Organization of the work of medical and preventive institutions at different stages of medical provision of the rural population. Organization of medical care for the rural population

Organization of medical care for individuals

Population groups.

Educational and methodological manual for students

(IX semester)

Penza, 2005.

Information sheet:

The educational and methodological manual “Organization of medical care for certain groups of the population” was prepared by the department of hygiene, public health and healthcare of Penza State University (head of the department, candidate of medical sciences Dmitriev A.P.).

Participated in the compilation: Ph.D. Zubrianova N.S.

The educational and methodological manual was prepared in accordance with the “Program on “Public Health and Healthcare” for students of medical faculties of higher medical educational institutions”, developed by the All-Russian Educational, Scientific and Methodological Center for Continuing Medical and Pharmaceutical Education of the Ministry of Health of Russia and the UMCpcp and approved by the Head of the Department of Educational medical institutions and personnel policy N.N. Volodin in 2000

This educational manual has been prepared for students to independently prepare for practical classes on this topic.

TOPIC: Organization of medical care for the rural population. Organization of medical care for workers of industrial enterprises. Protecting the health of women and children.

I. Organization of medical care for the rural population

Basic principles of organizing medical care for the rural population.
FAP, local hospital, independent medical outpatient clinic.
Central regional hospital.
Regional Hospital.

II.Organization of medical care for workers of industrial enterprises..

Main problems of industrial medicine.
Medical and sanitary unit (MSU)
Health center

4. Shop doctor.

III. Organization of obstetric and gynecological care:

Organization of antenatal clinic work.
The main sections of the work of a local obstetrician-gynecologist
Accounting and reporting in antenatal clinics.
Organization of inpatient obstetric and gynecological care.
Analysis of the activities of the maternity hospital hospital.

IV.Organization of medical and preventive care for children:

Organization of the work of a children's clinic.
Preventive work of the children's clinic
Therapeutic work of a children's clinic
Anti-epidemic work of the children's clinic
Performance indicators of the children's clinic
Children's preschool institutions. Schools, boarding schools, holiday camps.
Organization of inpatient care for children.

V. Medical care for women and children living in rural areas.

Main: Public health and healthcare. Under. Ed. V.A. Minyaeva, N.I. Vishnyakova. Textbook. With. 248-315

Additional: Public health and healthcare. Yu.P. Lisitsyn, N.V. Polunina. Textbook.

Qualifying tests in social hygiene and healthcare organization. Ed. O.P. Shchepin and A.I. Vyalkova.

THEORETICAL PART:

I. Organization of medical care for the rural population

The organization of medical care for the rural population, its features are related to the nature of work and living conditions of rural residents. Currently, the number of rural residents in Russia is 39.8 million people, or 27% of the total population.

Unlike urban residents, in rural areas the population density is much lower, which is due to the large radius of their settlement; seasonal nature of work; occupational hazards (working with insecticides, animals, etc.); the roads are not always in good condition, which causes difficulties in the timeliness of providing medical care, etc. The listed points influenced the specifics of organizing medical care for rural residents, which consists in its stage-by-stage implementation, the presence of certain organizational forms and methods of work, and mobile teams; creation of special medical institutions, including seasonal preschools.

The following are distinguished: 3 stages of providing medical care to rural residents :

Stage I - rural medical site; Stage P - district institutions; Stage III - regional institutions.

Main institutions Stage I are a paramedic-midwife station (FAP), a local hospital or an independent medical outpatient clinic; Stage II - central district hospital; Stage III - regional Hospital. In addition, if necessary, rural residents receive medical care in urban health care institutions. Research Institute clinics of medical universities.

The main functions of medical institutions at each stage are as follows: in a rural medical district, residents are provided with pre-medical and first qualified medical care, and sanitary and anti-epidemic measures are carried out. At the second stage, specialized assistance is provided according to its main types. The third stage is characterized by the provision of highly qualified assistance of all types to rural residents.

Rural medical station - This is the first link in the system of providing medical care to the rural population. In addition to a rural district hospital (SUB) or an independent medical outpatient clinic, it includes paramedic and obstetric centers, collective farm maternity hospitals, seasonal and permanent nurseries, paramedic health centers at industrial enterprises and trades. The network of these institutions is built depending on the location and size of settlements, service radius, the economy of the area and the condition of roads. 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 per medical area varies within 5--7 thousand inhabitants at optimal radius section 7-10 km(distance from the point village in which the SMS is located to the most remote settlement of the rural medical district). However, depending on natural and economic-geographical factors affecting the availability of medical care, the size of medical areas and the size of their population can be different: for example, in the North, the radius of the area varies between 50-100 km. The number of rural settlements per medical area also varies depending on the nature of their settlement, the average population and the development of the road network. All medical institutions that are part of the medical district are organizationally united and operate according to a single plan under the leadership of the chief physician of the local hospital.

The nearest medical institution to which rural residents turn for medical care is a paramedic and midwife station (FAP). It plays an important role in the overall system of organizing medical care for the rural population. The presence of a FAP is one of the features of rural healthcare, due to the need to bring medical care closer to the population with a large service radius of the local hospital and a low density of rural residents.

Recommended standard for the number of residents for organizing a FAP- 700 or more at a distance to the nearest medical facility of at least 5 km. If the distance to the nearest medical facility exceeds 7 km, then FAP can be organized in settlements with a population of 300-500.

Main tasks paramedic and midwife station in accordance with the order of the USSR Ministry of Health No. 1000 (1981) are:

Providing first aid;

Timely completion of all doctor's orders;

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 child and maternal mortality;

Increasing the sanitary and hygienic culture and medical activity of the population.

The main medical institution at the rural medical site is local hospital or independent medical outpatient clinic(clinic). The nature and volume of medical care in a local hospital is mainly determined by its capacity, equipment, and the availability of specialist doctors. However, regardless of capacity, any local hospital should provide outpatient and inpatient care for therapeutic and infectious patients, assistance during childbirth, medical and preventive care for children, emergency surgical, trauma and dental care.

District hospital capacity depends on the service radius, population size and density, distance to the district hospital, the presence of industrial enterprises, as well as the characteristics of local conditions.

There are four categories of rural district hospitals: Category I hospitals have 75-100 beds; II - 50-75; III - 35-50 and IV - 25-30 beds. The average bed capacity of district hospitals is approximately 35 beds.

Category I hospitals have specialized beds for therapy, surgery, obstetrics, pediatrics, infectious diseases, and tuberculosis. As a rule, such hospitals are equipped with clinical diagnostic equipment;

At a rural district hospital, there should be, as a department, mobile dispensary to bring qualified medical care closer to the population, which is especially important in conditions of poor roads, muddy roads and remoteness of medical institutions.

The main functions of a rural medical station are the provision of medical and preventive care and sanitary and anti-epidemic work.

The most widespread type of medical care is outpatient care. Assistance is provided by doctors at the local hospital and paramedics at medical and obstetric stations. The hospital's doctors provide outpatient care to adults and children, provide home care and emergency care. A rural doctor is essentially a general practitioner(family doctor).

Features in the organization of outpatient and inpatient care in rural district hospitals are expressed as follows:

There is no clear time limit for outpatient appointments;

Visiting hours for patients must be scheduled at the most convenient time for the population, taking into account the seasonality of agricultural work;

In the absence of a doctor, the patient must be seen by a paramedic;

House calls in the village (where the local hospital is located) are received by a doctor; in other settlements - a paramedic;

One preventive day a week is necessary for the doctor to go around the site and perform the functions assigned to him;

Duty in a hospital with the right to stay at home and with mandatory notification of staff about your location in case of emergency assistance.

It should be noted that there is a tendency towards the reduction of low-capacity rural district hospitals and their repurposing into departments of central district hospitals, social assistance institutions, etc.

Second stage of medical care rural residents includes district health care institutions, which include:

Central District Hospital;

Numbered district hospitals;

Center for State Sanitary and Epidemiological Surveillance of Rural District;

TB Dispensary;

Medical and sanitary unit, etc.

As a rule, district medical institutions are located in the district center (city or village). The main link in the system of organizing medical care is central district hospital (CRH), which provides specialized care in its main areas to residents of the entire region, respectively, of all rural medical districts. In accordance with the order of the Ministry of Health of the Russian Federation No. PO dated 04/09/98, the Central Regional Hospital is entrusted with the functions of the health care management body of the rural administrative region. In addition, the Central District Hospital provides organizational and methodological management of the district's medical institutions.

Among the main tasks of the Central District Hospital are::

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

Operational and organized methodological management of healthcare institutions in the region;

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

The development and implementation of measures to improve the quality of medical care also helped improve the health of the population.

Exists 6 categories of central district hospitals depending on the number of deployed beds (from 400 to 100 beds). Average bed capacity of the central district hospital, located in urban villages, there are approximately 270 beds, and in rural villages - 165 beds.

In addition to the central district hospital located in the district center, there may be other district hospitals in the district, so-called numbered hospitals, which can serve as a branch of the central district hospital or specialize in one or another type of medical care. It should be pointed out that in the so-called assigned area, i.e. in the area located around the central district hospital, there is no need for a rural district hospital, since its functions are performed by the central district hospital itself.

Chief Physician of the Central District Hospital is also the chief physician of the district, whose functions include:

Direct management of the activities of the Central District Hospital, responsibility for the preventive, therapeutic, diagnostic, administrative, economic and financial activities of the hospital;

Management of the activities of all medical institutions in the region;

Responsibility for the organization and level of healthcare in the district.

In his work on managing the health care of the district and the central district hospital, the chief physician of the Central District Hospital relies on his deputies for organizational and methodological work (usually he is also the head of the organizational and methodological office of the Central District Hospital), for childhood and obstetrics, as well as for the medical unit, under whose subordination he is activities of district specialists.

As a rule, the central district hospital works under the chief physician medical advice.

The Medical Council is created for the operational management of healthcare. It includes responsible employees and specialists: deputy chief physicians, chief physician of the district sanitary and epidemiological station, head of the clinic of the Central District Hospital, head of the central district pharmacy, chairman of the district committee of trade unions of medical workers, chairman of the district committee of the Red Cross and Red Crescent Society, leading specialists of the district (therapist, surgeon, pediatrician , obstetrician-gynecologist, etc.).

Organizational and methodological office and specialist doctors of the Central District Hospital carry out the orders of the chief physician on the organizational and methodological management of health care institutions in the district, which is carried out by organizing scheduled visits of medical specialists to rural district hospitals for consultations and providing practical assistance to colleagues on issues of diagnostic, treatment and preventive work; systematic study by employees of the organizational and methodological department of the main quality indicators of the work of medical institutions in the region (morbidity rate, mortality rate, general and child mortality, discrepancies between clinical and pathological diagnoses); on this basis, developing measures to improve the quality of medical care; organizing events to improve the qualifications of medical personnel.

To improve the qualifications of doctors in the region, clinical and anatomical conferences, seminars, meetings, lectures and reports are organized and held on the basis of the Central District Hospital, at which doctors get acquainted with new methods of work of the best medical and preventive institutions of the region, the region, and improve the qualifications of paramedical workers of the FAP.

Hospital care for the rural population in the Central District Hospital is provided according to 10 specialties or more (therapy, surgery, obstetrics, gynecology, pediatrics, traumatology and orthopedics, urology, otorhinolaryngology, neurology, psychiatry, allergology, dentistry, dermatovenerology, ophthalmology, infectious diseases, etc.).

On the basis of the Central District Hospital, interdistrict typified departments are organized in various profiles (ophthalmology, orthopedic traumatology, otorhinolaryngology, urology, neurology, etc.), the functions of which can be performed by specialized departments of a hospital or clinic.

The need for such departments arises if the central district hospitals of the surrounding areas do not have the ability to provide qualified medical care in this specialty. The assignment of the functions of an interdistrict specialized treatment and prophylactic department to the corresponding department of the hospital and the assignment of the corresponding population of rural areas to it is carried out by a higher health authority, taking into account the geographical location, economic ties, and the state of transport links.

Currently a priority in the development of rural healthcare is strengthening and improving outpatient care: new assigned therapeutic and pediatric medical stations are being organized, various types of mobile medical care are being developed, in particular mobile medical teams, mobile dental offices and denture laboratories. Much attention is paid to organizing ambulance and emergency medical care, staffing with doctors and paramedical personnel, equipping with modern diagnostic and treatment equipment, providing off-road ambulance transport, telephone and radio communications.

Third stage provision of medical care to rural residents includes regional health care institutions located in the regional center. The main institution at this stage is regional Hospital (republican, regional), performing the following main functions:

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

Organizational and methodological assistance to treatment and preventive institutions in the region;

Coordination of treatment-and-prophylactic and organizational-methodological work;

Providing emergency medical care by means of air ambulance and ground transport with the involvement of medical specialists from various institutions;

Management and control of statistical accounting and reporting of medical institutions;

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

Study and analysis of morbidity, disability, general and child mortality of the population;

Participation in the development of measures aimed at reducing them;

Generalization and dissemination of best practices in the work of medical and preventive institutions in the region in the introduction of new organizational forms of medical care, modern methods of diagnosis and treatment;

Carrying out activities for the specialization and improvement of doctors and nursing staff of treatment and preventive institutions in the region.

Thus, the regional hospital is a medical, scientific, organizational, methodological and educational center for healthcare in the region.

Bed capacity The regional hospital depends on the population of the region. There are 5 categories of regional hospitals depending on bed capacity (from 300 to 800 beds or more). The most cost-effective are regional hospitals with 700-1000 beds with all specialized departments, however, each hospital, regardless of its capacity, must have the following structural units: hospital; advisory clinic; diagnostic and treatment departments; laboratory; organizational and methodological department with a medical statistics office; department of emergency and planned advisory care.

At the regional hospital there should be boarding house for the sick, since they come from all over the region and need a place to live during the examination and clarification of the diagnosis, if they are not hospitalized immediately. At regional hospitals: should be dormitory for medical workers, so they come from all over the region to various conferences, seminars, courses, etc.

Advisory clinic must be staffed by experienced, highly qualified medical specialists who are able to provide patients with referrals and .; medical institutions in the region, qualified consultation to establish or clarify the diagnosis, determine further treatment and the need for hospitalization. The work of the advisory clinic is planned, for which a certain number of vouchers are sent to medical institutions in the region, taking into account the throughput of the clinic. Rational distribution of vouchers will make up for the lack of specialized medical care in the regions.

Patients referred to the advisory clinic should be examined as much as possible on the spot and the results of the research given to them. Violation of this rule contributes to the delay of the patient in the regional center. A consultant from the regional hospital travels on call from regional specialists in cases where the patient’s condition does not allow transporting him to the regional center

The clinic organizes and conducts scheduled on-site consultations with medical specialists together with the department of emergency and planned advisory care. If necessary, hospitalization in the appropriate department of the regional hospital is carried out through the emergency department. The advisory clinic provides a medical report for each patient, which indicates the diagnosis of the disease, treatment and further recommendations, and sends it to the appropriate treatment and preventive institution.

The clinic systematically analyzes cases of discrepancies in diagnoses, errors made by doctors when examining and treating patients locally, and also compiles situational reviews and information letters to improve diagnostic and treatment work in medical institutions in the region.

Department of emergency and planned advisory medical care provides on-site assistance upon calls from the regions and ensures the transportation of patients to specialized medical institutions not only in the region, but also outside it, the urgent delivery of various medications and supplies necessary to save the lives of patients, as well as for carrying out urgent anti-epidemic measures. In addition, the department maintains constant contact with teams sent to provide medical assistance. For this purpose, air ambulance or ground transport are used, depending on the severity of the disease, distance, road conditions, weather, time of year, etc.

To perform the above functions, the department must be provided with sanitary transport, special kits (surgical, gynecological, for blood transfusion, etc.).

Organizational and methodological department (structural part) of the regional hospital is directly subordinate to the chief physician and serves as the base for the regional health administration to introduce advanced organizational forms and methods of work into practice.

Each department serves as an organizational and methodological center for medical and preventive institutions in the region. Organizational and methodological work, which is an integral part of the activities of all departments of the hospital, is coordinated by the organizational and methodological department, which, in addition, studies the volume and nature of the activities of medical institutions in the region, provides organizational, methodological, treatment and advisory assistance to the authorities and health care institutions of the region; studies health indicators of the region's population; organizes staff training.

The regional hospital is a permanent base for advanced training of doctors and nursing staff of medical institutions in the region. Employees of the organizational and methodological department take part in drawing up annual and long-term plans for staff development, taking into account the need for mandatory advanced training for doctors at least once every 5 years and specific requests from the field.

Specialization and improvement of medical personnel is carried out in the regional hospital in the workplace with complete separation from work, in intermittent courses with partial separation from work, with the participation of specialists from the regional hospital on the basis of city and central district hospitals. Of great importance in improving the qualifications of doctors are general medical or specialized regional, interdistrict and district scientific and practical conferences, the agenda of which is developed by the organizational and methodological department, taking into account the wishes of the managers and doctors of medical institutions in the region. Doctors improve their skills by participating in research work under the guidance of specialists from regional hospitals, medical universities, etc.

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

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

Protecting the health of rural residents is part of the entire healthcare system. Therefore, the basic principles inherent in healthcare in general are also characteristic of rural healthcare.

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

The unity of the principles of providing medical and preventive care to the urban and rural population: preventive nature, locality, mass character, specialization of medical care, universal accessibility.

Currently, the level of inpatient medical care for rural residents has almost reached the level of city residents. At the same time, the level of outpatient medical care in rural and urban populations differs significantly. The same applies to the quality of medical services.

The existing differences in the organization of medical care for the rural population are due to: the unique system of population settlement; low population density; seasonality of agricultural labor; significant remoteness of settlements from each other; reduction in the proportion of people of working age; an increase in the proportion of elderly and elderly in rural areas; insufficient development of transport links;

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

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

Stage I - previously - a rural medical district (VDU), which includes a complex of medical institutions: a) a rural district hospital (RPH, provides both outpatient and inpatient care) or a rural medical outpatient clinic (RVA, provides only outpatient care)

b) first aid station (FAP) c) health centers (if there is an industrial enterprise in the serviced area). At present, there are no emergency medical services; internal medical assistance and local hospitals are branches of the Central District Hospital, and FAPs are branches of the emergency medical service.

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

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 FAP staff there are: 1 position of paramedic or midwife or nurse and 0.5 positions of nurse. Costs for FAPs are 1.5 -2.0% of the district budget.

Functions of the FAP: - provision of pre-medical care and timely implementation of doctor’s prescriptions; - carrying out preventive and anti-epidemic work; - organizing patronage for pregnant women and children, - carrying out measures to reduce infant and maternal mortality; - hygienic training and education of the population.

The rural medical district (VSU) served 7-9 thousand people within a radius of 7-9 km. The local hospital is the main institution at the VU, consisting of a hospital and an outpatient clinic.

Depending on the number of beds, there may be category I - 75 -100 beds, category II - 50 -75 beds, category III - 35 -50, IV - 25 -35 beds. The local hospital provides all types of qualified medical and preventive care.

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

If district hospitals are unprofitable, they are closed or repurposed into rehabilitation departments of district hospitals, and independent rural medical outpatient clinics (SVA) are opened for medical care of the population, whose staff should include: a general practitioner, a dentist, an obstetrician-gynecologist, and a pediatrician.

From the staffing standards of medical personnel in district hospitals: 1. The positions of doctors for providing outpatient care to the population are established per 10,000 population: Adult Children's population General practitioner 4.0 Pediatrician - Obstetrician-gynecologist 0.6 Surgeon 0.4 - 8.0 - 0.3 2.5 Dentist

2. The positions of doctors in hospital departments are established at the rate of 1 position: - general practitioner – for 25 beds; - pediatrician – for 20 beds; - surgeon – for 25 beds; - dentist – for 20 beds. The bed capacity of the rural district hospital is 27 -29 beds.

Organization of work of the SMS: - provision of medical and preventive assistance to the population; - introduction into practice of modern methods of prevention, diagnosis and treatment of patients; - development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care.

organizing and carrying out a set of preventive measures among the population of the site - carrying out treatment and preventive measures to protect the health of mothers and children - studying the causes of general morbidity and morbidity with temporary disability and developing measures to reduce it -

- organization and implementation of clinical examination of the population, especially children and 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 of the condition of industrial and communal premises, water supply sources, children's institutions, public catering establishments; - carrying out treatment and preventive measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms

- organization and implementation of events for sanitary and hygienic education of the population, promotion of a healthy lifestyle, including rational nutrition, and strengthening physical activity; fight against alcohol consumption, smoking and other bad habits.

Stage II – territorial medical association (TMO). The TMO is led by the Chief Physician of the TMO (he is also the chief physician of the Central District Hospital) and his deputies: - deputy for medical services to the population (he is also the head of the organizational and methodological office); - deputy for medical affairs (if the number of beds is 100 or more);

- deputy for medical and social examination and rehabilitation (with a population of at least 30,000 people served); - deputy for obstetrics and childhood (with a population of at least 70,000 people served); - Deputy for Economic Affairs; - Deputy for administrative affairs.

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

Principles of formation of TMO: 1. A certain population size – 2. optimal size of TMO – 100 -150 thousand population. 2. Organizational and financial separation of outpatient and inpatient facilities. 3. Coincidence of the boundaries of the TMO service area with the administrative boundaries of the district (city). 4. Rational unification of institutions - unification of institutions providing medical care to adults and children.

Functions of TMO: 1. Organization of medical and preventive care for the attached population, as well as for any citizen who seeks medical help. 2. Carrying out preventive measures. 3. Providing emergency care to patients.

4. Timely provision of medical care at the reception, at home. 5. Timely hospitalization. 6. Medical examination of the population. 7. Conducting a medical and social examination. 8. Conducting hygienic training and education. 9. Analysis of the activities of health care facilities.

At this stage, the district pediatrician and the district obstetrician-gynecologist are responsible for organizing treatment and preventive care for women and children. If the population of the district is 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 regional medical institutions. The regional hospital is a large multidisciplinary medical and preventive institution that provides full, highly qualified, highly specialized care to residents of the region. This is a center for organizational and methodological management of medical institutions located in the region, a base for specialization and advanced training of doctors and nursing staff.

Structure of the regional hospital: 1. Hospital. 2. Advisory clinic. 3. Other departments (kitchen, pharmacy, morgue). 4. Organizational and methodological department with a medical statistics department. 5. Department of emergency and planned advisory care, etc. The bed capacity of the regional hospital is 1000-1100 beds for adults, 400 beds for children.

The children's and women's population of the region receives all types of qualified specialized medical care at the advisory clinic. Inpatient care for women is provided in regional maternity hospitals, regional dispensaries and other medical institutions in the region.

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

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

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

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

102 First stage. Rural medical 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.

The first stage is a rural medical station, where patients receive qualified medical care; the second stage - district medical institutions and the leading institution at this stage is the central district hospital, providing 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.

A rural medical district is the first link in the system of medical care for the rural population. The composition of a rural medical district, in addition to a rural district hospital or an independent medical outpatient clinic, includes paramedic stations, seasonal and permanent nurseries, paramedic health centers at industrial enterprises and trades. The network of these institutions is built depending on the location and size of settlements, service radius, the economy of the area and the condition of roads. The average population in a medical area ranges from 5-7 thousand inhabitants with an optimal radius of the area being 7-10 km (the distance from the point village in which the SMS is located to the most remote settlement of the rural medical area). Depending on natural and economic-geographical factors, the size of medical districts and their population may vary.

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

The nearest medical institution to which rural residents turn for medical care is a paramedic-midwife station (FAP). The presence of paramedic-midwife stations is one of the features of rural healthcare, due to the need to bring medical care closer to the population in conditions of a large service radius of the local hospital and low density rural residents.

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

The main tasks of the FAP are:

Providing first aid;

Carrying out sanitary and anti-epidemic measures to prevent and reduce morbidity and injury;

Timely and full implementation of 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 district is a local hospital or an independent medical outpatient clinic (polyclinic).

Regardless of the capacity, any local hospital should provide outpatient and inpatient care for therapeutic and infectious patients, assistance during childbirth, medical and preventive care for children, emergency surgical and trauma 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 SUB 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 to bring medical care closer.

The main functions of a rural medical station are:

Providing treatment and preventive care to the population;

Carrying out sanitary and anti-epidemic work.

Outpatient medical care is provided to the population of the rural medical district in the local hospital and at first aid stations. SUB doctors provide outpatient care to adults and children, provide home care and emergency care. A doctor in a village must be a general practitioner (family doctor); he must continue the traditions of the zemstvo doctor.

The following features can be highlighted in the organization of medical care in the SMS:

There is no clear time limit for outpatient appointments;

Reception hours for patients should be scheduled at the most productive time for the population, taking into account the seasonality of agricultural work;

The ability to see 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 the village, house calls in another locality of the rural medical station are carried out by a paramedic;

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

103 Second stage. 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

The second stage of medical care for rural residents:

District health care institutions: central district hospital, numbered district hospitals, district center of state sanitary inspection, dispensaries, medical 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 region, respectively, of all rural medical districts.

The main tasks of the Central District Hospital:

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

Operational and organizational methodological management of healthcare institutions in the region;

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

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

In addition to the central district hospital, located in the district center, there may be other district hospitals in the district, so-called “numbered” hospitals, which can serve as a branch of the central district hospital or specialize in one or another type of medical care. In the so-called assigned area, i.e. in the area 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 managing the health care of the district and the central district hospital, the chief physician of the Central District Hospital relies on his deputies;

For organizational and methodological work (usually he heads the organizational and methodological office of the Central District Hospital);

For childhood and obstetrics;

On the medical side;

Organizational forms of leadership:

1. The work of the Medical Council under the chief physician of the Central District Hospital.

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

3. Activities of district specialists.

The chief physician uses the organizational and methodological office and specialist doctors of the Central District Hospital for organizational and methodological management of healthcare institutions in the district, which is carried out by:

Organization of scheduled visits of specialist doctors to rural district hospitals for consultation and provision of practical assistance to doctors of these institutions on issues of treatment, diagnostic and preventive work;

Systematic study by employees of the organizational and methodological department of the main quality indicators of the work of medical institutions in the region - development on this basis of measures to improve the qualifications of medical personnel.

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

Currently, the priority direction in the development of rural healthcare is to strengthen and improve outpatient care: new assigned therapeutic and pediatric areas 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 ambulance and emergency medical care in rural areas, staffing them with doctors and paramedical personnel, and equipping them with modern diagnostic and treatment equipment.

104 Third stage. Regional medical institutions : regional hospital with a consultative clinic and air ambulance department, dispensaries, dental clinic, 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 for healthcare in the region. The regional hospital performs the following main functions:

Providing the population of the region with a full range of highly qualified specialized advisory outpatient and inpatient medical care;

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

Coordination of treatment, preventive, organizational and methodological work carried out by all specialized medical institutions in the region;

Providing emergency medical care by means of air ambulance and ground transport with the involvement of medical specialists from various institutions;

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

Analysis and management of the quality of medical care provided in the regional hospital itself and in all medical institutions in 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 best practices in the work of medical and preventive institutions in the region in 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 nursing staff of treatment and preventive institutions in the region;

Structural departments of the regional hospital: inpatient department, advisory clinic, treatment and diagnostic departments, offices and laboratories, organizational and methodological department with a department of medical statistics, department of emergency and planned advisory care.

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

Department of emergency and planned advisory medical care:

Provides emergency and planned advisory assistance on site on calls from the districts;

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

Maintains constant contact with teams sent to provide medical assistance;

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

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

Provides organizational, methodological, treatment and advisory assistance to regional health authorities and institutions;

Studies the health indicators of the region's population;

Organizes staff training;

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

At regional seminars, conferences, ten-day events;

In workplaces with complete separation from work;

On intermittent courses with partial separation from work;

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

Currently, the following tasks of rural healthcare and ways to solve them can be identified:

1. Moving closer to urban 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 types of medical care.

2. Approaching specialized care by:

Strengthening the central district hospital;

Creation of inter-district specialized departments;

Creation of mobile dental offices and dental prosthetic laboratories.

The main feature of providing medical care to village residents is its phasing. Conventionally, there are three stages in organizing 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 and 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 the corresponding 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. At 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 obstetric-gynecological (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

niyams 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 shown 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.

Chapter 12. Features of the organization of medical care for residents of rural areas

12.1. GENERAL PROVISIONS

In 2008, in the rural healthcare of the Russian Federation there were 1,749 central district hospitals, 481 district hospitals, 39,179 paramedic and obstetric centers, which employed 46.2 thousand doctors and 208 thousand paramedical personnel.

The organization of medical care for rural residents is based on the same principles as for the urban population. However, the special way of life of villagers, the settlement system, low (compared to the city) population density, poor quality and sometimes lack of roads, and the specifics of agricultural work leave their mark on the system of organizing medical care for rural residents. This concerns the type, capacity, location of health care institutions, their provision of qualified medical personnel, and the possibility of receiving specialized medical care. These features also dictate the need to develop and introduce differentiated standards for individual types of resources. For example, for rural areas located in large areas with low population density (the Far North, Siberia, the Far East), the population standard for organizing a first aid station or a general medical (family) practice center should be significantly lower than that in the south of the country, where population density is higher, settlements are located close to each other and there are good transport links.

12.2. COMPLEX THERAPEUTIC AREA

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

(Fig. 12.1).

Rice. 12.1. Stages of providing medical care to the rural population

First stage- rural health care institutions that 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 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 feldsher-midwife station 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, primarily infant, maternal, and working age;

Providing pre-medical care to the population;

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 manager 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 residents

the village serves 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 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. She may be outpatient clinic both part of the hospital structure and 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.

12.3. CENTRAL DISTRICT HOSPITAL

Second phase 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, structure and level of care.

leftism, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, central district hospitals 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 diseases and obstetric-gynecological (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. 12.2.

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas and paramedics of FAPs is provided by specialists from central regional hospitals. 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 a given municipal area 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 through the referrals of paramedics from FAPs, outpatient doctors, and general medical (family) practice centers.

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 central district hospitals. Preventive and therapeutic work in children's clinics and children's departments of district hospitals 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 central district hospitals.

Rice. 12.2. Approximate organizational structure of the central district hospital

12.4. REGIONAL (TERIORAL, DISTRICT, REPUBLICAN) HOSPITAL

Third stage Providing medical care to the rural population is represented by healthcare institutions of the constituent entity of the 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 is a large multidisciplinary medical and preventive institution designed to provide full specialized care not only to rural residents, but also to the entire population of the constituent entity of the Russian Federation. It is a center for organizational and methodological management of medical institutions located in the region (region, district, republic), and is the basis for specialization and advanced training of doctors and paramedical personnel.

The approximate organizational structure of a regional (regional, district, republican) hospital is shown in Fig. 12.3.

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 the work of a regional (regional, district, republican) hospital has its own characteristics. One of these features is the presence within the hospital advisory clinic, where residents of all municipal districts (city districts) of a constituent entity of the Russian Federation come for help. 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. Patients are hospitalized in inpatient departments of the hospital, as a rule, on the referral of specialists from district, city, central district hospitals, emergency medical teams and emergency and planned advisory care departments.

Rice. 12 .3. Approximate organizational structure of a regional (regional, district, republican) hospital

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, in the regional (regional, district, republican) hospital the 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.

Research work represents one of the areas of activity of the regional (regional, district, republican) hospital. It includes conducting research together with departments of medical universities and research institutes, introducing scientific results into the practical work of medical institutions, organizing scientific conferences and seminars, the work of scientific societies of doctors, etc.

Further ways to improve the organization of medical care for rural residents include developing a network of general medical (family) practice centers, strengthening the material and technical base and equipping inter-district centers based on large central district hospitals with modern medical equipment, providing ambulance stations (departments) with sanitary transport and communications equipment. , development

air ambulance services, the introduction of telemedicine, the development of high-tech types of medical care on the basis of regional (regional, district, republican) hospitals. Bringing specialized types of medical care closer to the population should follow the path of developing its mobile forms (travelling clinics, mobile dental offices, fluorographic units, etc.). An important condition for increasing the availability of medical care for rural residents is staffing health care institutions with medical personnel. To solve this problem, it is necessary to switch to a contract-based form of training and distribution of personnel, provide housing for young specialists, and introduce an effective system of material incentives for labor.

Public health and healthcare: textbook / O. P. Shchepin, V. A. Medic. - 2011. - 592 p.: ill. - (Postgraduate education).