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 quantity 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,

implementation into practice modern methods 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 therapeutic 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 people 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, child care facilities, institutions Catering and etc.;

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

organization and implementation of sanitary measures hygiene education 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 it, 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 management of the activities of the FAP is carried out by the hospital or outpatient clinic to which it is subordinate.

Among the organizational principles of modern public health, one of the important ones is maintaining the unity and continuity of medical care for the population in urban and rural areas. In general, medical support for the rural population is characterized by limited availability of medical care as well as low effectiveness of medical, social and preventive measures. The main reasons for the deterioration of medical care in rural areas are: limited funding; outdated organizational forms of support...

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Mikhalyuk S.F.

ORGANIZATIONS OF MEDICAL SERVICES FOR THE RURAL POPULATION.

Among the organizational principles of modern public health, one of the important ones is maintaining the unity and continuity of medical care for the population in urban and rural areas. Most of the population lives in rural areas. In the Republic of Belarus, 28-30% 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 influence the organizational forms and methods of work of rural medical organizations.

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

• features of population settlement;
• characteristics of agricultural labor (seasonality, low level of mechanization, high proportion of manual labor, often significant distance from place of residence to place of work, etc.);
• outflow of youth and people of working age to urban areas;
• aging population in rural areas;
• lower living standards in rural areas;
• socio-economic and everyday difficulties.

In general, medical support for the rural population is characterized by limited availability of medical care, as well as low effectiveness of medical, social and preventive measures.

The main reasons for the deterioration of medical care in rural areas are:

• limited funding;
• outdated organizational forms of providing medical care;
• weak material and technical base;
• lack of personnel, transport, communications;
• high cost of drugs;
• disruption of continuity at different stages of medical care.

In this regard, the task of bringing together the levels of medical care for urban and rural populations remains relevant to this day.

The goal of reforming the system of organizing medical care for the rural population is to preserve and develop state system healthcare, ensuring social justice in the field of health care, ensuring affordable and high-quality medical care, as well as increasing its efficiency.

The key areas for the development of health care in rural areas are:

1. Preservation of a unified state healthcare system.
2. Improving the health of the population by improving the living standards of rural residents and improving environmental conditions.
3. Optimization of personnel policy in rural areas and development of programs for social development and protection of healthcare workers. Improving health care legislation in order to consolidate medical workers in rural areas, restoration and provision of minimum benefits (free housing, heating and lighting, internship benefits, advanced training, etc.)
4. Improving the functioning of mechanisms for the effective distribution of resources by supporting priority areas in the activities of rural health care organizations (introducing a doctor’s institute general practice).
5. Strict adherence to medical and organizational principles of forming a network of institutions in rural areas, taking into account the population’s need for medical care and the prospects for the medical, demographic and medical and organizational situation.
6. Improving the structure and functions of rural treatment and prevention organizations.
7. Ensuring continuity in the work of the rural district network and specialized services.
8. Development of primary accounting and reporting documentation, examination of its feasibility.
9. Creation of medical and social care institutions (with a rehabilitation focus) for the elderly, disabled and elderly people in local hospitals with joint financing of these beds by health care and social protection services.
10. Expansion of medical and social care in outpatient clinics and at home.
11. Giving the health care system the status of the main system establishing corresponding requirements for other sectors National economy according to the criterion of their influence on the health of the population and provision of a favorable living environment.

For a number of years, there has been a negative “growth” of the population with an excess of mortality over the birth rate. The age structure of the population has changed towards aging. In the Republic of Belarus, the share of people over 60 years of age is 19.0% (in rural areas 31%, in cities 14%.

In 2003, 44.9% of inpatient and outpatient clinics were located in adapted premises. About half of hospitals and outpatient clinics did not meet sanitary standards. In dilapidated and emergency buildings there were 125 buildings for various purposes of healthcare organizations, incl. in emergency situations 22. 148 hospitals and 232 outpatient clinics had stove heating, 37% of hospitals did not have hot water supply, and 2% did not have cold water.

The main goals of social reforms in the field of health care should be:

• ensuring conditions for compliance with constitutional guarantees for the provision of medical care to the population and control over sanitary and epidemiological well-being;
• ensuring the sustainability of the functioning of healthcare institutions, changing the volume and procedure for financing the industry;
• increasing the economic and clinical efficiency of the use of financial, material and human resources healthcare;
• ensuring the protection of the patient’s rights to receive timely and high-quality medical care;
• integration into the world community.

Healthcare management in the republic is carried out according to a three-level principle:

strategic level, which is represented by the Ministry of Health and government authorities; they make legislative and regulatory decisions (laws, decrees, resolutions, orders, instructions), i.e. determines the industry strategy for the future, mandatory for execution and management;

the tactical level, represented by territorial regional authorities, which are guided by the provisions and orders of the strategic level. Their most important function is to coordinate the activities of territorial health care systems;

operational level, which includes the management of healthcare facilities, their structural divisions and services.

The organization of medical and preventive care for the rural population is based on the same organizational principles as for the urban population.

Basic principles of healthcare:

• state character;
• planning;
• free;
• general availability;
• preventive focus;
• connection with science;
• public participation in health care.

The main task of rural healthcare is to fully satisfy the needs of rural residents in all types of medical care.

Main feature The organization of medical care for the rural population is the staged nature of its provision. The essence of the stage principle is that at each of the subsequent stages the patient receives the appropriate health care, which could not be provided to them at the previous stage.

The classic scheme for organizing medical care for the rural population is presented in three stages:

Stage I. Rural medical station: U private hospital, which includes a hospital, an outpatient clinic, a day hospital, paramedic and obstetric stations, and a pharmacy.Medical clinicIt contains the same units with the exception of the hospital.

Stage II. Central District Hospitalas part of a hospital for adults and children, specialized departments, a consultative clinic, and an organizational and methodological office.

The district center of hygiene and epidemiology (RCHE) and the district pharmacy work in close contact with the central district hospital.

Stage III. Regional, republican hospital,which includes a hospital with specialized departments, a consultative clinic and an organizational and methodological department; department of emergency and planned advisory medical care;

• Regional specialized institutions(oncology dispensary, anti-tuberculosis dispensary, blood transfusion station, etc.);
• Regional Center for Hygiene and Epidemiology;
• Clinics of medical and research instituteslocated in the regional center;
• Regional pharmacy department.

Let's consider some features that are typical for the population living in rural areas

Features of the work of the rural population.

1. Seasonality of work (affects the use of medical care: 45% - winter, 25% - spring, 10% - summer, 20% - autumn).
2. Influence of meteorological (weather) factors (working outdoors).
3. Frequent changes in work operations.
4. Working over long distances.
5. Features of physical activity.
6. Special temporary work schedule (from dawn to dusk, milkmaid).
7. Features of rural labor mechanization
8. Dust, noise, vibration.

Features of the habitat.

1. Contact with biological objects (animals, insects).
2. Influence of environmental factors (chemicals, fertilizers, nitrates, etc.)
3. Sanitary problems (water supply, personal hygiene, etc.).
4. Problems of transport accessibility, specifics of settlement, communications, etc. and medical care.
5. Nutritional features;
6. Seasonal vitamin imbalances.

3. Socio-psychological characteristics.

1. Feelings of community and loneliness.
2. Traditions of a “joint society” Smoking and alcoholism..
3. “Collective farmer” complex.

4. Features of the demographic characteristics of the rural population.

1. Children and adolescents under 18 years of age - 5-30%.
2. Average age (18-60) - 4 - 20%.
3. Elderly and senile (60 or more) - 50-80%.

5. Family composition.

1. Families consisting of 1 person - 5-20%.
2. Families of 2 people - 15-40%.
3. Families of 3 people - 15-30%.
4. Families of 4 people or more - 5-10%.

The health status of the rural population is determined by:

To analyze health status, WHO recommends using:

1. Vital registers, i.e. demographic data;
2. Census results;
3. Current information from health services;
4. Epidemiological surveillance data;
5. Selective or screening studies;
6. Disease registries;
7. Other sources (including those not related to healthcare).

Morbidity rate of the rural population according to the data of visits to healthcare facilities.

1. The leading reasons for appeals from the rural population are: diseases of the respiratory system - 30-35%, diseases of the circulatory system - 20-30%, diseases of the digestive system - 10-20%, neoplasms - 5-8% per thousand population. It is natural that the appeal rate for individual diseases varies significantly depending on the demographic characteristics and regional characteristics (Chernobyl).

Morbidity rate of the rural population according to medical preventive examinations:

1. Diseases of the nervous system and sensory organs - 25-30%.

2. Respiratory organs - 25 30%.

3.Cardiovascular system - 10-40%.

4.0 digestive organs - 6-12%.

Morbidity rate of the rural population according to hospitalization data

The structure of hospitalized patients and the duration of inpatient treatment is determined by age and gender structure.

Children under 16 years old:

1. pneumonia and tonsillitis;
2. ARVI;
3. infectious diseases.

Average age (17-55 years):

1. diseases of the nervous system and sensory organs;
2. respiratory diseases (men) and gynecological diseases (women);
3. diseases of the digestive system.

Elderly and senile age (55 years and older):

1. cardiovascular diseases;
2. respiratory diseases (RDD);
3. neoplasms.

Characteristics of visits to health workers in rural areas.

1. Treatment and advisory- 57%, of which: a) therapeutic profile - 35-55%; b) dental - 20-30%; c) pediatric - 10-15%; d) surgical - 10-15%.

2. Dispensary - 18%, of which: a) therapeutic profile -50-65%; b) pediatric - 25-35%; c) surgical - 10-15%.

3.Preventive- 25%, of which: a) pediatric - 25-30%; b) dental - 20-25%, d) obstetrics and gynecology - 15-25%, therapeutic - 10-15%.

Pre-medical and first medical aid to the rural population is provided in the institutions of the rural medical district. For village residents, this is the first stage of medical care the closest and most accessible link in the healthcare system.

Rural medical station - functional education, which is the main organizing link between primary health care and all specialized types of medical care at its different stages. The average population is 5-7 thousand people, the average service radius is 8-15 km.

Rural medical area is a territory with a living population, served by doctors located on it medical organization. The territory of the VU usually corresponds to the boundaries of rural administrative units (one, rarely two rural councils). At the VUU, either rural district hospitals with outpatient clinics or independent rural medical outpatient clinics are organized. The work of these institutions is led by chief physicians, respectively the chief physician of a rural district hospital or the chief physician of a rural outpatient clinic. All rural medical institutions deployed at the rural medical site (FAPs) are subordinate to them.

The village in which the local hospital (outpatient clinic) is located is called a point village. The distance of the most distant village from the point village is called the radius of the site.

Tasks of a rural medical district (district hospital, rural medical outpatient clinic):

1. providing medical and preventive care to the population;
2. introduction into practice of modern methods of prevention, diagnosis and treatment of patients;
3. development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care;
4. organization and implementation of a set of preventive measures among the population of the site;
5. carrying out treatment and preventive measures to protect the health of mothers and children;
6. studying the causes of general morbidity and morbidity with temporary disability and developing measures to reduce it;
7. organization and implementation of clinical examination of the population, especially children and adolescents;
8. implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.);
9. implementation of current sanitary supervision of the condition of industrial and communal premises, water supply sources, child care institutions, public catering establishments;
10. carrying out treatment and preventive measures to combat tuberculosis, skin and venereal diseases, and malignant neoplasms;
11. organizing and conducting sanitary and hygienic eventseducation of the population, promotion of a healthy lifestyle, including balanced nutrition, strengthening physical activity; combating alcohol consumption, smoking and other bad habits;
12. wide involvement of the public in the development and implementation of measures to protect public health.

In accordance with these tasks, the responsibilities of the doctor (doctors) of the rural medical district have been developed:

A special place in the professional activity of a doctor in a rural medical district is occupied by issues of maternal and child health. If there are two or more doctors in a rural medical outpatient clinic or rural district hospital, by order of the chief physician, one of them is assigned responsibility for the medical care of children in the area.

Paramedic and midwife station (FAP).(1990 3012. 2000 2848 (-164) 2005 2524 (-324) ((Σ . 488) tendency to decrease).

Paramedic and midwife stationis a specific feature of rural healthcare and occupies a very important place in providing the rural population with medical care.

Paramedic and midwife stations are outpatient clinics. Their creation was caused by the peculiarities inherent in rural health care - the need to bring medical care closer to the population in conditions of a large service radius of the local hospital (outpatient clinic) in relation to all existing settlements.

Organized in villages with a population of 700 or more and a distance of more than 5 km to the nearest medical organization, 300-700 people and a distance of more than 5 km, less than 300 people and a distance of more than 6 km.

Led by a paramedic, midwife and nurse.

Tasks of the FAP.

improving the sanitary and hygienic culture of the population;

Providing pre-medical care to the population, fulfilling doctor’s prescriptions;

Providing medical care in case of acute diseases and accidents;

active patronage of women and children; sanitary education work

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, persons in contact with them and those suspected of infectious diseases;

sale of medicines.

The management of the activities of the FAP is carried out by the hospital or outpatient clinic organization to which it is subordinate.

The FAP must have premises that meet the sanitary and hygienic requirements and objectives of the institution.

An important area of ​​FAP activity is strengthening the health of mothers and children. To implement it, the FAP is assigned the following functions:

widespread dissemination of information about family planning methods;

early detection of pregnant women;

registration of pregnant women;

patronage and dynamic monitoring of women during pregnancy and after discharge from the maternity hospital;

differentiated observation and care of newborns, premature and physically weakened children, especially children of the 1st, 2nd and 3rd years of life;

Direction and content of FAP activities

Sanitary and anti-epidemic work	Treatment and preventive care for adults	Health care for women and children
Current sanitary supervision	Outpatient appointment, home care	Monitoring pregnant women and women in labor
Anti-epidemic measures in the outbreak	Providing pre-hospital medical care	Psychoprophylactic preparation of pregnant women for childbirth
	Participation in medical examinations and medical examinations	Providing assistance to women in labor and postpartum
Measures to reduce occupational morbidity	Fulfilling medical prescriptions	Providing medical care to gynecological patients
Carrying out preventive vaccinations	Health care for the population during field work	Dispensary observation of children. Providing therapeutic and preventive care to children.
Working with a sanitary asset		Prevention of rickets, control over rational nutrition, physical development of children.

Currently, the share of participation of the FAP in the provision of medical and preventive care to village residents is still large, since it serves a significant number of the population and is the closest, most accessible type of medical care, especially to residents of remote villages. Depending on the distance of a settlement from a medical outpatient clinic, local hospital or central district hospital, the share of rural residents’ visits to the FAP ranges from 30 to 40% or more of the total level of visits.

Conclusions:

1. FAP is one of the most accessible and widespread types of medical care for the rural population.
2. FAPs play an important role in providing medical and preventive care to residents of rural areas.

FAP documentation: 1) patient admission log; 2) a journal of suggestions and comments of the doctor (specialists); 3) doctors’ departure schedule. The rest of the documentation is determined by the management of the SUB, IAS, and the Central District Hospital.

Rural medical outpatient clinic (RVA).(1990 319. 2000 418 (+ 99). 2005 589 (+ 171) ((Σ . + 270) tendency to increase).

Rural medical outpatient clinicis the primary link in the system of social-hygienic, treatment-and-prophylactic, and sanitary-anti-epidemic provision of the rural population.

Organizes and provides first medical and pre-medical care.

The tasks of the IAS are the tasks of the IAS. The staffing structure depends on the number of people served. Typically, there is 1 general practitioner per 1,300 adults, 1 pediatrician per 800 children. Dentist - 1 position for 1.5 doctor positions. Positions can be combined for several SVA or SUB (then work according to schedule)

Medical documentation: in full from an outpatient clinic.

Specifics: I) Logbook of the departure of the main specialists;

2) Schedule of visits of specialists from the Central District Hospital.

Rural district hospital- is the main medical and preventive institution of the VU.(SUB 1990 447 with a number of beds 15270. In 2000 388 11501. In 2002 346 9990 + 1 nursing care center with a number of beds 15. In 2003 302 9475 + 4 nursing care facilities with a number of beds 100. In 2004 221 6019 + 47 nursing care centers with a number of beds of 990. In 2005 184 with a number of beds 5056 + 90 nursing care centers with a number of beds 2017 - downward trend).

Depending on the service radius, population size and density, rural district hospitals are divided into 4 categories:

I category 75-100 beds. Such a local hospital should have specialized beds for therapy, surgery, obstetrics, pediatrics, infectious diseases, and tuberculosis. As a rule, such a hospital has an X-ray room.

The volume of outpatient care is most often the same as in SVA. However, it may additionally be:

surgical, obstetric-gynecological, etc. Diagnostic capabilities are significantly increasing: X-ray biochemical laboratories.

More than 100 beds are usually already a village or district hospital. Service radius is usually up to 15 km, population 5 thousand or more

Tasks of the SMS:

1) tasks of the VCA

2) organization of inpatient medical care for the population;

3) analysis of the use of hospital beds and work aimed at increasing the efficiency of its use;

4) prevention of hospital infections;

5)organization of hospital nutrition;

6) maintaining hospital facilities (utilities, transport, landscaping, fire safety measures, logistics, etc.).

7) medical and social function;

Medical documentation: full documentation of outpatient and inpatient medical institutions.

Features of the analysis of the work of the SMS: 1) terms of hospitalization;

2) seasonality of hospitalization; 3) re-hospitalization;

4) distribution of hospitalization indicators by day of the week. 2/3 of the budget is spent on inpatient treatment.

The SUB provides inpatient care and performs medical and social functions; on its own territory should almost completely satisfy the need for pre-medical, first aid.

Territorial Medical Association (TMO).Central District Hospital (CRH).(1990 - 137 with the number of beds 37397, 2000 137 - 33796, 2005 1 26 with number of beds 2 6889)

The central district hospital is the main institution for providing qualified medical care. At the same time, the Central District Hospital is the center for organizational and methodological management of the district's healthcare.

Based on capacity, central district hospitals are divided into 5 categories:

The capacity of the central district hospital and other structural medical institutions is determined by the average annual number of deployed beds. Regardless of the bed capacity, the size of the population served and the service radius, the central district hospital must have a certain list of structural units:

clinic;

hospital with treatment departments for basic medical specialties;

reception department;

diagnostic and treatment departments (offices) and laboratories;

organizational and methodological office;

emergency department;

utility block (catering unit, laundry room, garage, etc.).

If the district center does not have an independent children's hospital with a consultation and a dairy kitchen, or a maternity hospital with a antenatal clinic, then the women's and children's clinics and the dairy kitchen, as structural units, are included in the clinic of the Central District Hospital.

The central district hospital implements the principle of unity of command in the person of the chief physician of the central district hospital (TMO). A medical council is created under the chief physician, there is a certain number of deputies, a chief accountant, and a chief nurse.

Peculiarities:

is legal entity;

is the manager financial resources;

has public governance structures (medical council, council of paramedics, council of nurses, etc.).

makes organizational and management decisions;

has specialized departments;

has an organizational and methodological office (department);

has an emergency medical service;

departments (services) can perform inter-district functions;

has chief specialists;

In the region, in addition to the central district hospital, specialized dispensaries (anti-tuberculosis, skin and venereal diseases) can be organized, which operate as inter-district institutions (serve the population of nearby areas). In enlarged districts that emerged as a result of the merger of two or more districts, former district hospitals continue to function, retaining all their functions, organizational structures and standards for serving the population.

In each district of the republic, institutions of the sanitary and anti-epidemic service are also organized and functioning - regional centers of hygiene and epidemiology (RCHE). Settlements located around the district center and served by the district's medical institutions (clinic or central district hospital) are called assigned areas.

TMO tasks:

1) providing the required volume of highly qualified inpatient and outpatient medical care to the population;

2) operational and organizational-methodological management, as well as control over the work of all healthcare institutions and individuals those engaged in individual medical activities in the region;

3) planning, financing and organizing logistics for health care institutions in the district;

4) planning and implementation of measures to develop a network of medical institutions;

5) development and implementation of measures aimed at improving the quality of medical care for the population of the region, reducing morbidity, disability, hospital mortality, child and general mortality and improving the health of children, adolescents and women;

6) timely and widespread introduction of modern methods and means of prevention, diagnosis, treatment and rehabilitation into the practice of all health care facilities in the region;

7) development, organization and implementation of measures for the deployment, rational use, professional development and education of medical personnel and other personnel of health care institutions in the district;

8) maintaining hospital facilities.

The chief physician has a certain number of deputies:

1) deputy for medical care-supervises organizational and methodological support for the work of health care facilities in the district, supervises the work of chief specialists;

2) deputy for medical affairs - supervises inpatient medical care and emergency medical services;

3) deputy for outpatient work - supervises outpatient medical care;

4) deputy for medical and rehabilitation examination supervises morbidity with temporary and permanent disability, all types of examinations;

5) Deputy for Childhood and Obstetrics - oversees issues of maternal and child health;

6) deputy for administrative and economic work - oversees the issues of logistical support for the work of health care facilities.

Regional level of medical care.

The leading medical and preventive institution, organizational, methodological and consulting center for healthcare in the region is the regional hospital, for the children's population - the regional children's hospital.

Structure of the regional hospital:

hospital with an emergency department (specialized departments);

consultation clinic (may be separate);

diagnostic and treatment departments, offices, laboratories;

organizational and methodological department and department of medical statistics;

emergency and routine consultation departments;

radiology department;

pathology department;

business units (catering department, warehouses, etc.).

Objectives of the regional hospital:

provision of advisory, specialized or qualified medical care that cannot be provided in other medical institutions regions;

assistance to institutions and health authorities of the region in improving the quality of treatment and preventive work locally, generalizing best practices and improving forms and methods medical activities;

coordination of treatment-and-prophylactic and organizational-methodological work carried out by all specialized medical institutions in the region;

allocation of air ambulances and ground transport for emergency and planned advisory assistance to patients;

systematic analysis of the health status of the population of the region and the activities of medical institutions, development, together with the main specialists of the regional health department, of the necessary measures to reduce morbidity and improve the quality of medical care.

On the basis of regional hospitals, retraining courses for advanced training of medical workers in the region can be conducted. The bed capacity of a regional hospital depends on the population of the region. The average capacity of a regional hospital in the Republic of Belarus is 1000 beds.

Specialized dispensaries have been organized in all regions (anti-tuberculosis, oncology, etc.). as well as other specialized medical institutions (regional psychiatric hospital), which are regional centers for the provision of specialized medical, organizational and methodological assistance.

Separately, we should dwell on the characteristics of some types of medical crossbreeds for the rural population.

Emergency medical care in rural areas.

At the level of FAP, SUB, SVA, it is provided by the medical staff of these institutions at any time of the day.

The most important issues in organizing ambulance and emergency medical care for the rural population are:

1) availability of a schedule and procedure for providing this type of medical care in all rural health care facilities;

2) availability of packing bags, bags and their necessary equipment;

3) the presence of algorithms for the provision of emergency medical care in all health care facilities and, above all, in the emergency medical service dispatch service, recording the receipt of calls and the measures taken;

4) proper continuity (on the principle of feedback) between the emergency medical services service, outpatient clinic service, dispatch services of farms and enterprises;

5) training the population in providing self- and mutual assistance, increasing the sanitary literacy of the population;

6) development and availability of incentives for participation in this type of assistance for all health workers, incl. and nursing staff;

7) training of medical personnel to provide emergency and emergency medical care;

8) priority of medicinal and logistical support for this type of medical care.

Nursing staff in the rural health care system.

In rural areas, it plays a very significant role in the provision of medical care and other public health tasks.

Therefore, it is necessary to plan and implement:

1) constant training of nursing staff using all types and methods of training;

2) preparation and training for the adoption of independent medical decision;

3) expansion of functions and rights, delegation of powers, participation in all types of medical activities of healthcare facilities.

Features of organizing the provision of medical care to the rural population.

1.Stepwise.

2. Travel forms of work.

3.Development of general medical practice

4.High role and importance of nursing staff. 5.Combination of treatment-and-prophylactic and sanitary-anti-epidemic measures.

6. Development of hospital-substituting technologies.

5.Medical and social nature of the organization of work.

7.Priority of organizational work with local governments.

8. Development and implementation of telemedicine.

All other features are determined by the socio-economic situation and the quality of work of managers of the healthcare system at all levels.

PAGE 6

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GBOU VPO "Smolensk State Medical Academy"

Topic: “Features of organizing maternal and child health care in rural areas”

Completed:

SAVINOV P.V.

Smolensk 2013

Introduction

Fundamentals of the state system of protection of motherhood and childhood

1. Organization of medical care for children and mothers in rural areas

1.1 Rural medical station

1.1.1. Paramedic and midwifery stations (FAP)

1.1.2. Rural dispensary

1.2. Central District Hospital

1.3. Regional health institutions

Conclusion

Bibliography

INconducting

Among the organizational principles of modern public health, one of the important ones is maintaining the unity and continuity of medical care for the population of urban and rural areas. Medical care for the rural population is based on the basic principles of healthcare organization. However, there are a number of factors that determine differences between urban and rural areas and influence the organizational forms and methods of operation of rural health care institutions. Such factors include the characteristics of the settlement of residents, service radius, specific conditions of the labor process, etc. Meanwhile, all residents of rural areas should be provided with affordable medical care, especially for women’s and children’s health programs.

Fundamentals of the state system of protection of motherhood and childhood. In the system of maternal and child health care, seven stages of providing treatment and preventive care can be distinguished, the consistent implementation of which determines the organizational unity of this system:

Forming the health of a girl as a future mother, preparing her for future motherhood

Treatment and preventive care for women before pregnancy

Antenatal fetal care - maintaining the health of a woman and child during pregnancy until childbirth

Intranatal fetal care - maintaining the health of a woman and child during childbirth

Health protection of the newborn and mother during the postpartum period

Protecting the child's health before entering school

Protecting the health of a schoolchild and transferring him under supervision to a teenage network.

The system of maternal and child health care extends not only to the urban population, but also to the rural population. The only peculiarity is that the implementation of this system lies with medical structures that are not typical for urban areas.

1. Organization of medical care for children and mothers in rural areas

Medical care for women and children living in rural areas, like the entire population, is provided in stages.

Stages of providing medical care: Stage 1 - rural medical district and its medical institutions; 2nd stage - medical institutions of the region; Stage 3 - the region and its medical (regional) institutions.

The main institutions at the 1st stage are a local hospital or an independent medical outpatient clinic; at the 2nd stage - the central district hospital; at the 3rd stage - regional (regional, republican) hospital.

1.1 WITHYelsky medical station

A rural medical district is the first link, the 1st stage 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 first aid stations, collective farm maternity hospitals, seasonal and permanent nurseries, and paramedic health centers at industrial enterprises and trades. 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.

At the rural medical site, mainly preventive, anti-epidemic and, to a small extent, therapeutic care for children is provided. Children with mild forms of illness are most often hospitalized in rural hospitals. in severe cases, care is provided in the central district hospital. Since low-power rural district hospitals are not sufficiently provided with pediatricians, children are often assisted by a general practitioner.

1.1.1 Paramedic and midwifery stations (FAP)

The nearest medical institution to which rural residents turn for medical care is a paramedic and obstetric station.

Paramedic and midwifery stations (FAP) provide outpatient care mainly to pregnant women and children in the first years of life. Most FPAs are usually staffed by a paramedic and midwife or a nurse and a nurse.

Among other tasks, FAP employees are entrusted with organizing patronage for pregnant women and children, holding public events to reduce child and maternal mortality, and under the guidance of a doctor, carrying out a set of preventive, anti-epidemic and sanitary and hygienic measures aimed at reducing morbidity.

Paramedical workers of the FAP provide emergency pre-hospital medical care on an outpatient basis or at home, and carry out preventive work. In cases requiring medical care or consultation, patients are referred to a local doctor. FAPs are required to keep records of all pregnant women in the territory they serve and organize dispensary observation of them. In case of pathological abnormalities, the midwife is obliged to refer the pregnant woman to see a doctor or show her to the doctor during the next doctor’s appointment at the FAP.

After each independent delivery, the paramedic or midwife in the case of a live birth must issue the parents a “Medical Birth Certificate” (form No. 103/u-84). In the event of a child’s death during the 1st week of life, a “Medical Certificate of Perinatal Death” is filled out (form No. 102-2/u-84). At the FAP, there may be several beds for hospitalization of women in labor and hospitalization of infectious patients.

In the area covered by the FAP, medical supervision of children is carried out by a visiting nurse, or, if this position is not available at the FAP, by a paramedic or midwife.

All work of nursing staff in organizing medical supervision of children is carried out under the guidance of a local pediatrician assigned to the medical station of a district children's clinic, rural hospital or outpatient clinic. FAP workers systematically conduct medical examinations of children and vaccinations in accordance with the plan drawn up by the district State Center for Sanitary and Epidemiological Sanitation.

Medical supervision of children in the FAP is carried out by pediatricians who come to the FAP on fixed days.

When going to the FAP, the pediatrician must perform a significant list of work, including: preventive examinations of healthy children and children registered at the dispensary, visiting newborns and children at risk, examining sick children, conducting in-depth examinations of children in kindergartens and other types of medical treatment. - preventive work.

The following mode of observation by a doctor of young children in a medical facility is advisable:

The first medical visit to a newborn is no later than the 3rd day after discharge from the hospital

The second medical patronage is on days 15-18, combined with the beginning of specific prevention of rickets. Subsequent examinations during the first year of life - monthly during the doctor’s visit to the FAP. Children from 1 to 2 years of age are examined by a doctor once every 3 months, children of the third year of life - every 6 months. Children from risk groups and those registered at the dispensary are examined according to individual plans.

The visiting nurse, who is the link between the family and the pediatrician, visits children much more often. Thus, in the first year of life, up to 23-25 ​​patronage visits are made to a child. During the first month of life, the nurse visits the newborn at least 2 times a week. In the second - third month of life, three scheduled visits are carried out per month, during the 4th to 6th month of life - 2 visits, after 6 months and up to a year - once a month. Children in the second year of life are visited every 3 months, in the third year - once every six months.

Patronage visits to a pregnant woman begin from the 30th week of pregnancy. There are 3 visits - at 30, 32 and 38/39 weeks. Given the great complexity of the adaptation period, many midwives, starting from the first day of discharge of the mother and child from the maternity ward, visit them daily or every other day for a week.

1.1.2 Rural dispensary

A rural outpatient clinic is a medical and preventive institution designed to carry out broad preventive measures in the area of ​​its activity to prevent and reduce morbidity, carry out early identification of patients, carry out medical examinations of healthy and sick people, and provide qualified assistance to the population.

An outpatient clinic can be an independent institution or part of a hospital. Among the activities of outpatient clinics, a significant place is occupied by the tasks of protecting motherhood and childhood. A doctor at a rural outpatient clinic, as a rule, undergoes special training in the issues of medical and preventive care for the child population.

The leading medical institution in a rural medical area is a rural district hospital, and in outpatient areas - a medical outpatient clinic with rural children's consultations.

Treatment and preventive care for children at a rural medical site is provided by doctors and paramedics under the direct supervision of the chief physician of the local hospital. The tasks facing the doctor responsible for serving children in a rural medical district are identical to the tasks of a city district pediatrician.

Everyday medical and preventive care for children in rural areas is provided in outpatient clinics, rural children's clinics, in-patient departments of local hospitals and at home.

1.2 Central District Hospital

The district healthcare level differs more high level organization of medical care for children, therefore, pediatricians from the central district hospital should come to rural children's clinics 1-2 times a quarter according to the schedule (second stage). Responsibility for organizing maternal and child health care in an area with a population of over 70 thousand residents lies with the deputy chief physician of the Central District Hospital for childhood and obstetrics. He is also responsible for assessing the level and quality of medical care for children and mothers in the area. In areas with a population of less than 70 thousand, the direct organizer of the pediatric service is the district pediatrician.

The Central District Hospital includes visiting medical teams, mobile fluorographic and dental offices, clinical diagnostic laboratories, which makes it possible to provide the necessary medical, consultative and diagnostic assistance to the population of all ages.

To serve children living in rural areas and in need of hospital treatment in somatic, general surgical, and infectious diseases departments, about 70% of the total pediatric bed capacity is concentrated in the Central District Hospital. About 10% of the bed capacity is located in local hospitals and 20% is provided for hospitalization of children in regional central hospitals.

1.3 Regional health institutions

The third stage of medical care for the rural population is provided by regional health care institutions. At this stage, highly qualified medical care is provided in almost all specialties.

The main institution at this stage is the regional hospital (republican, regional), performing 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 health care facilities in 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; rural medical obstetric

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

Study and analysis of morbidity, disability, general and child mortality in the region, participation in the development of measures aimed at reducing them;

Generalization and dissemination of best practices in the work of health care facilities 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 health care facilities in the region.

Each regional hospital, regardless of its capacity, should have the following structural units:

Hospital;

Advisory clinic;

Treatment and diagnostic departments, offices and laboratories;

Organizational and methodological department with a medical statistics department;

Department of emergency and planned advisory care.

Pediatricians and obstetricians of the regional center, in addition to providing highly qualified specialized medical care, are entrusted with the functions of supervisors of rural areas in carrying out organizational, methodological, treatment and advisory work. Thus, the regional hospital is a treatment and preventive, scientific, organizational, methodological and educational center for rural healthcare areas of the region.

Conclusion

From the presented material it is clear that the healthcare system adopted in Russia assumes equal provision of medical care to the entire population, regardless of place of residence. Unfortunately, there are a number of problems that place residents of rural areas in conditions significantly different from the urban population. Such problems include understaffing of rural medical stations and insufficient medical equipment. In addition, the experience of zemstvo doctors was lost, which in recent years has begun to be revived in the form of a system of general medical practice and family medicine.

Bibliography

1. Nursing / ed. Kotelnikova G.P. and others - Rostov-on-Don Phoenix, 2006. 666 p.

2. Nursing / ed. A.F. Krasnova t.1-2 M 1999

3. Skvirskaya G.P. "Federal target program“Family Medicine” // “Healthcare” No. 2 1996

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Unity of principles for providing treatment and preventive care for urban and rural populations: 1) preventive in nature; 2) locality; 3) mass participation; 4) specialization of medical care 5) general availability.

Features of providing medical and preventive care to the rural population:

1) stages of assistance

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

Features of the organization of rural medical care:

1) low density population – rural population in 2004 2,803,600, 2005 2,744,200, 2006 2,691,500. Compared to 2002, the rural population decreased by 118 thousand. In 2005, 90,307 people were born, of which 24,205 (26.8%) were born in rural areas. The birth rate in 2005 was 9.2 in the Republic of Belarus, in rural areas – 8.9. The mortality rate in rural areas is 2.2 times higher than in the city. Infant mortality in general is 6.4, in rural areas – 9.3. Life expectancy in rural areas is 64.52 years, in cities 70.53 years.

Crowding is the number of people in a populated area. The average rural population is 200 people.

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

3) poor quality of roads

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

5) conditions, lifestyle, traditions

6) low supply of specialists

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

Stage I – previously – rural medical station (VSU), including a complex of medical institutions:

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

B) first aid station (FAP)

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

Currently There are no SVUs, SVA and local hospitals are branches of the Central District Hospital, FAPs are branches of the SVU.

Main function of the stage: provision of first 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 the medical institution. When serving more than 400 people. in the staff of the FAP there are: 1 position of a paramedic or midwife or nurse and 0.5 positions of a 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 work and anti-epidemic work;

– organization of patronage for pregnant women, children,

– carrying out measures to reduce infant and maternal mortality;

– hygienic training and education of the population.

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

District hospital- This 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. At the local hospital All types of qualified medical and preventive care are provided. Medical assistance to the population during field work is of great importance. Significant work is being done to protect the health of women and children, to introduce modern methods of prevention, diagnosis, and treatment.

Provides all types of medical and preventive care to pregnant women, mothers and children 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.

At Unprofitable activities of local hospitals, they are closed or converted into branches Rehabilitation of district hospitals, and for medical care of the population they open Independent rural medical outpatient clinics(SVA), whose staff should include: a general practitioner, a dentist, an obstetrician-gynecologist, and a pediatrician. Medical care for patients with dental diseases in a local hospital or in a rural outpatient clinic is provided by a dentist (dentist).

From the staffing standards for medical personnel at local hospitals:

1. The positions of doctors for providing outpatient care to the population are established per 10,000 population:

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 care to the population

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

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

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

– carrying out therapeutic and preventive measures to protect the health of mothers and children

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

– organization and implementation of medical 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; combating alcohol consumption, smoking and other bad habits

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

Stage II – territorial medical association (TMO).

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

– deputy for medical services to the population (also 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 issues;

– Deputy for administrative and economic affairs.

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

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

TMO is a complex of health care facilities that are functionally and organizationally interconnected. TMO may include:

clinics (adults, children, dental);

antenatal clinics, dispensaries, hospitals, maternity hospitals;

ambulance stations;

children's sanatoriums and other institutions.

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

Principles of formation of TMO:

1. A certain population size - the optimal size of the TMO - 100-150 thousand people.

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.

TMO tasks– providing accessible and qualified treatment and preventive care to the population.

TMO functions:

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.

Main treatment and preventive institutions Stage II includes the central district hospital (CRH) and other district institutions (see question 102).

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

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

Stage III – regional hospital and regional medical institutions.

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. (see question 104).

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

Advisory clinic provides the population with highly qualified, highly specialized medical care, provides on-site consultations, correspondence consultations by telephone, analyzes the activities of medical institutions, discrepancies between the diagnoses of the referring institutions and the clinic, the diagnoses of the clinic and the hospital, and error analysis. Does not have the right to issue sick leave.

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.

Outpatient qualified specialized dental care patients receive treatment in regional dental clinics, inpatient care is provided in the dental departments of regional hospitals.

The number of hospital organizations in rural areas in 2005 was 274, of which there were 184 district hospitals, nursing hospitals – 90. The number of outpatient clinics was 3326. There were 253 independent medical outpatient clinics in 2005, and 336 general practitioner outpatient clinics in 2005. FAPs in 2005 – 2524.

IVstage: republican level(RSPC, republican hospitals).

Medical assistance to the rural population is provided on a general basis, but the implementation of therapeutic and preventive measures in an optimal volume and at a sufficient level is complicated by a number of circumstances that must be taken into account when organizing it, namely: socio-economic, medical-demographic, medical-social, natural conditions , stages, infrastructure development, a significant part of pre-medical care, the creation of mobile forms of medical and preventive care.

The organization of medical care for the rural population is based on the principles of stages. There are four stages of assistance:

Stage I – the rural medical district provides primary health care.

Stage II – district medical institutions provide mainly secondary (specialized) care.

Stage III – regional hospitals and dispensaries provide highly specialized care.

Stage IV – interregional and state specialized centers.

At each stage, the activities of all medical institutions are interconnected.

I. Rural medical station - organized to provide medical care to residents of settlements remote from the regional center. It includes a local hospital or outpatient clinic and paramedic and obstetric stations.

Tasks of the rural medical station:

• providing medical and preventive care to the population;
• carrying out anti-epidemic measures;
• carrying out activities to protect the health of mothers and children;
• implementation of continuous sanitary supervision of the territory, objects economic activity, educational and educational institutions;
• study of the health status of the population;
• carrying out activities for hygienic education of the population.

A rural medical district is created to provide primary health care on a local basis for residents of settlements remote from the regional center. The average population in the area is 3800 inhabitants and with an average service radius of 7.2 km. When organizing a site, the population size, the distance between settlements, settlement patterns, and the area of ​​the area are taken into account.

A rural district hospital is located in a so-called point village with a significant population and has an average capacity of 15.7 beds.

The structure of the SMS includes: an outpatient clinic, a clinical laboratory, a hospital, an X-ray room, and a physiotherapeutic room.

The functions of the SMS are: timely detection of diseases, provision of outpatient and inpatient care, carrying out preventive measures, dispensary observation and examination of disability.

Inpatient care, which is provided in a local hospital, is predominantly of a therapeutic profile, although sometimes emergency surgical care is provided, children and infectious patients are hospitalized.

The local hospital includes a rural medical outpatient clinic. It can also exist on its own. The staffing schedule determines the presence of four specialists who provide outpatient care: a therapist (family doctor), a pediatrician, an obstetrician-gynecologist (in populated areas with a population of over 1000 people) and a dentist.

The rural outpatient clinic provides timely detection and treatment of diseases in the outpatient clinic and at home: timely hospitalization, referral for consultations with specialists; carries out the selection of persons for dispensary observation; conducts an examination of temporary disability and sends it to MSEC; conducts dynamic monitoring of the health status of pregnant women and children, carries out health-improving and anti-epidemic measures.

A significant number of villages with a small population and their significant distance from health care institutions contribute to the development of mobile forms of medical care (mobile medical outpatient clinics, dental offices, diagnostic fluorography complexes).

Together with the rural outpatient clinic, outpatient and polyclinic care to the population at the pre-medical stage is provided by a paramedic and obstetric station (FAP).

The main tasks of the FAP are: provision of medical and preventive care (first aid, patronage of pregnant women and children, participation in medical examinations) and carrying out sanitary and educational activities (carrying out preventive vaccinations, identifying infectious patients, participating in ongoing sanitary surveillance).

The second stage of providing medical care to the rural population includes the following institutions: central district hospital (CRH), district hospital, district SES, central district pharmacy.

The main institution for providing secondary specialized care is the Central District Hospital. The main functions of which are the provision of outpatient and inpatient specialized treatment and preventive care, as well as ambulance and emergency care, consultations with patients.

The Central District Hospital has specialized departments: therapeutic, surgical, infectious, neurological, pediatric, obstetric and gynecological. Other specialized departments (cardiology, gastroenterology, traumatology, otolaryngology, ophthalmology) can also be created on the basis of the Central District Hospital, which operate as inter-district departments. They carry out consultations with patients from assigned areas and hospitalize them, and also develop measures to improve the quality of specialized care and improve the qualifications of medical personnel.

Structure of the Central District Hospital:

• clinic;
• hospital;
• emergency department;
• pathological and anatomical department;
• information and analytical department.

Tertiary, highly specialized, highly qualified medical care for rural residents is provided by Stage III institutions, which include regional hospitals, dispensaries, regional SES, blood transfusion stations, and forensic bureaus.

The objectives of the regional hospital are: advisory outpatient care, highly specialized inpatient care, organizational and methodological work (assessment of the health status of the region's population, analysis of the activities of all health care facilities in the region and individual services, drawing up an action plan to improve the quality of medical care, advanced training of medical workers).

Structure of the Central District Hospital:

• advisory clinic;
• hospital;
• medical, auxiliary and diagnostic units;
• Center for Medical Statistics;
• departments of emergency and planned advisory care;
• administrative and economic part;
• pension.

Highly specialized medical care for the rural population is also provided by interregional medical institutions and centers that are part of research institutes, universities, regional hospitals or existing independently (IV stage medical support rural population).