Obstetric and gynecological care rural population
Features of the living and working conditions of the rural population, expressed in the dispersion of settlements, the difference in the forms of organization of agricultural production, the variety of types of agricultural work (farming, livestock farming, poultry farming), the large scope of these works, their seasonality, determine the features of the organization of all medical care in a rural area, in including obstetrics and gynecology. Obstetric and gynecological care is provided to the rural population by a complex of medical and preventive institutions. Depending on the degree of proximity to the rural population, on the specialization and qualifications of medical care, the level of material and technical equipment in the system of providing obstetric and gynecological care, it is customary to distinguish three stages.
Stages of obstetric and gynecological care. First stage: implementation of pre-medical and first medical aid. This stage is a rural medical site. It includes a rural district hospital with an outpatient clinic and a hospital, paramedic and obstetric stations (FAP), and maternity hospitals. The location of the first stage is the periphery of the district.
The second stage: provision of qualified medical care. It includes district (registered) and central district hospitals, which include obstetrics and gynecology departments and antenatal clinics. The location of the second stage is the regional center.
Third stage: providing the rural population with highly qualified (specialized) obstetric and gynecological care. It includes a regional (territorial, republican) hospital, which includes obstetrics and gynecology departments and a antenatal clinic or an independent maternity hospital with a antenatal clinic. The location of the third stage is the regional (territorial, republican) center.
Medical obstetric and gynecological care at a rural medical site is carried out by a general practitioner - the chief physician of the rural district hospital (if there are two doctors in the district hospital - one of them). Under his direct supervision, a midwife works at the local hospital, who helps the doctor both in the hospital (takes part in the management of childbirth) and in the outpatient clinic (takes part in monitoring pregnant women, postpartum women and treating gynecological patients). The number of maternity beds in a rural district hospital usually does not exceed 3–5. To bring qualified medical care closer to rural residents, there is a gradual reduction in the number of maternity beds in rural district hospitals and an expansion of the number of beds in district and central district hospitals. However, in a number of areas where, due to local conditions, it is not possible to provide the population with obstetric and gynecological care in district and central hospitals, rural district hospitals are being consolidated, and in accordance with this, the number of maternity beds is being expanded to eight, and the position of an obstetrician-gynecologist is provided.
Pregnant women and women in labor with a pathological course of pregnancy and childbirth and a burdened obstetric history should not be admitted to a local hospital (if there is no obstetrician-gynecologist on staff). Despite the presence of a medical hospital on the periphery of the region - a rural district hospital, the bulk of obstetric and gynecological care in a rural medical district relates to pre-medical care, and is carried out by midwives from a medical and obstetric station and a collective farm (inter-collective farm) maternity hospital. The work of these institutions is carried out under the direct supervision of the chief physician of the rural district hospital. If a local hospital has an obstetrician-gynecologist on staff, the latter carries out all medical advisory assistance at the paramedic-midwife station and in the collective farm maternity hospital.
FAP: work structure
Paramedic and midwife stations (FAP) are provided for by the nomenclature of medical institutions. A FAP is organized in a village with a population of 300 to 800 residents in cases where there is no rural local hospital or outpatient clinic within a radius of 4–5 km. All work of the FAP is provided by a paramedic-midwife, midwife, and nurse. The number of service personnel is determined by the capacity of the FAP and the size of the population it serves. The FAP provides the following positions:
paramedic - 1 position for a population of 900 to 1300 people; 1 position for a population of 1300 to 1800 people; 1.5 positions with a population of 1800 to 2400 people. and 2 positions with a population of 2400 to 3000 people;
nurse - 0.5 positions for a population of up to 900 people and 1 position for a population of over 900 people.
Depending on the local conditions FAP can only provide outpatient care or have maternity beds. In the latter case, the FAP provides inpatient care along with outpatient care. Due to the fact that the FAP provides medical care to the entire rural population, and not just women, the room in which it is located should consist of two halves: a paramedic and an obstetrician.
Obstetric part of the FAP. The obstetric part of the paramedic-midwife station (FAP) should have the following set of premises: an entrance hall, a waiting room and a midwife's office. FAPs that have maternity beds, in addition to these premises, must have an examination room, delivery and postpartum wards. The FAP midwife carries out all the work on organizing and providing obstetric and gynecological care to rural residents within the service radius of the point. The responsibilities of the FAP midwife include: identifying all pregnant women in the service area as early as possible, ensuring dispensary observation of them, including carrying out the necessary treatment and preventive measures, patronage of pregnant women, postpartum women and children under the age of 1 year; carrying out health education work among women; provision of medical care during normal childbirth; identifying gynecological patients, referring them to a doctor and providing them with medical care as prescribed by the doctor. Significant assistance in the early detection of pregnant women is provided by door-to-door visits conducted by the FAP midwife. When monitoring pregnant women, the midwife performs the bulk of the necessary research. So, at the first visit of a pregnant woman, the midwife collects a detailed history, general (heredity, previous diseases, etc.) and special obstetric (menstrual, sexual, generative, lactation functions, gynecological diseases, etc.). From the medical history, the midwife finds out the peculiarities of the course of previous pregnancies, the presence of extragenital diseases and other abnormalities in the woman’s health that can affect the course of pregnancy and childbirth.
The midwife begins the examination of each pregnant woman with an examination of the internal organs: cardiac activity, measuring blood pressure (in both arms), examining the pulse, examining urine for protein (by boiling). The midwife currently studies the health status of pregnant women based on measuring height, body weight (over time), the presence of edema, pigmentation, the condition of the mammary glands and nipples, and the condition of the abdominals. Carrying out a special obstetric examination, the midwife measures the external dimensions of the pelvis and, through a vaginal examination, determines the gestational age and internal dimensions of the pelvis. In the second half of pregnancy, measures the height of the uterine fundus above the womb, determines the position and presentation of the fetus, and listens to its heartbeat.
For a general blood test, group affiliation, determination of the Rh factor, antibody titer, Wasserman reaction, and a general urine test, the pregnant woman is sent to the nearest laboratory. Here, a bacteriological study of the vaginal flora is carried out to determine the degree of purity, the discharge of the urethra, cervix and vagina for gonococcus, and the reaction of vaginal secretions. X-ray examinations in pregnant women (x-ray of the chest, fetus, pelviography) are performed only if there are strict indications.
A thorough examination of pregnant women makes it possible to identify various pathological conditions, on the basis of which these pregnant women are identified as high-risk groups and require the closest attention to them during pregnancy; during childbirth and the postpartum period, high-risk groups are distinguished for cardiac pathology, bleeding in the postpartum and early afterbirth periods, inflammatory and septic complications after childbirth, endocrinopathies - diabetes mellitus, obesity, adrenal insufficiency and other types of obstetric and somatic pathologies. All individual cards Pregnant women belonging to the risk group are usually marked with appropriate color markings, indicating in a certain color the risk of a particular pathology (red - bleeding, blue - toxicosis, green - sepsis). The scope of research in gynecological patients also includes the collection of general and special gynecological history. The study of women's health is currently carried out on the basis of a general clinical examination, similar to the examination of pregnant women. A special gynecological examination includes two-manual and instrumental (examination in mirrors) examination. A bacterioscopic examination of the discharge of the urethra, cervix and vagina for gonococcus is carried out using provocation methods, according to indications - the Bordet-Gengou reaction; examination of a vaginal smear for cell atypia; research on functional diagnostic tests.
If a woman needs a biochemical blood test for cholesterol, bilirubin, sugar, residual nitrogen and a urine test for acetone, urobilin, bile pigments, she is sent to the nearest multidisciplinary laboratory. Women and couples who have a history of hereditary diseases or children with deformities of the central nervous system, Down's disease, or defects of the cardiovascular system are sent for examination, including to determine sex chromatin, to specialized medical genetic centers. When monitoring pregnant women, the FAP midwife is obliged to show each of them to the doctor. If a woman’s pregnancy is progressing normally, then she will meet with a doctor at her first scheduled visit to the FAP. All pregnant women who exhibit the slightest deviation from the normal development of pregnancy should be immediately referred to a doctor.
At each subsequent visit to the FAP, the pregnant woman undergoes the necessary repeated examinations. In the second half of pregnancy, you need to especially carefully monitor the possible development of late toxicosis, for which you need to pay attention to the presence of edema, blood pressure dynamics and the presence of protein in the urine. It is very important to monitor the dynamics of a pregnant woman’s weight.
Organization of patronage work. A mandatory part of a midwife’s work in monitoring pregnant women should be conducting classes on psychoprophylactic preparation for childbirth. In organizing monitoring of pregnant women in rural areas, as well as in the city, patronage work is very responsible. Patronage of pregnant and gynecological patients is an element of the active dispensary method. The goals of patronage are very diverse, so each patronage visit to a woman has a specific goal. First of all, this is an acquaintance with the living conditions of a woman. Knowing the peculiarities of life of each family ( living conditions, family composition, level of material security, degree of culture, including health literacy), it is easier for a midwife to monitor the health status of the population. The purpose of patronage is the need to find out the health status of a pregnant woman who did not show up for an appointment at the appointed time. In this case, the midwife, in a conversation with the pregnant woman, finds out general state women, performs a thorough examination, pays attention to the presence of edema, and measures blood pressure. During long periods of pregnancy, she measures the circumference of the abdomen and the height of the uterine fundus, and determines the position of the fetus. Having made sure that there are no deviations from the normal development of pregnancy, the midwife sets a date for the woman to appear for the next examination. If there is the slightest sign of pregnancy complications, the midwife invites the pregnant woman to see a doctor or informs the doctor about this, who decides whether the pregnant woman can be treated at home or whether she needs to be hospitalized. In the latter case, the midwife monitors the timeliness of the woman’s admission to the hospital and continues active monitoring after she is discharged home. The reason for patronage may be the desire to make sure that the woman is following the doctor’s orders correctly, or the need to conduct additional tests (laboratory tests, measure blood pressure).
The FAP midwife is obliged to provide patronage to children, especially the first 3 years of life. In this case, it is necessary to observe the frequency of observations of children of the 1st year of life by the midwife (paramedic) of the FAP: 1st month of life - observation only at home - 5 times; 2nd month of life - observation at home - 3 times; 3–5 months of life - observation at home - 2 times a month; 6–12th months of life - observation at home - once a month. In addition, a child under 1 year of age must be examined by a pediatrician at the FAP at least once a month. Thus, the midwife sees the child during the 1st year of life 12 times during preventive examinations by a doctor and 20 times during home visiting.
The midwife's patronage work is strictly planned. The plan provides for days of visiting villages and hamlets. A special notebook keeps records of patronage work and records all visits to women and children. The midwife enters all advice and recommendations into the home visiting nurse’s work notebook (patronage sheet) for subsequent verification of their implementation.
Mobile teams from the Central District Hospital. The majority of women from rural areas gives birth in the obstetric departments of the Central District Hospital. If necessary, inpatient qualified medical care is provided to rural women in large republican, regional, and regional maternity hospitals. To bring medical outpatient care closer to residents of rural areas, visiting teams from the Central District Hospital are created, which arrive at medical and obstetric centers according to the approved schedule. The visiting team includes an obstetrician-gynecologist, a pediatrician, a therapist, a dentist, a laboratory assistant, a midwife, and a children's nurse. The composition of the visiting team of doctors and paramedical workers is brought to the attention of the heads of medical and obstetric centers.
Carrying out preventive periodic examinations. The paramedic and midwife are required to have in their area a list of women subject to preventive and periodic examinations. Practically healthy women with a good obstetric history and a normal course of pregnancy during the period between team visits are observed by a midwife at a FAP or local hospital, and are sent to the nearest local or regional hospital for childbirth. With a group of women for whom pregnancy is contraindicated, the obstetrician-gynecologist and midwife talk about the dangers of pregnancy for their health, possible complications pregnancy and childbirth, teach them to use contraceptives, and recommend intrauterine contraceptives. When visiting the team again, the obstetrician-gynecologist checks the obstetrician-gynecologist's compliance with the prescriptions and recommendations. Significant assistance in the early detection of pregnant women is provided by door-to-door visits conducted by a midwife. All identified pregnant women, starting with the most early dates pregnancy (up to 12 weeks), and postpartum women are subject to medical examination.
In the normal course of pregnancy, a healthy woman is recommended to attend a consultation with all tests and doctors’ opinions 7–10 days after the first visit, and then visit the doctor in the first half of pregnancy once a month, after 20 weeks of pregnancy - 2 times a month, after 32 weeks - 3–4 times a month. During pregnancy, a woman should attend a consultation approximately 14–15 times. If a woman is ill or has a pathological course of pregnancy that does not require hospitalization, the frequency of examinations is determined by the doctor on an individual basis. It is important that pregnant women carefully attend consultations during antenatal leave.
Hospitalization of pregnant women in medical hospitals. Very important in the work of a FAP midwife is the timely hospitalization of pregnant women in medical hospitals when initial signs of deviation from the normal course of pregnancy appear, as well as women with a burdened obstetric history. Pregnant women with a narrow pelvis (with an external conjugate of less than 19 cm), abnormal fetal position and breech presentation, immunological incompatibility of the blood of mother and fetus (including a history), extragenital diseases, and the appearance of bloody discharge from the genital tract are subject to prenatal hospitalization in medical hospitals. , edema, the presence of protein in the urine, increased blood pressure, excessive weight gain, when a multiple pregnancy is established, as well as other diseases and complications that threaten the health of a woman or child.
When sending a pregnant woman to an obstetric hospital, it is very important to choose the right method of transportation (medical transport, air ambulance), associated transport, and also correctly decide on the institution where this pregnant woman should be hospitalized. A correct assessment of the health status of a pregnant woman will allow you to avoid multi-stage hospitalization, and immediately assign the patient to the obstetric hospital where there are all the conditions for providing her with full medical care.
Carrying out childbirth at a medical facility. At the paramedic-midwife station, only normal (uncomplicated) births are provided. In cases where one or another complication occurs during childbirth (which cannot always be foreseen), the FAP midwife should immediately call a doctor or (if possible) take the woman in labor to a medical hospital. In this case, it is very important to resolve the issue of means of transportation. It must be remembered that women with unseparated placenta, preeclampsia and eclampsia, as well as with threatening uterine rupture cannot be transported. If a woman with an unseparated placenta needs to be transported due to certain complications of pregnancy, the FAP midwife is obliged, first of all, to manually separate the placenta and transport the woman with a contracted uterus.
If it is impossible to provide the woman with the necessary assistance to such an extent that she is in a state of transportability, a doctor should be called to her and a plan of further action should be outlined with him. When providing emergency pre-medical care to a pregnant and laboring woman, a FAP midwife has the right to perform the following obstetric operations and aids: turning the fetus on its leg when the uterine pharynx is fully open and the waters are intact or have just broken, removing the fetus by the pelvic end, manual separation of the placenta, manual examination of the uterine cavity , restoration of the integrity of the perineum (after a rupture of the perineum or perineotomy). If there is bleeding in the early postpartum period, the midwife must exclude rupture of the birth canal tissue. Complications that arise during childbirth require the midwife, in addition to urgently calling a doctor, to take clear organizational actions, on which the outcome of the birth largely depends. The midwife must be fully proficient in the primary methods of resuscitation of newborns born with asphyxia.
Maintaining documentation for the FAP. It is very important in the work of a FAP midwife to carefully maintain documentation. For each pregnant woman who applies to the FAP, an “Individual Card of a Pregnant Postpartum Woman” (f-111/u) is filled out. If obstetric complications or extragenital diseases are detected, a duplicate of this card is filled out and sent to the district obstetrician-gynecologist.
There are many options for storing individual cards. One of the most convenient options for work, which can be recommended, is as follows: a box for storing individual cards (the width and height of the box must correspond to the size of the card) is divided by transverse partitions into 33 cells. Each partition is marked with a number from 1 to 31. These numbers correspond to the dates of the month. When scheduling a pregnant woman's next appointment, the midwife places her card in a box marked with the corresponding date of the month, i.e., the day on which she needs to attend. Before starting work, the midwife takes out all the individual cards from the box corresponding to the day of the appointment and prepares them for the appointment - they will check the accuracy of the records and the availability of the latest tests. Having completed the appointment with the pregnant woman, he assigns her a day of subsequent appearance and places the card of this pregnant woman in a cell with a mark corresponding to the day of the month for which she is scheduled to appear. At the end of the appointment, it is easy to judge by the number of remaining cards about pregnant women who did not show up for the appointment on the day assigned to them. The midwife places these cards in the 32nd cell of the box marked “Patronage”. Then the midwife visits at home (patronizes) all women who do not show up for appointments. All cards of those who have given birth and are subject to dispensary observation until the end of the postpartum period are placed in the 33rd cell marked “Postpartum women”.
For each woman in labor, a “History of Childbirth” is filled out (f-099/u). All women who give birth in a FAP are registered in the birth register (f-098/u). In addition to these documents, the FAP keeps a diary-notebook for recording pregnant women (f-075/u) and a diary (f-039-1/u). When a pregnant woman (after 28 weeks of pregnancy) or a postpartum woman is sent to a medical obstetric hospital, she is given an “Exchange Card” (account no. 113). If a pregnant woman is hospitalized before 28 weeks, she is given an extract from the medical history (account no. 27). When leaving the hospital, she receives an extract from the medical history using the same form, which is given to her by the midwife of the FAP.
Organizing and conducting preventive examinations of rural women. An important section in the work of a midwife at a medical and obstetric station is the organization and conduct of preventive examinations of women. It is advisable to carry out preventive examinations of rural residents in the autumn-winter period so that before the start of spring field work complete the recovery of identified patients. All work on organizing preventive examinations is led by the district obstetrician-gynecologist and the chief midwife of the district. An inspection plan is drawn up in advance, which indicates the place where the inspection will be carried out and the calendar dates for inspections for each locality. Preventive examinations are carried out by FAP midwives who have undergone special training and instruction. To successfully conduct a preventive examination, the midwife must first make a door-to-door visit, the task of which is to explain to women the purpose of the examination, the method of conducting it, and the place of the examination.
The purpose of preventive examinations is the early detection of pre-tumor, tumor, inflammatory and so-called functional diseases of the genital organs in women and the prescription of appropriate treatment if necessary. Preventive examinations also make it possible to identify among the organized part of the female population occupational hazards that affect the genital organs, and to develop measures to eliminate them. Direct examination of women consists of two sequential procedures - examination of the external genitalia, vagina and vaginal part of the cervix (using mirrors) and two-handed examinations to determine the condition of the internal genital organs.
During preventive examinations, objective diagnostic methods are used: cytological examination of vaginal discharge, “prints” from the cervix, colposcopic examination. To carry out laboratory research, material is taken from various parts of the woman’s genitourinary system:
smears from the urethra and cervical canal for bacteriological examination of Neisser gonococci and flora. The material obtained from the urethra is applied to a glass slide in the form of a circle, and from the cervical canal - in the form of a streak in the longitudinal direction;
A smear from the posterior vaginal fornix to determine the degree of purity of the vaginal contents is taken after inserting the speculum and using a stick with cotton wool wound at the end. A smear is applied to a glass slide in the longitudinal direction in the form of a line;
A smear from the side wall of the vagina for hormonal cytodiagnosis is also taken after the insertion of speculum and using a stick with cotton wool wound around its end. The stroke is applied in the form of a stroke along the glass;
a scraping smear from the surface of the cervical erosion is obtained using a spatula and applied with a stroke across the glass slide; A scraping smear from the cervical canal is taken using a Volkmann spoon and applied to the glass in the form of a circle (or several circles).
At the slightest suspicion of the presence of a disease, which arises from a midwife performing a preventive examination, the woman should be immediately referred to a doctor. In carrying out preventive examinations, it is very important to carefully register and record all women examined, for which a list of persons subject to a targeted medical examination for identification is compiled (form No. 048/u). To register and record women who are subject to active dispensary observation, dispensary observation control cards are created for them (form No. 030/u).
Another institution providing pre-hospital obstetric and gynecological care in rural areas is the collective farm maternity hospital. The following premises must be provided in a collective farm maternity hospital: a vestibule, a reception room, a labor room (10–12 sq. m), a postpartum ward (6 sq. m for 1 mother and child bed), a kitchen, and a toilet. Each collective farm maternity hospital has from 2 to 5 beds (at the rate of 1 bed per 1000 population). The collective farm maternity hospital is located at a distance of 6–8 km from the rural medical site to which it is attached. Under good transport conditions, this distance can be increased to 10–15 km. Collective farm maternity hospitals are served by a midwife, whose responsibilities are similar to those of a midwife at a FAP. If in one village near the FAP there is a collective farm maternity hospital and due to the volume of its work there is no need for an independent staff, the service of the latter is entrusted to the midwife of the FAP.
Issues of labor protection in the work of obstetrics and gynecology services. In the work of obstetric and gynecological services in rural areas at all stages, a lot of space is occupied by the issues of labor protection of female agricultural workers. Agricultural work has its own characteristics, the main of which are seasonality, the implementation of various production operations in a short time under any weather conditions. This requires significant effort and tension from a person, which inevitably leads to violations of the work and rest regime. Female agricultural workers experience additional adverse effects from production factors such as noise, vibration, dust, contact with pesticides (pesticides) and mineral fertilizers. The main work on implementing measures aimed at protecting the labor of rural residents is carried out by hygienists. But the obstetrics and gynecology service should also take part in this work, since unfavorable production factors also have a negative impact on the specific functions of the female body.
To improve the health of women employed in agriculture, it is necessary to carry out a number of organizational measures aimed at protecting the female body from the effects of adverse factors in agricultural production. This is achieved by introducing mechanization and automation of labor-intensive processes, removing women from night work and work with pesticides, from working in highly dusty conditions, reducing vibration and sound pressure to a minimum, rational alternation of work and rest, organizing sanitary facilities, ensuring timely and rational nutrition, widespread use of dispensaries, etc. Work on labor protection of female workers Agriculture is carried out and controlled by special commissions, which include an obstetrician-gynecologist, a representative of the SES, a representative of a trade union organization, and a safety engineer. In monitoring compliance with all labor protection requirements for collective farmers, great responsibility lies with paramedical workers (the senior midwife of the district and the midwife of the FAP).
Equipping the midwife's office at the FAP. The midwife performs a significant amount of work at the paramedic-midwife station, so the midwife’s office must be equipped with scales, a gynecological chair, mirrors, sterilizers, a centimeter tape, an obstetric stethoscope, a pelvis, everything necessary for taking smears for cytological examination. To provide emergency obstetric care, the feldsher-midwife station must have a midwife bag equipped with everything necessary for delivery and treatment of the newborn.
Obstetric bag equipment. 1. Instruments, care items and dressings.
Scalpel - 1
Mouth retractor - 1
Anatomical tweezers - 1
Kocher clamps - 2
Scissors - 1
Metal spatula - 1
10 ml syringe - 1
2 ml syringe - 1
Medical needles - 6
Medical gloves - 1 pair
Urethral metal catheter - 1
Sterile catgut - 2 amp.
Obstetric stethoscope - 1
Medical thermometer - 1
Medical scarf - 1
Sterile linen (set) - 1
Towel - 2
Sterile sheets - 2
Bedding - 2
Underlay oilcloths - 2
Blankets:
children's - 1
adults - 1
Cold baby diapers - 2
Iodine sticks - 10 pcs.
Compress cotton wool - 50 g
Bandages 7 m x 5 cm - 2 pcs.
Bandages 10 m x 5 cm - 3 pcs.
Sterile bags - 4
Absorbent cotton wool - 25 g
Warm baby diapers - 2
Adhesive plaster - 1 pc.
Gray cotton wool - 50 g
Packages for processing umbilical cord residues (“umbilical bags”) - 2
Fabric centimeter - 1
Package for childbirth ("birth package") - 1
Soap - 1
Surgical gloves - 1 pair
Surgical sterile silk in ampoules No. 8 - 1 amp.
Medical gowns - 2 pcs.
Harness - 1
Tonometer - 1
Eye dropper - 1
Beaker - 1
Esmarch rubber mug - 1
Medicines.
Atropine sulfate (9.1% solution in ampoules of 1 ml) - 1 amp.
Platyphylline hydrotartrate (0.2% solution in ampoules of 1 ml) - 1
Analgin (50% solution in ampoules of 2 ml) - 2
Dibazol (1% solution in ampoules of 1 ml) - 6
Papaverine hydrochloride (2% solution in ampoules of 2 ml) - 2
Cordiamine (in ampoules of 2 ml) - 3
Caffeine sodium benzoate (10% solution in ampoules of 1 ml) - 3
Calcium gluconate (10% solution in ampoules of 10 ml) - 1
Calcium chloride (10% solution in ampoules of 10 ml) - 2
Lobeline (1% solution in ampoules of 1 ml) - 1
Glucose (40% solution in ampoules of 20 ml) - 2
Adrenaline (0.1% solution in ampoules of 1 ml) - 2
Ephedrine (5% solution in ampoules of 1 ml) - 1
Diphenhydramine (1% solution in ampoules of 1 ml) - 2
Eufillin (2.4% solution in ampoules of 10 ml) - 1
Novocaine (0.5% solution in ampoules of 5 ml) - 2
Pituitrin for injection in ampoules of 1 ml - 2
Validol 0.06 g - 10 tubes.
Nitroglycerin 0.5 mg - 1 tube
Valerian tincture 30 ml - 1 fl.
Alcohol iodine solution (5%) - 1
Hydrogen peroxide (3% solution, 50 ml) - 1
Ammonia solution (10% 40 ml) - 1
Ethyl alcohol 95% - 25 ml
Boiled water - 30 ml
Isotonic sodium chloride solution for injection (0.9% solution per 20 ml)
Benzylpenicillin sodium salt 1,000,000 units - 2 fl.
Pregnancy prevention, anti-abortion propaganda. Midwives in rural areas are faced with the task of instilling in women a negative attitude towards abortion as an operation that can cause trauma to the woman, often leading to gynecological and other diseases. In addition, for older women with Rh-negative blood and signs of infantilism, it is necessary to especially persistently explain the importance of maintaining the first pregnancy. FAP midwives independently conduct anti-abortion propaganda in the territory of the service area, receiving appropriate organizational and methodological instructions from obstetrician-gynecologists of central district and district hospitals.
Of great importance in promoting the prevention of abortion is the issue of modern means of contraception, the features of their action, and their effective use. It is necessary to explain which means are the most effective and harmless, and to warn against the use of harmful and ineffective means and methods. When conducting interviews, the FAP midwife must identify the following groups of women: those wishing to terminate the pregnancy; who came to the consultation after an abortion; postpartum women after discharge from the obstetric hospital; those who applied for a preventive examination; getting married.
Particular attention is paid to the use of oral contraceptives, since, provided they are taken correctly, they are among the most effective. Hormonal contraceptives are synthetic analogues of the female sex hormones estrogen and progesterone and their derivatives. When they are introduced, a state of pregnancy is created in a woman’s body, the so-called “pseudo-pregnancy”, which ensures sterility. The main mechanism for ensuring sterility with the help of oral contraceptives is to suppress ovulation, that is, the maturation and release of a mature egg from the ovary.
Advantages of using oral medications. The midwife should explain to women the positive aspects of taking hormonal contraceptives:
softening premenstrual tension;
beneficial effect on women with irregular menstrual cycles, which become more regular and menstrual bleeding often decreases; there is evidence of improvement in the condition of women suffering from iron deficiency anemia;
reducing the risk of pelvic inflammation among women using oral contraceptives;
improvement of the condition in diseases of the sebaceous glands - pimples and blackheads disappear;
relief of pain in the middle of the cycle;
providing a protective effect against rheumatoid arthritis;
there may be a decrease or increase in libido;
protective effect against the development of benign breast tumors.
However, when taking oral contraceptives, undesirable effects occur in the form of breast tenderness, weight gain of no more than 2 kg, headaches (migraines), vaginal discharge, menstrual irregularities, and sometimes spontaneous bleeding or intermenstrual uterine bleeding is observed. Contraindications to taking hormonal contraceptives are: breast cancer; all types of genital cancer; liver dysfunction; recent liver disease or jaundice; deep vein thrombosis; pulmonary embolism; cerebral vascular injury; rheumatic heart disease; phlebeurysm; cardiovascular diseases, including hypertension and diabetes with complications (in history or in the form of clinical manifestations); undiagnosed abnormal uterine bleeding; congenital hyperlipidemia. As contraindications, it is necessary to take into account age over 40 years; smoking and age over 35 years; history of acute preeclampsia during pregnancy; in nulliparous women - rare, irregular menstruation, amenorrhea, later menarche; lactation lasting less than 6 months; planned surgery; bouts of depression. The following diseases also need to be taken into account: mild hypertension (diastolic pressure above 90, but below 105 mm Hg); chronic kidney disease not accompanied by hypertension; epilepsy; migraine; diabetes mellitus without vascular complications; gallbladder diseases.
Intrauterine method of contraception. Another effective method of preventing pregnancy is intrauterine contraception, which is based on the introduction of an intrauterine device into the uterine cavity that prevents pregnancy. There are the following types of IUDs: non-medicated (Lippes loop, Margulis spiral, double helix); medicinal (basic) - copper-containing (TCi 200, etc.) and hormone-releasing agents. The mechanism of the contraceptive action of the IUD is to disrupt the implantation of the fertilized egg, accelerate the migration of the latter, as a result of which it prematurely ends up in the uterine cavity when the endometrium is not yet prepared for implantation; the effect of medicated IUDs on the endometrium. In this case, a process like chronic endometritis occurs in the endometrium with symptoms of local endometrial atrophy, swelling, increased vascularization and, possibly, disturbances in hormonal secretion.
Before inserting the IUD, the midwife should collect instruments and devices; brief women and provide them with the necessary information; collect anamnestic data by filling out questionnaire; reassure the woman, and also make sure that she is fully aware of the meaning of the IUD, including the advantages and disadvantages of the method, understands the procedure for inserting the IUD and the need for clinical monitoring while wearing the IUD. After insertion of the IUD, the woman must be examined for the first time after 1 month, then after 3 months. In the future, the woman should attend consultations at intervals of 6 months, appearing for examination in the period between menstruation.
List of instruments, devices and sterilization products:
Navy;
conductor (without IUD);
gloves;
Cusco mirror;
lift;
bullet forceps;
uterine probe;
scissors;
bullet irons;
metal trays;
weak aqueous solution of iodine (for sterilization);
tampons for the vulva;
a light source commonly used in consultation.
Instruments must be sterile and ready before insertion of the IUD. Sterilization of instruments is carried out in a dry-heat oven or by boiling at general rules according to instructions. Sterilization of IUDs is carried out by washing them in soapy water and then placing them in a 2% chloramine solution for 3 days (with a daily change of solution). Before use, the IUD is placed in 96% ethyl alcohol for 2 hours. Leaving the IUD in alcohol for long term promotes compaction, which can cause their fragility.
Before intrauterine contraception, women undergo a bacterioscopic examination of smears from the cervical canal, vagina and urethra for flora and degree of purity, a clinical blood test, and, if indicated, a urine test. The IUD is inserted only if the hemogram is normal, I–II - the degree of purity of the vaginal contents. The IUD is inserted on the 5th–7th day of the menstrual cycle, immediately after an uncomplicated abortion or 4–6 months after an uncomplicated birth. Sometimes it is permissible to insert an IUD on the 5th–6th day after an uncomplicated birth, provided that the postpartum period is normal. The introduction of an IUD to women who have been treated for inflammatory diseases of the uterus and appendages is possible only after 6–10 months, in the absence of exacerbation of the process.
Contraindications for IUD insertion:
Acute, subacute and chronic inflammatory diseases of the female genital organs with frequent exacerbations, including inflammatory diseases of the cervix.
Presence of pregnancy or at least suspicion of it.
Infectious and septic diseases and fever of any etiology.
Isthmic-cervical insufficiency.
History of septic (or infected) miscarriage within 3 months before the proposed IUD insertion.
Postpartum pelvic infection within 3 months before the intended insertion of the IUD.
Benign tumors and neoplasms of the female genital organs.
Polyposis of the cervical canal, leukoplakia, cervical erosion.
Polyposis, endometrial hyperplasia.
Tuberculosis of the genitals.
Menstrual irregularities (menorrhagia, metrorrhagia).
Anemia.
Disorders of the blood coagulation system (diathesis, thrombocytopathy, etc.).
Congenital or acquired anomalies of the uterus (fibromatous submucous nodes), incompatible with the design or shape of the IUD, the size of the uterine cavity not corresponding to the size and shape of the IUD.
Stenosis or obstruction of the cervical canal (danger of perforation).
Dysmenorrhea or menorrhagia with disability (history) - for hormonal IUDs.
Repeated expulsions of IUDs (especially large ones).
Allergy to substances released by the IUD (copper, antifibrinolytic substances, hormones).
No history of childbirth.
Observations on women using IUDs. Immediately after insertion of the IUD, dizziness, weakness, nausea, and pain in the lower abdomen may occur. In such cases, it is advisable to rest, administer painkillers, antispasmodics, and inhale ammonia vapors. After insertion of the IUD, minor bleeding may appear for 3–5 days or nagging pain in the lower abdomen that does not require specific therapy. Sexual abstinence is required for the first 7–10 days after insertion of the IUD.
The maximum period of stay of the IUD in the uterine cavity should not exceed 4 years, since with prolonged use the properties of the material from which the IUD is made changes; its contraceptive ability decreases. Indications for removal of the IUD: prolonged pain, bleeding such as menopause or metrorrhagia, exacerbation of the inflammatory process in the genitals, partial expulsion of the IUD, a woman’s desire to become pregnant, expiration of the IUD use period. The positive aspects of IUDs are their high efficiency, duration of use, the possibility of removal at any time, the permissibility of use during breastfeeding, and the absence of unwanted sensations during sexual intercourse.
Clinical examination of the rural population and preventive examinations. The most important section of the work of FAP medical workers is preventive medical examinations of the population, which are carried out in order to identify diseases in the initial stages and carry out the necessary therapeutic and health measures. Preventive medical examinations of the population are the initial stage of the dispensary observation system. The objectives of medical examinations are: active identification of persons with general and occupational diseases in their early stages; dynamic monitoring of the health status of persons exposed to adverse factors; identification of diseases that occur unfavorably under the influence of certain factors, as well as pathologies that may contribute to the development of an occupational disease; determination of deviations in indicators characterizing physical development and ability to work; development of recommendations aimed at improving working conditions, eliminating or significantly reducing unfavorable production factors; carrying out individual treatment and preventive measures based on the results of a medical examination in order to restore impaired body functions and the ability to work of the sick.
According to the classification of G.A. Novogorodtsev and co-authors, all medical examinations are divided into preliminary, periodic and targeted. Children are subject to preliminary medical examinations when they are admitted to a nursery, kindergarten, or school; pupils or students upon admission to technical schools and universities; teenagers getting a job, as well as all persons entering work in certain sectors of industry, agriculture, construction, transport, public catering, etc. Periodic medical examinations are carried out for the above groups of persons throughout the entire labor activity for dynamic monitoring of their health, maintaining their ability to work and ensuring creative longevity.
Targeted medical examinations provide for the identification of diseases that are the most common and pose a danger to ability to work and life: tuberculosis, cancer, cardiovascular diseases. In carrying out mass medical examinations, two stages are conventionally distinguished: preparatory and actual working. During the preparatory period, the contingent of persons subject to preventive examinations, the timing and place of examinations are determined, teams of doctors and paramedical workers are created and instructional and methodological meetings and seminars are held with them.
The contingents of workers and employees subject to preliminary and periodic inspections indicating occupational hazards are established by the SES, and it is in writing according to approved form requests lists of these persons from the heads of rural settlements and enterprises. The lists are compiled in 3 copies (for the chief physician of the Central District Hospital, SES and the head of the agricultural enterprise); The head of the personnel department, with the participation of an occupational health and safety engineer, endorses the documents, signs them with the head of the agricultural enterprise, and they are certified with a seal. The SES develops a schedule for carrying out preventive examinations, indicating the composition of the medical team and the scope of laboratory examinations. The inspection schedule must be coordinated and approved with the leadership of rural settlements and agricultural enterprises and brought to each medical institution.
The second, or actual working, period consists of the direct organization and conduct of medical examinations, and, as a rule, it begins in December in order to complete all health-improving activities by the start of mass field work. The Central District Hospital issues an order indicating the specific tasks facing the team of doctors, and a senior doctor (usually a therapist) is appointed. Preventive examinations can be carried out at the central district hospital, local hospital, or outpatient clinic. Teams of doctors can directly travel to populated areas, located at the first aid station, in premises specially adapted for examinations. The order, timing and those responsible for attending the inspection are determined by order of the head of the rural locality.
When doctors visit sites, paramedics and midwives prepare premises, appropriate equipment, instruments, clarify lists of persons to be examined, which helps doctors reduce the loss of working time and study in more detail the working conditions of specific professional groups. To attract the population to participate in inspections, radio broadcasts, publications in local newspapers, lectures, conversations, as well as individual invitations to apartments by sanitary activists and paramedics can be organized according to a set schedule. Responsibility for attendance at inspections of workers rests with the heads of agricultural enterprises and trade union organizations. At the end of the preventive inspections, a final report is drawn up for each enterprise.
Clinical examination. One of the most important types of preventive work of a paramedic is medical examination of the population. Medical examination of the population includes:
annual examinations of the population by doctors with the participation of paramedical workers and carrying out the necessary laboratory diagnostic and functional studies;
additional examination of those in need using modern diagnostic methods;
carrying out the necessary medical and recreational activities;
dispensary observation of patients and persons with risk factors. The objectives of the medical examination are:
determination and assessment of the health status of each person;
ensuring an increase in the level and quality of annual examinations and clinical supervision with the required volume of research;
expanding the participation of various specialists and nursing staff in medical examinations with the leading role of the local (shop) doctor;
improving technical support for annual examinations and dynamic monitoring of public health using automated systems;
ensuring the necessary statistical recording and reporting, transfer of information about the examinations and health-improving activities carried out for each person at the place of his observation.
The annual medical examination of the entire population is envisaged in 2 stages. During the period of preparation for the introduction of annual medical examination, the entire population living in the service area of the FAP is personally taken into account in accordance with the “Instructions on the procedure for recording the annual medical examination of the entire population.” In rural areas, police lists of residents are compiled by paramedics of the FAP during door-to-door visits, they are clarified in village and township administrations and transferred to the local hospital (outpatient clinic). For personal registration of each resident, nursing staff fill out the “Medical Medical Examination Card” and number it in accordance with the number medical card outpatient (form No. 025/у). After clarifying the composition of the population, all “Medical Medical Examination Cards” are transferred to the card index.
After conducting a personal census of the entire population, the following groups are distinguished:
newborns;
children 1 and 2 years of age;
preschool children in organized groups;
schoolchildren under 15 years of age;
teenagers (schoolchildren, students of vocational schools and secondary special educational institutions, working teenagers aged 15–17 years);
disabled people and participants of the Great Patriotic War, participants in the war in Afghanistan, liquidators of the consequences of the accident Chernobyl nuclear power plant;
pregnant women; workers in industry, construction, transport, communications;
workers of communal, medical and preventive, children's and other enterprises, organizations and institutions;
machine operators, livestock breeders, field farmers, greenhouse workers and other agricultural workers;
students of higher educational institutions and students of secondary specialized educational institutions;
personal pensioners receiving medical care in a given healthcare institution;
persons under medical supervision;
other population groups not included in the above list.
Scope of research at the first stage of medical examination. In rural areas (except for regional centers and assigned areas), the following scope of examinations is recommended at the first stage of medical examination.
Children's population: Annual examinations by a pediatrician (in the absence of a pediatrician - a therapist), a dentist (dentist). A pediatrician must examine children of the 1st and 2nd year of life, and before entering school - a pediatrician, neurologist and surgeon.
Nursing staff conducts: anthropometric measurements; determination of visual acuity; determination of hearing acuity; preliminary assessment of physical and neuropsychic development; tuberculin tests.
The following laboratory, diagnostic and instrumental studies: blood test (ESR, hemoglobin, leukocytes, erythrocytes); general urine analysis; stool analysis for worm eggs; blood pressure measurement from 7 years; fluorography of the chest organs from 13 years of age.
Adult population: Annual examinations by a therapist, dentist, obstetrician-gynecologist (in his absence, a midwife), and other specialists - as indicated.
Nursing staff, including FAPs, collect anamnestic data using a specially designed questionnaire; anthropometric measurement; blood pressure measurement; gynecological examination of women with taking smears (for cytological examination); determination of visual acuity; tonometry (persons over 40 years old); determination of hearing acuity, tuberculin tests (adolescents 15–17 years old).
Laboratory, diagnostic and instrumental studies: blood test (ESR, hemoglobin); urine test for sugar, urine test for protein (express method); ECG (after 40 years); fluorography (x-ray) annually; smear cytology from 18 years of age in women; mammography (fluoromammography) once every 2 years in women over 35 years of age.
The scope of research carried out during the annual medical examination of agricultural workers in the main professions includes the following groups:
machine operators;
repair shop workers (mechanics, turners, electric welders, battery workers, blacksmiths);
livestock breeders (milkmaids, cattlemen, pig farmers, calf farmers);
poultry farmers (poultry workers, operators, egg sorters, slaughterhouse workers, etc.);
plant protection agronomists, pesticide storekeepers, greenhouse workers, plant protection workers;
greenhouse workers (greenhouses, agronomists).
For each profession, the order provides for the identification of an etiological factor, examination by specialists (mandatory, according to indications) and laboratory tests, mandatory and according to indications.
Stages of dispensary work. In dispensary work, it is necessary to stage dispensary observation, and there are 3 stages: planning work in connection with annual examinations of the organized and unorganized population (stage I); identification of populations subject to dispensary observation (stage II); carrying out active dynamic observation, treatment and rehabilitation measures ( Stage III). The scope of medical examinations and diagnostic studies during pregnancy and the postpartum period includes the following nosological forms: physiological pregnancy in a healthy woman, as well as a normal postpartum period. The frequency of observation by an obstetrician-gynecologist, examinations by doctors of other specialties, the name and frequency of laboratory and other diagnostic tests, basic treatment and health measures, and hospitalization were established.
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General provisions
In 2008 in rural health care 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 certain species 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.
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 - healthcare institutions rural settlement, which are part of a complex therapeutic area. At this stage, rural residents receive pre-medical, as well as basic types of medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).
The first medical institution that a rural resident, as a rule, turns to is a paramedic and obstetric station (FAP). It functions as a structural unit of a local or central district hospital. It is advisable to organize FAPs in settlements with a population of 700 or more, with a distance to the nearest medical facility of more than 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.
The 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;
. provision of pre-medical medical care to the population;
. participation in ongoing sanitary supervision of children's preschool and school educational institutions, communal, food, industrial and other facilities, water supply and cleaning of populated areas;
. conducting door-to-door surveys according to epidemiological indications in order to identify infectious patients, persons in contact with them and persons suspected of infectious diseases;
. improving the sanitary and hygienic culture of the population.
Thus, the FAP is a healthcare institution with a more preventive focus. It may be entrusted with the functions of a pharmacy selling ready-made dosage forms and other pharmaceutical products to the public.
The work of the FAP is directly headed by the head. In addition to him, the FAP also employs a midwife and a visiting nurse.
Despite the important role of FAPs, the leading medical institution at the first stage of providing medical care to village residents is the local hospital, which may include a hospital and an outpatient clinic. The types and volume of medical care in a local hospital, its capacity, equipment, and staffing largely depend on the profile and capacity of other medical institutions that are part of the healthcare system of a municipal district (rural settlement). The main task of a local hospital is to provide primary health care to the population.
Outpatient care to the population is the most important section of the work of a local hospital. It can be an outpatient clinic, either part of the hospital structure or independent. The main task of the outpatient clinic is to carry out preventive measures to prevent and reduce morbidity, disability, mortality among the population, early detection of diseases, and medical examination of patients.
Doctors at the outpatient clinic see adults and children, make house calls and provide emergency care. Paramedics can also take part in the reception of patients, but medical care in an outpatient clinic should primarily be provided by doctors. In the local hospital, an examination of temporary disability is carried out and, if necessary, patients are sent to medical examination.
In order to bring specialized medical care closer to village residents, doctors from the central district hospital go to the outpatient clinic according to a certain schedule to receive patients and select them, if necessary, for hospitalization in specialized institutions. IN Lately In many regions of the Russian Federation, there is a process of reorganization of local hospitals and outpatient clinics into centers of general medical (family) practice.
O.P. Shchepin, V.A. Medic
Medicinal health centers are organized in enterprises with 1,000 or more workers, paramedics - up to 1,000 people.
Medical units are created at large enterprises with a number of employees of 4,000 or more, and at enterprises of the chemical, coal, oil refining and mining industries - 2,000 or more.
A special role in the system of medical care for the working population in the Russian Federation belongs to health centers at industrial enterprises.
Medical care for workers is carried out according to the shop principle, which consists of assigning one shop therapist position per 1500-2000 workers.
Health centers are assigned the following main tasks:
· provision of medical care for diseases and conditions both posing a direct threat to the employee’s life and in the absence of such;
· organization of medical evacuation;
· monitoring the health status and working conditions, including express diagnostics of the health of enterprise employees when going to work, during work and after its completion;
· participation in preliminary and periodic medical examinations of employees; carrying out measures to prevent occupational, infectious and non-infectious diseases and injuries;
· direct participation in the organization of first aid and evacuation in the event of various emergencies and liquidation of medical consequences of emergency situations at the enterprise.
Preventive work plays a major role in the activities of shop therapists. It can only be effective if the features are properly studied of this production and working conditions of workers, as well as knowledge of specific occupational pathologies. Based on the study of technological and sanitary-hygienic features of production, medical doctors develop appropriate measures to reduce morbidity and occupational injuries.
In the Russian Federation, slightly less than 30% of the country's population lives in rural areas.
Medical care for the rural population is based on the basic principles of healthcare organization. However, the factors that determine the differences between city and village affect the organizational forms and methods of work of rural medical institutions: the nature of the settlement of residents, service radius, seasonality of work, exposure to weather conditions during field work, specific conditions of the labor process, unsettled economic activities and household conditions, regional-national characteristics and customs, educational and cultural level, etc.
The main features of the organization of medical care for the rural population of Russia were and are currently:
Phased;
Availability of special treatment and preventive institutions in the structure of rural healthcare;
Special organizational forms and methods of work of medical personnel and health care facilities in general.
Conventionally, there are 3 stages of providing medical care to rural residents. The main organizational forms of medical care are inpatient and traveling.
The first stage is a rural medical area, covering an area with a radius of 5-10-15 km (in different regions of Russia) and including the following health care facilities: a rural district hospital, a medical outpatient clinic, paramedic and paramedic-obstetric medical posts, health centers, and nurseries at industrial and agricultural enterprises -gardens, etc. At this stage, rural residents receive qualified medical care (therapeutic, surgical, obstetric and gynecological, dental, and in some cases pediatric). These conditions are most consistent with compliance with the principles of general medical practice and family medical and social services.
FAP is organized in settlements with a population of 700 or more, with a distance to the nearest medical facility of at least 5 km, and at a distance of more than 7 km from the nearest medical facility, a FAP can be organized in settlements with a population of 300-500 people.
The main tasks of the FAP are: providing first-aid care and carrying out sanitary, health-improving and anti-epidemic measures aimed at preventing diseases, reducing morbidity and injuries, and improving the sanitary and hygienic culture of the population. The FAP paramedic provides first aid for acute diseases and injuries, carries out vaccination work, physiotherapeutic measures, and fully carries out the doctor’s prescription, organizes patronage for children and pregnant women, and, under the guidance of a doctor, carries out preventive, anti-epidemic and sanitary-hygienic measures.
The next second stage in providing medical care to the rural population is the regional link, headed by the central district hospital (CRH); CRHs are available in all district administrative territories. In each regional center there is a center for state sanitary and epidemiological surveillance (SSES). In the structure of district health care, these may be interdistrict specialized centers, numbered hospitals, dispensaries, health centers, health centers, district and city hospitals, etc.
The third stage (level) of medical care for the rural population is regional health care institutions located in the regional center (regional hospital with a consultative clinic, dispensaries, dental clinic, regional center of state sanitary and epidemiological surveillance, etc.). At this stage, highly qualified medical care is provided in almost all specialties.
Features of providing primary health care to women.
Order No. 50 (most likely!) whoever comes across it, write to Olya, the material will be dropped during the exam
Organization of primary health care on the principle of general practice (family medicine).
Family medicine is the observation and treatment of a patient throughout his life.
The main advantages of the family medicine system:
A holistic approach to the health of observed families;
Availability and convenience of treatment;
Possibility of early diagnosis of severe and life-threatening diseases;
Visiting the patient at home;
Carrying out prevention;
Providing psychological assistance to the patient and his family.
Family medicine is the most effective medical consultation, since the doctor
Observes the patient and his environment for a long time;
Treats the patient individually in a comfortable and familiar environment (at home or in his office);
Knows the patient’s entire family and easily establishes relationships;
If necessary, assigns the patient to a specialist.
The general practitioner is the first to see the patient, assess his condition, and make a preliminary diagnosis. This specialty - general practitioner - combines biological, clinical disciplines and psychology, which makes it possible to provide continuous and comprehensive care to the person and his family.
A general practitioner treats people of all ages; he is not limited to the narrow boundaries of one discipline, thereby providing a comprehensive and individual approach to the patient. You can contact your family doctor with questions not only of a medical nature.
The basis of the general practitioner's department's activities is working with families. The main goals of a family nurse’s work are to maintain health and prevent diseases in their patients. The family nurse must take into account factors that negatively affect the health of the wards: smoking, alcohol abuse, drug addiction, as well as occupational hazards. A family nurse must be competent in matters of the humanities - be a good teacher and psychologist. Carry out manipulations (massage, physiotherapy, etc.).
Organization of medical care for urban and
rural population
1. Principles of organizing medical care to the population in the Russian Federation
2. The advantage of providing medical care to workers
3. Dispensary method
4. The principle of specialization of medical care
5. Organization of medical and preventive care for the rural population
Introduction
The organization of medical and preventive care for the population is provided both in the city and in the countryside. The organization of treatment and preventive care for the urban population consists of 3 stages:
1. Primary health care (PHC) is provided by outpatient clinics, hospitals, emergency medical services, paramedic and obstetric centers, and health centers.
2. Inpatient medical care is provided in a hospital setting.
3. rehabilitation treatment - in hospitals and outpatient clinics.
Primary health care is the basic, accessible and free type of medical care for every citizen, which includes: treatment of the most common diseases, as well as injuries, poisoning and other emergency conditions; medical prevention of major diseases; sanitary and hygienic education; carrying out other activities related to the provision of health care to citizens at their place of residence.
The provision of medical and preventive care is built in accordance with certain principles:
1) accessibility and free guaranteed volume of free medical care in accordance with the state guarantee program. The program defines the types, volumes, procedures and conditions for providing free medical care to the population. The government guarantee program is reviewed annually;
2) the inseparability of treatment and prevention;
3) continuity of health care institutions;
4) advantage in providing MT to working people;
5) locality;
6) dispensary method.
1. Principles of organizing medical care to the population in the Russian Federation
To organize high-quality medical care, continuity is carried out between the ambulance, clinic, and hospital. Continuity is achieved through the exchange of information between doctors of medical institutions, holding joint clinical conferences, consultations - this makes it possible to improve the qualifications of medical personnel and reduce duplication of patient treatment.
1) an agreement between the clinic and the hospital for hospitalization of the patient;
2) the discharge summary is transferred to the clinic;
3) organization of rehabilitation treatment departments (aftercare) in clinics
4) doctors of the clinic must alternately work in the hospital.
2. The benefits of providing medical care to workers
Medical support for workers is provided in specialized institutions - medical units (MSU), medical or paramedic health centers. Medical units can be of an open type - they serve working enterprises, their relatives and the population of the adjacent territory. Currently, these are all medical units, as well as closed ones (only employees of this enterprise). Medical and paramedical health centers operate according to the company’s work schedule. Paramedic health centers can be mobile.
The work of the shop service is assessed, first of all, using Form No. 16 - based on the results of an analysis of morbidity with temporary disability. An important section is the work of a shop doctor with people who are often ill for a long time (for 1 disease there are 4 cases and 40 days of temporary disability per year). The shop doctor compiles lists of people who are often sick for a long time. Treatment is carried out in consultation with specialists. The enterprises have health resorts. Medical and sanitary units can function in the form of:
1. APU
2. United Hospital.
Medical care for workers is also provided by a general network of medical and preventive institutions, primarily in cases where enterprises do not have a medical and sanitary unit and the number of employees is below the established standards. (The vitamin plant is attached to the 5th clinic. The cable plant is attached to the 1st clinic). The reception desk has a separate window for serving employees.
The local principle is the assignment of a certain contingent of the population to a local doctor.
3. Dispensary method
Clinical examination - active monitoring of the health status of certain groups of the population (healthy and sick), registering these population groups for the purpose of early detection of diseases, dynamic observation and comprehensive treatment of sick people, carrying out measures to improve their working and living conditions, preventing the development and spread of diseases , restoration of working capacity and extension of the period of active life 3.
The organizational process of medical examination includes the following stages:
1. selection of contingents through active identification and registration.
2. carrying out a set of therapeutic and social-preventive measures, i.e. carrying out the clinical examination itself, assessing the results of the effectiveness of the clinical examination.
Identification of persons subject to medical examination is carried out, as a rule, when patients are seen by a doctor in a clinic or at home and as a result of various preventive examinations, where the earliest stages of diseases are identified. medical dispensary treatment
Dynamic observation of group I (healthy) is carried out through annual preventive medical examinations. For this group of dispensary observation, a general plan of medical, health-improving, preventive and social measures is drawn up, which includes measures to improve working and living conditions, sanitary and hygienic education and promotion of a healthy lifestyle.
Dynamic observation of group II is aimed at eliminating or reducing the influence of risk factors, increasing the resistance and compensatory capabilities of the body.
Currently, the method is used in working with a certain population:
1. - children under 18 years of age;
2. - pregnant women;
3. - pupils and full-time students;
4. - disabled people of War;
5. - athletes;
6. - individual population groups in accordance with the basic SGBP;
7. - patients subject to dispensary observation.
The clinic allocates dispensary days to work with dispensary patients. Clinical examination is carried out in 2 stages.
Stage 1 indicators:
1. Complete coverage of medical examinations;
2. Contingent subject to mandatory medical examination. Approximately 80% of the population is covered by dispensary observation. In addition, additional medical examination is carried out as part of National project"Health". Based on the results of the medical examination, the local therapist or GP distributes the citizens who have undergone medical examination into 5 groups of health status:
I - “practically healthy”,
II - "with high risk development of diseases requiring preventive measures",
III - “those in need of further examination and treatment on an outpatient basis”,
IV - “those in need of further examination and treatment in a hospital setting”,
V - “those in need of high-tech types of medical care.”
Citizens classified:
to group I - they do not need dispensary observation, they are given a preventive conversation on a healthy lifestyle;
for group II - a program of preventive measures carried out in this APU is drawn up;
to group III - additional examinations are prescribed and, if necessary, treatment on an outpatient basis;
to group IV - additional examinations are prescribed and, if necessary, treatment in a hospital setting;
to group V - are sent to the Commission of the healthcare management body of the constituent entity of the Russian Federation for the selection of those in need of high-tech medical care.
The medical examination standard includes examination by the following specialists:
1. fluorography, mammography (for the female population over 40 years of age) or ultrasound examination of the breast, ECG (electrocardiogram), UAM (general urinalysis), CBC (complete blood count), total cholesterol and lipid profile, sugar, tumor markers ( 40 years and older)
2. examinations by specialists: local or general practitioner, obstetrician-gynecologist (for the female population), urologist (for the male population), neurologist, surgeon, ophthalmologist, endocrinologist.
Quality of additional medical examination: absence of newly diagnosed diseases in late stages, including cancer, tuberculosis, severe forms of diabetes mellitus, stroke, heart attack, and other diseases leading to long-term and permanent disability (three months after completion of medical examination)4 .
4. The principle of specialization of medical care
For separate category patients are provided with specialized medical care provided by:
Specialized emergency medical team,
Subspecialists of outpatient clinics,
In departments of multidisciplinary hospitals.
In dispensaries.
Dispensaries - these are specialized treatment and preventive institutions for the active identification of patients, treatment, rehabilitation and prevention. All dispensaries are of republican significance and are financed from the budget of the Republic of Belarus
Types: cardiology, physical therapy, skin and venereal diseases, etc. Dispensaries include a clinic and a hospital. An important section of the work is advisory assistance to the general network of treatment and preventive institutions.
The quality of medical care in specialized hospitals is higher than in a general hospital. For example, a cardiac dispensary is a cardiology department of a hospital or a therapeutic department. However, this is an expensive type of medical care.
5. Organization of medical and preventive care for the rural population
Built on the same organizational principles, as for the urban population. The main ones are the district and dispensary. Differences in the organization of medical care are determined by a number of factors: low population density of rural residents; remoteness of the place of residence from regional centers; poor provision of communication means; specific working and living conditions - seasonal nature of agricultural work 5. Contact with animals, chemical fertilizers, etc.
Features of medical care:
1. up to 40% of the volume of medical care is provided by paramedics - (paramedic and midwifery stations);
2. large service radius;
3. lower provision of material, technical and human resources (therapeutic and diagnostic equipment, doctors, beds);
4. preferential medical care for persons engaged in agricultural work.
The first stage of providing medical care to the rural population is a rural medical station (RMU). Qualified pre-medical and medical care is provided. The radius of the site is 5-7 (up to 20) km. The rural medical district includes: a rural district hospital (RPH), a rural medical outpatient clinic (MVA), a FAP (medical and obstetric station), nurseries, paramedical health centers at enterprises, and dispensaries.
Medical care is provided in 6 - 8 specialties: therapy, pediatrics, dentistry, surgery, obstetrics and gynecology. A rural medical site located in the area of the central district hospital is considered assigned and its population turns directly to it. In a complex therapeutic area there are 2000 or more adults and children.
Stage II - qualified specialized medical care in regional medical institutions, as part of the central district hospital, central district pharmacy, district hospitals, inter-district dispensaries (for 10-20 specialties).
Stage III - highly qualified, highly specialized assistance in almost all specialties is provided in republican institutions, dental clinics, advisory clinics, centers, including AIDS, medical prevention centers, etc.
Stage I of providing medical care to the rural population - rural district hospital (RPH). In the Republic of Belarus (2006) - 53. Four categories depending on the total number of beds, from 25 to 100 beds. Day hospitals can be deployed in the SUB. The SUB provides outpatient and inpatient medical care: therapeutic, dental, infectious diseases, assistance during childbirth in urgent cases, emergency surgical and traumatological care, and assistance to children.
The main functions of a rural district hospital: provision of qualified medical care; prevention of morbidity and injury; organizational and methodological management and control over the activities of feldsher-midwife stations and other institutions of the 1st stage, planned visits of doctors to subordinate institutions of the 1st stage.
1. bringing medical care closer to agricultural workers during the period of mass field work.
2. current sanitary supervision of institutions and facilities, water supply, and cleaning of populated areas.
The following features are identified in the organization of outpatient and inpatient care in the SUB:
1. there is no clear time limit for outpatient appointments;
2. visiting hours for patients should be scheduled at a time more convenient for the population, taking into account the seasonality of agricultural work;
3. the possibility of receiving patients by a paramedic in the absence of a doctor;
4. house calls are served by a doctor only in the village where the SMS is located; house calls in other settlements of the rural medical district are served by a paramedic;
5. duty in a hospital with the right to stay at home and mandatory information to staff about their location in case of need for emergency care;
6. Allocating one preventive day a week from the doctor to visit the site.
When visiting the FAP, the local doctor provides methodological assistance in the work of the FAP and must carry out the following basic activities on site:
a. check the accuracy and reliability of records on the admission of patients, on vaccinations, dispensary observation of pregnant women, children and seriously ill patients;
b. advise patients who apply to the FAP independently or invited by a doctor and paramedic;
c. visit and consult at home pregnant women, children under 2 years of age, and seriously ill patients;
The rural medical outpatient clinic (RVA) provides outpatient care. The functions are the same as for a rural district hospital, but there is no 24-hour hospital
According to the standards, a paramedic-midwife station is organized with a population of 700 or more at a distance to the nearest medical institution from 2 to 4 km, with a population of 300-700 - 4-6 km, less than 300 people over 6 km.
A paramedic can work at a paramedic-midwife station; paramedic and midwife; paramedic, midwife and visiting nurse. Submits to general issues administration of a rural settlement, and for special cases - the chief physician of the local hospital.
Functions of the paramedic-midwife station:
1. provision of pre-hospital medical care,
2. fulfilling doctor’s orders,
3. patronage of children and pregnant women, monitoring the health of the disabled and agricultural specialists,
4. carrying out preventive, anti-epidemic, sanitary and hygienic measures, immunization, under the guidance of a doctor,
5. medical examination of healthy and sick people,
6. sanitary and hygienic training and education of the population,
7. implementation medicines through pharmacies of category 2,
8. accounting and reporting, analysis of indicators. Monthly - reports to the organizational and methodological office of the central district hospital,
9. participation in the examination of disability with the permission of the chief physician of the district.
Stage II of providing medical care to the rural population - central district hospital (CRH). The capacity is divided into 6 categories from 100 to 400 beds. Structure of the central district hospital:
1. hospital with departments for main specialties (therapeutic, surgical, pediatric, obstetric, gynecological, infectious diseases),
2. clinic,
3. department of emergency and emergency medical care,
4. pathological department,
5. organizational and methodological office and auxiliary units.
The chief physician of the Central District Hospital (chief physician of the district) reports: on general issues - to the administration of the municipal district, on special issues - to the Ministry of Health of the Republic of Belarus. In his work he relies on his deputies:
1. for medical services to the population of the Ministry of Education and Science - head of the organizational and methodological office;
2. on childhood and obstetrics (with a population over 70,000);
3. medical department (responsible for the work of the hospital);
4. at the clinic (head of the clinic);
5. for clinical expert work (CER) - for the examination of temporary disability,
6. on the administrative and economic part (AHCh), etc.
For operational management, a medical council functions in the central district hospital. It consists of deputy chief physicians, the chief sanitary doctor of the district, the head of the clinic, the district pharmacy, the chairman of the district committee of trade unions, medical workers, the Red Cross Society, and the chief specialists of district 6.
Organizational and methodological management of the district's healthcare is provided by: district freelance specialists of the district and the organizational and methodological office of the Central District Hospital (OMK); senior paramedic and midwife of the district; district medical statistician
Functions of the organizational and methodological office:
1. Development of measures to improve the quality of medical care to the population of the region. Field work. Various types of mobile care - mobile medical teams, mobile outpatient clinics, dental offices, denture laboratories.
2. Methodological management of treatment and preventive institutions in the region;
3. Analysis of performance indicators, compilation annual reports;
4. Advanced training of medical workers.
Stage III of providing medical care to the rural population - republican medical institutions. Center for organizational and methodological management of medical institutions of the republic, a base for specialization and advanced training of doctors.
By capacity, republican clinical hospitals are divided into 5 categories. Priority direction in the development of rural health care is the strengthening and improvement of outpatient care, maternal and child health care
Since the early 90s of the twentieth century, reforms have been taking place in rural health care. New assigned therapeutic and pediatric areas are being organized, rural district hospitals are being reorganized into medical outpatient clinics, medical aid stations are being reorganized into first aid stations, and vacated beds are sometimes concentrated in the central district hospital. Behind last years are increasingly developing different kinds mobile medical care. In particular, visiting medical teams, clinical diagnostic laboratories, fluorographic installations, mobile dental offices and dental prosthetic laboratories, etc. are being organized.
Main functions of the Republican Clinical Hospital:
1. provision of highly qualified specialized consultative, diagnostic and therapeutic assistance to the population of the republic in clinics and inpatient settings using highly effective medical technologies;
2. providing advisory, organizational and methodological assistance to specialists in other treatment and preventive institutions of the republic, primarily at the rural level;
3. organization and provision of qualified emergency and planned advisory medical care using air ambulance facilities and ground transport;
4. carrying out an examination of the quality of the diagnostic and treatment process in medical institutions of the republic;
5. implementation of other expert functions on a contractual basis with the Ministry of Health of the Republic of Belarus (MOH RB), the republican mandatory fund health insurance(RFIF) and branches of compulsory medical insurance, etc.;
6. implementation under an agreement with the Ministry of Health of the Republic of Belarus and development of measures for implementation targeted programs development of medical care;
7. introduction into practice of medical institutions of the republic modern technologies, economic methods health insurance management and principles;
8. participation in training, retraining and advanced training of medical workers;
9. ensuring the effectiveness of preventive measures, increasing the level of sanitary and hygienic culture and active promotion of a healthy lifestyle.
Thus, the republican (territorial, regional) hospital is a medical, scientific, organizational, methodological and educational center of healthcare.
There are 5 categories of republican (territorial, regional) hospitals , from 300 to 800 or more beds, the most appropriate are hospitals with 700-1000 beds with all specialized departments. However, every republican (territorial, regional) hospital, regardless of its capacity, must have the following structural units: management (administration, accounting, office, archive, library, etc.), organizational and economic department, advisory clinic, hospital with an emergency department, diagnostic department, department of emergency planned and consultative medical care (EPKMP), automated control system department, pathological anatomical department department, ACh (catering unit, garage, laundry, boiler room, storage rooms and other units), a boarding house for patients during the examination period, a dormitory for medical workers.
Objectives of the polyclinic of the Republican Clinical Hospital:
1. provides advisory assistance to patients;
2. conducts on-site consultations with specialists;
3. analysis of the quality of outpatient care (market reviews, newsletters with an assessment of the level of treatment and preventive care in the regions).
To plan the work of the clinic, vouchers for consultation are sent to the districts. The republican clinical hospital has an organizational and economic department (OED), which performs the function of an organizational and methodological department, which is a structural part of the republican hospital and is directly subordinate to the chief physician. The structure of the department includes:
1. organizational and economic department;
2. clinical expert department;
3. Information and statistical department.
The main tasks of the organizational and economic department are implementation of modern medical and information technologies, economic management methods, principles of health insurance, training and retraining of medical personnel.
Freelance chief regional specialists are the organizers of appropriate specialized care in a rural area; a highly qualified medical specialist is appointed, the head of a department of the central regional hospital, who has a category. The appointment and dismissal of the chief district specialist is carried out by the chief physician of the central district hospital.
The main tasks of the chief district specialist: development and implementation of measures for the prevention of diseases, introduction into the practice of medical institutions of the latest methods of prevention, diagnosis and treatment of patients, in order to improve the health of the population, reduce morbidity, including temporary disability, disability and mortality . It should be emphasized the importance of the close connection of rural health care institutions with territorial administrative bodies and public organizations in further improving medical care for the rural population.
In medical institutions there is an operational department and quality management departments responsible for intradepartmental quality control and compliance with the standards of medical care.
Conclusion
The legislative definition and implementation of the rights of citizens to free, publicly available medical care is the most important social value of the state.
Improving the organization of medical care at the prehospital and hospital stages has led to significant changes in the structure of the outpatient, polyclinic and inpatient stages of providing medical care to the population. The reform of management and financing of healthcare in the Russian Federation, the introduction of health insurance for citizens, have placed new demands on the doctor providing primary medical care at the pre-hospital stage of treatment, regardless of the form of ownership, territorial subordination and departmental affiliation.
On modern stage In the development of healthcare, the organizational, methodological, treatment and advisory role of the main specialists on the staff of the Ministry of Health (therapist, surgeon, pediatrician, obstetrician-gynecologist) acquires a special role.
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 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 prevention, diagnosis, 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; fight against 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 higher authority health department. 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 major cities with a population of more than 100,000 people there may be several TMOs, one of them is the head 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 – optimal size 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.
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).