health education on issues of reproductive health protection.

work organization

In accordance with the tasks and functions, the Family Planning and Reproduction Center conducts the following specialized receptions:

1. "Gynecological endocrinology"

· Provides consultative and diagnostic assistance in the direction of specialist endocrinologists to patients with endocrinopathies;

· Diagnosis of breast pathology and referral to specialized hospitals; prevention of unwanted pregnancy, contraception in women with endocrine pathology.

2. "Pathological formation of reproductive function in adolescents"(2 rates of gynecologist-juvenile doctors) provides reception, diagnosis, treatment and rehabilitation for:

· Delayed sexual development;

· Premature puberty;

Obesity;

· Diseases of the thyroid gland;

· Hyperandrogenemia;

· Hypothalamic syndrome;

Diabetes mellitus, neurogenic anorexia

3. "Reproductive health of adolescents"- carry out the prevention, diagnosis, treatment and rehabilitation of inflammatory diseases of the pelvic organs, STIs, psychosomatic and psychological problems, unwanted pregnancy; selection of contraception, early gestational abortion, comprehensive preparation for termination of pregnancy for medical reasons and referral to a specialized hospital, health education on reproductive health.

4. "Andrology and Reproduction" carries out reception, diagnosis and treatment of puberty disorders in young men, prognosis of male fertility, male infertility, incl. with endocrinopathies, consultations for men of transitional age with diseases of the endocrine system (according to the indications of consultations of specialists - sexologist, psychotherapist, psychologist), complex examination for men during IVF.

5. �Female infertility� carries out reception, diagnosis and treatment of female infertility, consultations on the prognosis of a woman's reproductive function, preconception preparation of pregnancy in women with endocrinopathies, comprehensive training of women for IVF.

6. "Women's health after 40" carries out reception, diagnosis, treatment and consultation of women in the pre- and postmenopausal periods and after oophorectomy.

7. Reception of a psychotherapist

8. Reception of a psychologist

9. Reception of a sexologist- Specialized assistance is provided on issues of violations of sexual relations both in a married couple and individually.

108. Reproductive loss. Measures to prevent maternal and perinatal mortality, morbidity in newborns. Improvement of perinatal services within the framework of the national project "Health".

Reproductive losses are maternal and perinatal deaths, as well as loss of products of conception due to abortion and ectopic pregnancy.

Reproductive health care - methods, technologies and services that contribute to the formation, maintenance and strengthening of reproductive health by preventing the elimination of reproductive disorders throughout a person's life;

Mortality is understood as the process of population extinction, characterized by the statistically registered number of deaths in a particular population for a certain period of time.

Maternal mortality is an indicator characterizing the number of women who died during pregnancy, regardless of its duration and location, or within 42 days after its termination from any cause associated with pregnancy, burdened by it or its management, but not from an accident or a sudden onset of the cause, correlated with the number of live births

The perinatal period is the period from 28 weeks of gestation to the 7th day of a newborn's life. In turn, it is subdivided into antenatal (intrauterine), intrapartum (labor) and postnatal (1st week of life). The perinatal mortality rate is calculated as the ratio of the sum of the number of stillbirths and the number of children who died in the first 168 hours of life, to the number of live births and deaths, multiplied by 1000.

INFANT MORTALITY This is the number of children who died under one year of age per 1000 live births. There are 2 ways to calculate infant mortality. The lowest infant mortality rate is in Japan (5 ppm), in the Scandinavian countries 6-7 ppm, in the USA - 10 ppm. The infant mortality rate is considered as an operational criterion for assessing the sanitary well-being of the population, the level and quality of medical and social assistance, and the effectiveness of obstetric and pediatric services. IMPORTANT unification of the concepts of "live birth", "stillborn", "fetus" (late abortion). calculate such indicators as: - early neonatal mortality (the ratio of the number of children who died in the 1st week of life in a given year, to the number of live births in a given year, multiplied by 1000) (in Russia - 6-9 ‰); - late neonatal mortality (the ratio of the number of children who died at 2-4 weeks of life in a given year, to the number of live births in a given year, multiplied by 1000); - neonatal mortality (the ratio of the number of children who died in the first 28 days of life in a given year to the number of live births in a given year, multiplied by 1000) (in Russia - 9-11 ‰); - postneonatal mortality (the ratio of the number of children who died at the age of 29 days to 1 year, to the difference between the number of live births and the number of deaths in the first 28 days of life, multiplied by 1000) (in Russia - 7-8 ‰). Perinatal period from 28 weeks of gestation to the 7th day of the newborn's life. Divide into antenatal (intrauterine), intrapartum (labor) and postnatal (1st week of life). Factors influencing infant mortality: 1. Gender of the child: boys die more often than girls. Infant mortality is higher in premature babies. 2. Age of mother: the lowest infant mortality rate in children born to mothers aged 20-30 years. The highest child mortality is observed in first-borns and after 6-7 children. The healthiest 4 child. 3. Socio-ethnic factors (in countries with high fertility, high infant mortality).

MEASURES FOR PREVENTION OF MATERNAL AND PERINATAL MORTALITY AND DISEASE IN NEWBORNS

reducing the influence of risk factors: social-econ (welfare, labor conditions), social-biol (inherited, suffered a disease), social-hygiene (activity, nutrition, work-rest, honey literacy), environmental hygiene (kept in cart and soil and everyone's water), medical and organizational (low level of access to help, low level of qualifications of personnel, inadequate services to standards, low level of medical activity of patients). , popul) - a set of measures aimed at preventing the appearance of certain diseases or deviations in the state of health. Secondary prophylaxis - a set of honey, social services, san-gig, psychol and other measures, sent to early identified the disease and prevented exacerbations and chronicity. tertiary prfil - honey, psychol, teacher, social measures, I sent to restore or compensate for violations of physiology, social f-y org-ma, quality of life and work and formir health.

National Project "Health" (vaccination, diagnostics of congenital metabolic defects, financing of antenatal clinics and perinatal services)

The main goals of the priority national project "Health":

1. Strengthening the health of the population of Russia, reducing the level of morbidity, disability, mortality;

2. Increasing the availability and quality of medical care;

3. Strengthening primary health care, creating conditions for the provision of effective medical care at the pre-hospital stage;

4. Development of preventive health care;

5. Meeting the needs of the population for high-tech medical care.

Legal foundations of medical activities for family planning and planning of human reproductive function.

Artificial fertilization of a woman and implantation of an embryo are carried out in institutions that have received a license for the specified type of activity, with the written consent of the spouses (single woman).

A child born with the help of artificial insemination has the same rights in relation to parents as children born naturally. A husband who has given consent to the artificial insemination of his wife with the help of a donor is recorded by the father of the child she has born and cannot challenge paternity in court.

Information about the artificial insemination and implantation of the embryo, as well as the identity of the donor, constitutes a medical secret. In the event of disclosure of information about specific persons who participated in this procedure, the medical staff shall be held liable under the law.

The woman's rights to the information provided by the doctor performing the medical intervention on the procedure for artificial insemination and implantation of the embryo, the medical and legal aspects of its consequences, on the data of the medical and genetic examination, external data and the nationality of the donor are enshrined in Art. 35 Basics.

Artificial termination of pregnancy can be performed at the request of the woman (with gestational age up to 12 weeks), as well as for social reasons (with gestational age up to 22 weeks). The legislator highlighted one more point - medical indications and the woman's consent. In this case, the termination of pregnancy is carried out regardless of the gestational age.

The list of social indications was approved by the Government of the Russian Federation. These can be social and economic conditions of life, age, etc.

The list of medical indications for artificial termination of pregnancy is determined by the Ministry of Health of the Russian Federation. These include tuberculosis (all active forms), syphilis, HIV infection, malignant neoplasms of all localizations in the present or in the past, acute and chronic leukemia, congenital heart disease, etc.

If a pregnant woman is diagnosed with a disease that is not indicated in the list, but it poses a threat to the life or health of the pregnant woman or the newborn, the issue of terminating the pregnancy is decided individually. Medical indications for termination of pregnancy are established by a commission consisting of an obstetrician-gynecologist, a doctor of the specialty to which the disease (condition) belongs, and the head of a healthcare facility.

Artificial termination of pregnancy is carried out within the framework of compulsory medical insurance programs in institutions that have received a license for the specified type of activity, by doctors with special training.

Medical sterilization is permitted by law, i.e. surgical intervention, the result of which is the deprivation of a person's ability to reproduce offspring. To carry it out, a written statement from a citizen is required, age is more than 35 years or the presence of at least two children, and with medical indications and the consent of the citizen, it is performed regardless of age and presence of children. Medical sterilization of both men and women is carried out.

Medical indications for medical sterilization (determined by the RF Ministry of Health) include chronic ischemic heart disease, epilepsy, mental retardation, etc.

Medical sterilization is carried out in institutions of the state or municipal health care system that have received a license for the specified type of activity.

Illegal implementation of artificial insemination and embryo implantation, artificial termination of pregnancy, as well as medical sterilization entails criminal liability established by the legislation of the Russian Federation.

Polyclinic.

The polyclinic is a highly developed specialized medical and preventive institution, which provides medical assistance to incoming patients, as well as to patients at home, a complex of medical and preventive measures is carried out to treat and prevent the development of diseases and their complications .

The main tasks of the polyclinic are: provision of primary health care to the attached population on a territorial basis, both in the clinic and at home for adults and children; organization and implementation of a set of preventive measures among the attached population; organization and implementation of dispensary observation of the attached population; organization and implementation of measures for the sanitary and hygienic education of the attached population and the promotion of a healthy lifestyle.

Polyclinic structure

1 Reception

2 Prevention departments

3 Treatment-and-prophylactic units

4 Auxiliary diagnostic units

The main objectives of the national health project:

Strengthening the health of the population, reducing the level of morbidity, disability, mortality;

Improving the availability and quality of medical care;

Strengthening primary health care, creating conditions for the provision of effective medical care at the pre-hospital stage;

Development of preventive health care;

Meeting the needs of the population in high-tech types of medical care.

Primary medical and social assistance to the urban population is provided by outpatient clinics (territorial polyclinics serving the adult population) and institutions for the protection of mothers and children (children's clinics and women's clinics).

The main organizational and methodological principles of the work of polyclinics and territorial medical associations (TMO) are precinct (assignment to a medical position of the normative number of residents) and the widespread use of the dispensary method (systematic active monitoring of the health of certain contingents). The main planning and normative indicators regulating the work of polyclinics are indicated: the standard for the district (1,700 people for 1 position of the district therapist); load rate (5 visits per hour at an appointment at a polyclinic and 2 - when serving patients at home by a therapist); the staffing standard for district therapists (5.9 per 10,000 residents over 14 years old).

The measure of the capacity of polyclinics is the number of visits per shift (more than 1200 visits - I category, less than 250 visits - V category). TMO, to a greater extent than polyclinics and antenatal clinics, meet the new principles of organization and financing of primary medical and social care. They can more effectively organize the work of family doctors (order of the Ministry of Health of the Russian Federation No. 237 dated 26.08.92). A number of TMOs have created conditions for family health care, for example, joint work at the site of a therapist, pediatrician and gynecologist (obstetric-pediatric-therapeutic complex - APTK). At the same time, the indicator of work is not the dynamics of attendance, but changes in the state of health of the population (decrease in morbidity, disability, infant mortality, the number of advanced oncological diseases, the state of health of patients from dispensary groups, etc.).

The main activities of primary medical and social care institutions are: preventive work, medical examination, hygienic training and education of the population, promotion of a healthy lifestyle; medical and diagnostic work (including examination of temporary disability); organizational and methodological work (management, planning, statistical accounting and reporting, analysis of activities, interaction with other health care institutions, professional development, etc.); organizational mass work.

The polyclinic is headed by the chief physician. The structure of the polyclinic includes: registration, prevention department, treatment and prophylactic departments and offices, treatment and diagnostic units, administrative part, rehabilitation treatment departments, etc. The continuity of the polyclinic and hospital work is assessed by the number of patients prepared for planned hospitalization, and the exchange of documentation before and after their treatment in a hospital.

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