Medicinal health centers are organized in enterprises with 1,000 or more workers, paramedics - up to 1,000 people.

Medical units are created at large enterprises with a number of employees of 4,000 or more, and at enterprises of the chemical, coal, oil refining and mining industries - 2,000 or more.

A special role in the system of medical care for the working population in the Russian Federation belongs to health centers at industrial enterprises.

Medical care for workers is carried out according to the shop principle, which consists of assigning one shop therapist position per 1500-2000 workers.

Health centers are assigned the following main tasks:

· provision of medical care for diseases and conditions both posing a direct threat to the employee’s life and in the absence of such;

· organization of medical evacuation;

· monitoring the health status and working conditions, including express diagnostics of the health of enterprise employees when going to work, during work and after its completion;

· participation in preliminary and periodic medical examinations of employees; carrying out measures to prevent occupational, infectious and non-infectious diseases and injuries;

· direct participation in the organization of first aid and evacuation in the event of various emergencies and liquidation of medical consequences of emergency situations at the enterprise.

Preventive work plays a major role in the activities of shop therapists. It can be effective only if there is a proper study of the characteristics of a given production and the working conditions of workers, as well as knowledge of a specific occupational pathology. Based on the study of technological and sanitary-hygienic features of production, medical doctors develop appropriate measures to reduce morbidity and occupational injuries.

In the Russian Federation, slightly less than 30% of the country's population lives in rural areas.

Medical care for the rural population is based on the basic principles of healthcare organization. However, the factors that determine the differences between city and village affect the organizational forms and methods of work of rural medical institutions: the nature of the settlement of residents, service radius, seasonality of work, exposure to weather conditions during field work, specific conditions of the labor process, unsettled economic activities and household conditions, regional-national characteristics and customs, educational and cultural level, etc.

The main features of the organization of medical care for the rural population of Russia were and are currently:

Phased;

Availability of special treatment and preventive institutions in the structure of rural healthcare;

Special organizational forms and methods of work of medical personnel and health care facilities in general.

Conventionally, there are 3 stages of providing medical care to rural residents. The main organizational forms of medical care are inpatient and traveling.

The first stage is a rural medical area, covering an area with a radius of 5-10-15 km (in different regions of Russia) and including the following health care facilities: a rural local hospital, a medical outpatient clinic, paramedic and paramedic-obstetric medical posts, health centers, and nurseries at industrial and agricultural enterprises -gardens, etc. At this stage, rural residents receive qualified medical care (therapeutic, surgical, obstetric and gynecological, dental, and in some cases pediatric). These conditions are most consistent with compliance with the principles of general medical practice and family medical and social services.

FAP is organized in settlements with a population of 700 or more, with a distance to the nearest medical facility of at least 5 km, and at a distance of more than 7 km from the nearest medical facility, a FAP can be organized in settlements with a population of 300-500 people.

The main tasks of the FAP are: providing first-aid care and carrying out sanitary, health-improving and anti-epidemic measures aimed at preventing diseases, reducing morbidity and injuries, and improving the sanitary and hygienic culture of the population. The FAP paramedic provides first aid for acute diseases and injuries, carries out vaccination work, physiotherapeutic measures, and fully carries out the doctor’s prescription, organizes patronage for children and pregnant women, and, under the guidance of a doctor, carries out preventive, anti-epidemic and sanitary-hygienic measures.

The next second stage in providing medical care to the rural population is the regional link, headed by the central district hospital (CRH); CRHs are available in all district administrative territories. In each regional center there is a center for state sanitary and epidemiological surveillance (SSES). In the health care structure of districts, these may include interdistrict specialized centers, numbered hospitals, dispensaries, health centers, health centers, district and city hospitals, etc.

The third stage (level) of medical care for the rural population is regional health care institutions located in the regional center (regional hospital with a consultative clinic, dispensaries, dental clinic, regional center of state sanitary and epidemiological surveillance, etc.). At this stage, highly qualified medical care is provided in almost all specialties.

Features of providing primary health care to women.

Order No. 50 (most likely!) whoever comes across it, write to Olya, the material will be dropped during the exam

Organization of primary health care on the principle of general practice (family medicine).

Family medicine is the observation and treatment of a patient throughout his life.

The main advantages of the family medicine system:

A holistic approach to the health of observed families;

Availability and convenience of treatment;

Possibility of early diagnosis of severe and life-threatening diseases;

Visiting the patient at home;

Carrying out prevention;

Providing psychological assistance to the patient and his family.

Family medicine is the most effective medical consultation, since the doctor

Observes the patient and his environment for a long time;

Treats the patient individually in a comfortable and familiar environment (at home or in his office);

Knows the patient’s entire family and easily establishes relationships;

If necessary, assigns the patient to a specialist.

The general practitioner is the first to see the patient, assess his condition, and make a preliminary diagnosis. This specialty - general practitioner - combines biological, clinical disciplines and psychology, which makes it possible to provide continuous and comprehensive care to the person and his family.

A general practitioner treats people of all ages; he is not limited by the narrow boundaries of one discipline, thereby providing a comprehensive and individual approach to the patient. You can contact your family doctor with questions not only of a medical nature.

The basis of the general practitioner's department's activities is working with families. The main goals of a family nurse’s work are to maintain health and prevent diseases in their patients. The family nurse must take into account factors that negatively affect the health of the wards: smoking, alcohol abuse, drug addiction, as well as occupational hazards. A family nurse must be competent in matters of the humanities - be a good teacher and psychologist. Carry out manipulations (massage, physiotherapy, etc.).

The main feature of providing medical care rural population lies in its phasing. Conventionally, there are three stages to organizing medical care for the rural population.

Tab. 3. Stages of providing medical care to the rural population

The first stage is healthcare institutions in rural settlements, which are part of a complex therapeutic area. At this stage, rural residents receive pre-medical, as well as basic types of medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).

The first medical institution that a rural resident, as a rule, turns to is a paramedic and obstetric station (FAP). It functions as a structural unit 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 facility of more than 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.

The paramedic-midwife station is entrusted with 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, primarily infant, maternal, and working age;

Providing pre-medical care to the population;

Participation in ongoing sanitary supervision of children's preschool and school educational institutions, communal, food, industrial and other facilities, water supply and cleaning of populated areas;

Conducting door-to-door surveys according to epidemiological indications in order to identify infectious patients, persons in contact with them and persons suspected of infectious diseases;

Improving the sanitary and hygienic culture of the population.

Thus, the FAP is a healthcare institution with a more preventive focus. It may be entrusted with the functions of a pharmacy selling ready-made dosage forms and other pharmaceutical products to the public.
The work of the FAP is directly headed by the head. In addition to him, the FAP also employs a midwife and a visiting nurse.

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

Outpatient care to the population is the most important section of the work of a local hospital. It can be an outpatient clinic, either part of the hospital structure or independent. 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 medical examination of patients.

Doctors at the outpatient clinic see adults and children, make house calls and provide emergency care. Paramedics can also take part in the reception of patients, but medical care in an outpatient clinic should primarily be provided by doctors. In the local hospital, an examination of temporary disability is carried out and, if necessary, patients are sent to medical examination.

In order to bring specialized medical care closer to village residents, doctors from the central district hospital go to the outpatient clinic according to a certain schedule to receive patients and select them, if necessary, for hospitalization in specialized institutions. Recently, in many regions of the Russian Federation, there has been a process of reorganization of local hospitals and outpatient clinics into centers of general medical (family) practice.

Plan:

1. Stages of providing medical and preventive care to the rural population.

2. Organization of the work of a paramedic in a first-aid post for adults, children, women and maternity leave.

3. Regulatory documentation regulating the organization of medical and preventive care for the rural population.

4. Functional responsibilities of the FAP nurse.

5. Principles of accounting and reporting at the FAP.

6. Key performance indicators of the FAP.

Protecting the health of rural residents is part of the entire healthcare system. In protecting the health of rural residents, paramedical workers play a particularly important role.

Medical care for the rural population is based on the basic principles of healthcare organization (accessibility, qualifications, free of charge).

However, factors that determine differences between urban and rural areas influence the organizational forms and methods of operation of rural health care institutions:

1. the nature of the settlement of residents,

2. service radius,

3. seasonality of work,

4. exposure to weather conditions during field work,

5. specific conditions of the labor process,

6. unsettled economic activities and living conditions,

7. regional-national characteristics and customs,

8. educational and cultural level, etc.

The organization of medical and social assistance in rural areas, its volume and quality depend on:

1. remoteness of medical institutions from the place of residence of patients,

2. availability of qualified personnel and equipment,

3. opportunities to receive specialized medical care,

4. Possibility of implementing medical and social security standards.

Features of organizing the provision of medical care to the rural population.
1. Staged.
2. Travel forms of work.
3. Development of general medical practice
4. The high role and importance of nursing staff.

5.Combination of treatment-and-prophylactic and sanitary-anti-epidemic measures.

Conventionally, there are 3 stages of providing medical care to rural residents.

1. Rural medical station.

2. Central district hospital.

3. Regional hospital.

The first stage of providing medical care to the rural population

Rural medical district or (taking into account new organizational structures) territorial medical associations (local hospital, paramedic and paramedic-obstetric stations, health centers, maternity hospitals, nurseries, etc.).

Objectives of the Rural Medical District:

1. providing the population with publicly available qualified medical care (therapeutic, surgical, obstetric and gynecological, pediatric, dental);

2. carrying out sanitary and anti-epidemic measures;

3. formation of healthy lifestyle attitudes and skills among the population.

The main medical institution at the rural medical site is local hospital

The number of rural medical districts in a district is mainly determined by the population size and the distance to the central district hospital.

The average population in a medical area ranges from 5-7 thousand. residents at an optimal site radius 7-10 km.

The nature and volume of medical care in a local hospital are mainly determined by its capacity, equipment, and the availability of specialist doctors.

The staff of a rural district hospital, depending on its capacity, population and distance to the central district hospital (CRH), may include doctors in the main specialties (therapy, pediatrics, dentistry, obstetrics, gynecology and surgery).

Organization of work at the FAP

The primary importance in the structure of a rural medical district is the FAP.

FAP is an important link in carrying out preventive measures and providing pre-hospital medical care to the population at a rural medical site.

The organization of the work of the paramedic-midwife station is determined by a regulatory document - order of the Ministry of Health and Social Development dated May 15, 2012 No. 543n.

FAP can be organized when the number of residents in a rural locality is from 700-900 people or more and distance to the nearest medical facility 2 km.

300-700 people at a distance of 4 km to the nearest medical facility.

300 or less people if the distance is 6 km. and more.

A nurse is being added to the FAP staff - 0.5 rate for a population of 900-1300 people, 1 rate for 1300-1800 people.

To organize the work of a paramedic-midwife station, it is recommended to provide the following premises in its structure:

· procedural;

· room for paramedic and midwife;

· emergency room for childbirth;

· room for temporary stay of patients;

· bathroom for staff;

· bathroom for patients;

· sanitary room.

The standard equipment of the FAP is listed in the order in Appendix No. 17.

FAP tasks:

1. Treatment and preventive care for adults:

Outpatient care and home care,

· participation in preventive examinations and medical examinations,

· provision of first aid,

· Carrying out medical prescriptions,

· health care for the population during field work,

· carrying out measures to prevent agricultural injuries and reduce morbidity with temporary disability.

2. Medical care for women and children:

· monitoring pregnant women and women in labor,

· psychoprophylactic preparation of pregnant women for childbirth,

· providing assistance to women in labor and delivery,

· organization of mother and child school,

· providing medical care to gynecological patients,

· dispensary observation of children,

· Providing medical and preventive care to children.

3. Sanitary and anti-epidemic work:

· current sanitary supervision,

· anti-epidemic measures,

· measures to reduce infectious morbidity,

· carrying out preventive vaccinations,

· sanitary educational work,

· sanitary asset and work with it.

Functional responsibilities of a FAP nurse:

§ conduct a population census;

§ prepare the office for the reception;

§ carry out medical and diagnostic appointments of the paramedic;

§ measure temperature and blood pressure of patients;

§ examine for lice;

§ inform the paramedic about violations of the regimen, prescriptions by patients;

§ carry out patronage visits at home;

§ invite you to professional vaccinations according to the plan;

§ invite and monitor the progress of professional examinations and clinical examinations;

§ comply with the rules of ethics and deontology;

§ comply with safety regulations;

§ implement the conditions for transportation and storage of honey. immunobiological preparations according to the requirements;

§ sanitary and hygienic education and training of the population.

§ Timely and correct maintenance of medical records.

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

First stage- rural health care institutions that are part of complex therapeutic area. At this stage, rural residents receive pre-medical, as well as basic types of medical care: therapeutic, pediatric, surgical, obstetric, gynecological, dental.

The first medical institution that a rural resident usually turns to is first aid station (FAP). It functions as a structural unit 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 facility of more than 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.

The FAP is entrusted with solving a large complex of medical and sanitary problems:

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

Reducing mortality, primarily infant, maternal, and working age;

Providing pre-medical care to the population;

Participation in ongoing sanitary supervision of children's preschool and school educational institutions, communal, food, industrial and other facilities, water supply and cleaning of populated areas;

Conducting door-to-door surveys 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, the FAP is a healthcare institution

more of a preventive nature. At the 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 products to the population.

The work of the FAP is headed by head of the FAP, whose main objectives are:

Organization of treatment, preventive and sanitary-epidemiological work;

Outpatient reception and treatment of patients at home;

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

Preparing patients to be seen by a doctor at a FAP, conducting medical examinations of the population and preventive vaccinations;

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

Providing medical care to children in preschool and school educational institutions located in the territory of the FAP operation and not having appropriate paramedical workers on their staff;

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

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

Midwife FAP is responsible for the provision and level of provision of pre-hospital medical care to pregnant and gynecological patients, as well as for sanitary educational work among the population on issues of maternal and child health.

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

Visiting nurse carries out preventive measures to improve the health of the child population. For these purposes, it solves the following tasks:

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

Carries out measures to prevent rickets and malnutrition;

Conducts preventive vaccinations and diagnostic tests;

Conducts preventive work in preschool and school educational institutions (located in the territory of the FAP operation and not having appropriate paramedical workers on their staff);

Prepares sick children for admission to the FAP by a pediatrician;

Conducts door-to-door surveys according to epidemiological indications in order to identify infectious patients, persons in contact with them and those suspected of infectious diseases, etc.

If there is no position of a visiting nurse in the staffing table, the midwife, in addition to her duties, monitors the health and development of children in the 1st year of life. If there is no midwife or 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 village residents is local hospital, which may include a hospital and a medical outpatient clinic. The types and volume of medical care in a local hospital, its capacity, equipment, and staffing largely depend on the profile and capacity of other medical institutions that are part of the healthcare system of a municipal district (rural settlement). The main task of the local hospital is to provide primary health care to the population.

Outpatient care to the population is the most important section of the work of a local hospital. She may be outpatient clinic, part of the hospital structure, 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 medical examination of patients. Doctors at the outpatient clinic see adults and children, make house calls and provide emergency care. Paramedics can also take part in the reception of patients, but medical care in an outpatient clinic should primarily be provided by doctors. In the local hospital, an examination of temporary disability is carried out, and if necessary, patients are sent to medical examination.

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

On a scheduled schedule, they go to the outpatient clinic to receive patients and select them, if necessary, for hospitalization in specialized institutions. Recently, in many regions of the Russian Federation, local hospitals and outpatient clinics have been reorganized into centers of general medical (family) practice.

Second stage providing medical care to the rural population are healthcare institutions of the municipal district, and among them the leading place is occupied 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 care management body in the territory of the municipal district.

The capacity of the central district hospital and the profile of specialized departments within it depend on the population size, the structure and level of morbidity, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, central district hospitals have a capacity of from 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatric, infectious diseases and obstetrics and gynecology (if there is no maternity hospital in the area).

The chief physician of the central district hospital is the head of healthcare of the municipal district, appointed and dismissed by the administration of the municipal district.

An approximate organizational structure of the Central District Hospital is shown in Fig. 17.2.

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas and paramedics of the FAP is provided by specialists from the Central District Hospital. Each of them, according to the approved schedule, goes to the complex therapeutic area to conduct medical examinations, analyze dispensary work, and select 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 central district hospitals (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 Central District Hospital has clinic, which provides primary health care to the rural population in the following areas:

Rice. 17.2. Approximate organizational structure of the Central District Hospital

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

The provision of out-of-hospital and inpatient treatment and preventive care to children in the municipal area is entrusted to children's consultations (clinics) And children's departments of the Central District Hospital. The preventive and therapeutic work of children's clinics and children's departments of the Central District Hospital is carried out on the same principles as in city children's clinics.

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

The functional responsibilities of medical personnel, accounting and reporting documentation, and the calculation of statistical indicators of the activities of the Central District Hospital are not fundamentally different from those in city hospitals and administrative offices.

Third stage Healthcare institutions of the constituent entities of the Russian Federation provide the rural population with medical care, 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 preventive institution designed to provide full specialized care not only to rural, 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 in the region (region, district, republic), a base for specialization and advanced training of doctors and paramedical personnel.

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

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

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

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

Patients are referred to the advisory clinic, as a rule, after preliminary consultation and examination by district (city) medical specialists.

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

The department of emergency and planned advisory care works in close connection with regional center for disaster medicine.

In cases of emergencies, practical work to carry out sanitary tasks is carried out by teams of specialized medical care on constant readiness.

Unlike the central district hospital, 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 for the healthcare management body of a 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 paramedic (nursing) conferences, summarizing and disseminating the best practices of healthcare institutions, organizing medical examinations of the population, scheduled visits of specialists, publishing instructional and methodological materials, etc.

Purpose of the lesson.

Students should know:

1. System of organizing medical care for the rural population.

2.The main content and features of the work of medical institutions in rural areas,

3.Modern problems of rural healthcare and ways to solve them.

Main questions of the topic:

The structure of the district's medical and sanitary network and features of the organization of medical care for rural residents.

2. Rural medical area, its structure, principles of construction.

3. District hospital, its main tasks and scope of activities.

Medical and midwifery station, standards for its organization and main tasks.

Organization of medical and preventive care at a rural medical site (clinical examination, servicing rural workers during field work, the production principle of servicing agricultural workers).

Central district hospital, its main functions.

District health department (medical council, organizational and methodological office of the central district hospital, district specialists, forms and methods of their work).

Regional hospital, its structure and main functions.

The main feature of the system of providing medical care to village residents is its staged nature. Treatment and preventive care for the rural population is provided by a complex of medical institutions, ranging from first-aid posts to regional (territorial, republican) institutions.

First stage. Rural medical station includes the following medical institutions: a local hospital with an outpatient clinic (polyclinic) or an independent hospital (medical outpatient clinic, FAP, state farm (collective farm) medical dispensaries, pharmacy points, dairy kitchens. All medical and preventive institutions that are part of the rural medical district are close primary health care to the rural population and contribute to the successful solution of the tasks of providing this care in conditions of significant remoteness of settlements from district and central district hospitals.

Second phase. District medical institutions : central district and so-called zonal district hospitals located within the district with clinics and emergency departments, district dispensaries and other medical institutions.

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

The staged approach to providing medical care to rural residents pursues the goal of most fully meeting the needs of the population not only in primary health care, but also in its main types and in all narrow specialties.

LEVEL SYSTEM OF MEDICAL CARE ORGANIZATION.

Currently, for 10 territories of the region, a certain scheme for organizing healthcare has been proposed, in which each medical and preventive institution or group of medical and preventive institutions represents a certain level of medical care (paramedic stations - one level, medical outpatient clinics - another, district hospitals - the third etc.).

The availability of certain levels of medical care, as well as their number for each municipality, are determined taking into account specific conditions - material and technical equipment of medical institutions, personnel composition, remoteness of settlements from the main treatment and diagnostic bases, the need and provision of the population with outpatient clinics and inpatient types of medical care.

The specific volumes of medical and diagnostic care that should be provided at the FAP, in the local hospital, central district hospital, city, regional hospital are clearly indicated in the relevant Regulations on these medical institutions approved by the Ministry of Health of the Russian Federation.

The proposed leveled system of medical care is aimed at increasing the volume of outpatient care, reducing hospitalization and more efficient use of hospital beds. A distinctive feature of this system is that it is determined individually for each specific territory of the region and contributes to effective control over the implementation of the State Guarantee Program to provide the population of the Irkutsk region with medical care.

The proposed scheme for the level organization of medical care provides a combination, on the one hand, of the volumes of medical and diagnostic care for each type of treatment and preventive institution, defined in the relevant Regulations of the Ministry of Health of the Russian Federation, on the other hand, the most rational network and structure of health care institutions for each city or district of the region, which these volumes are fulfilled.

For example,

Ust-Kutsky district:

Ilevel: FAP (medical and obstetric stations) – 11.

IIlevel: Medical outpatient clinics – 5, including post offices. Yantal, Zvezdny village, Niya village, Ruchey village, Podymakhino.

IIIlevel: District hospital with 35 beds.

IVlevel: Central district hospital with 265 beds, including departments: therapy - 30 beds, infectious diseases - 30 beds, surgical - 27 beds, traumatology - 27 beds, dental - 6 beds, maternity and pregnancy pathologies - 45 beds, gynecological - 30 beds , neurological – 10 beds, dermatological – 30 beds, pediatric – 30 beds.

Clinic. Anti-tuberculosis dispensary with 35 beds.

Vlevel: OKB.

Bratsk district:

Ilevel: FAP – 33

IIlevel: Medical outpatient clinics – 7, including: post office. Transformed;

With. B-Oka, Shumilovo village, Tynkob village, Naragai village, Turma village, Chmir village.

IIIlevel: District hospitals – 4, including: Kaltuk village – 30 beds,

With. Pokosnoye – 25 beds, village. Tanguy – 50 beds, village. Klyuchi – Bulok – 15 beds.

IVlevel: Vikhorevsk City Hospital with 90 beds, including departments: therapy - 30 beds, infectious diseases - 15 beds, maternity - 10 beds, gynecological - 15 beds, pediatric - 20 beds.

Clinic.

Bratsk Central District Hospital with 180 beds (therapy – 55 beds, surgery – 35 beds, traumatology – 25 beds, urology – 10 beds, dentistry – 5 beds, gynecology – 25 beds, neurology – 25 beds).

Clinic.

Vlevel: OKB.

The main tasks of the VCA are:

providing medical and preventive care to the population,

introduction into practice of modern methods of prevention, diagnosis and treatment of patients based on the achievements of medical science and technology and best practices;

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

organization and implementation of a set of preventive measures among the population of the site aimed at reducing morbidity, disability and mortality;

carrying out treatment and preventive measures to protect the health of mothers and children;

studying the causes of general morbidity in the population and morbidity with temporary disability of workers and employees with the development of measures to reduce it;

organization and implementation of clinical examination of the population (healthy and sick), especially children, adolescents, women and persons at increased risk of cardiovascular, oncological and other diseases;

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

implementation of current sanitary supervision of the condition of industrial and communal premises, water supply sources, children's institutions, public catering establishments, etc.;

carrying out treatment and preventive measures to combat tuberculosis, skin and venereal diseases, and malignant neoplasms;

organizing and conducting events for sanitary and hygienic education of the population, promoting a healthy lifestyle, including a balanced diet, increasing 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.

The main medical and preventive institution of the VU is local hospital. Its power depends on the number of agro-industrial enterprises, service radius, distance to the district hospital, central district hospital, as well as on geographic and other local conditions.

There are four categories of district hospitals. Category I hospitals have a capacity of 75-100 beds. They provide specialized beds for therapy, surgery, obstetrics, pediatrics, and infectious diseases. Such hospitals should be well equipped with clinical diagnostic equipment. Category II hospitals (50-70 beds) must have beds for therapy, surgery, pediatrics, obstetrics, and infectious diseases. Category III hospitals (35-50 beds) provide beds for therapy for adults and children, surgery, obstetrics and infectious diseases. Category IV hospitals (with 25-35 beds) should have beds for therapy, surgery and obstetrics.

Paramedic and midwife station. This is a pre-hospital medical institution that provides health care to the rural population. The medical staff of the FAP carries out a complex of treatment, preventive and sanitary and anti-epidemic measures on the territory assigned to them, and provides first aid to patients at outpatient appointments and at home. Medical care for patients is provided within the competence and rights of a paramedic and midwife, under the guidance of a local doctor.

Its main tasks are:

Providing pre-medical care to the population;

Timely and full implementation of doctor’s prescriptions, organization of patronage for children and pregnant women, systematic monitoring of the health status of disabled people of the Great Patriotic War and leading agricultural specialists (machine operators, livestock breeders, etc.);

Implementation of measures to reduce mortality, including child and maternal mortality;

Participation in ongoing sanitary supervision of institutions for children and adolescents, communal, food, industrial and other facilities, water supply and cleaning of populated areas;

Conducting door-to-door surveys according to epidemic indications in order to identify infectious patients who have been in contact with them, and persons suspected of infectious diseases;

The FAP is under the jurisdiction of the village Council of People's Deputies and has an independent estimate intended to provide medical care and carry out preventive work in the assigned territory. The head of the FAP is obliged annually (in August-September) to present to the Village Council a reasonable estimate by item for the funds necessary for the point for the next year and seek its approval. The activities of the FAP are managed by the hospital or outpatient clinic to which it is subordinate.