Since 2002, the main emphasis in the provision of medical care has been placed on the organization of outpatient care for the population. The order on continuous improvement of this area was issued by the Ministry of Health of the Russian Federation (No. 350). For its implementation, a project of national importance "Health" is being implemented.
The role of leading structures is assigned to outpatient services, where about 80% of the population undergo a full course of treatment - from the first treatment to discharge, without the need for hospitalization.
Types of Institutions
The law “On the Basics of Protecting the Health of Citizens of the Russian Federation” regulates the organization of outpatient care for the population. The types of facilities were approved by the USSR Ministry of Health in 1978.
Clinic is a multidisciplinary medical treatment and prophylactic institution with a wide range of assistance. Patients have access to the help of doctors of many specialties, diagnostics, physiotherapy, high-tech care. If necessary, almost the entire range of services is provided at home.
Assistance to the population is provided on a territorial basis, where the doctor and nurse provide services to a certain number of residents. Also, doctors carry out methodological, preventive and educational work in the entrusted territory. Doctors of certain specialties provide home care as prescribed by the therapist in accordance with the territorial division.
Clinic nomenclature:
- City (including city children).
- Consultative and diagnostic (including children's).
- Dental (including children).
- Psychotherapeutic.
- Central district.
- Rehabilitation treatment.
- Physiotherapeutic.
Outpatient clinic - in terms of functionality, it is loaded, like a clinic, but it differs in smaller volumes of work, a limitation in the provision of high-tech care and a smaller representation of highly specialized doctors. As a rule, outpatient clinics are located in rural areas, the reception is carried out by a therapist, obstetrician-gynecologist, surgeon and pediatrician.
Outpatient clinics and clinics can be subjects of independent activity or be part of the structure of hospitals, dispensaries, antenatal clinics, feldsher points, etc. Organization of outpatient care for the urban population is the most widespread form of coverage of the population with qualified medical care.
System, principles
The principles of organizing outpatient care for the population are as follows:
- Accessibility for all segments of the population.
- Precinctness.
- Stage-by-stage and continuity of therapy.
- Prevention and education of the population.
- Massiveness.
- The professionalism of doctors and nurses.
The system of organizing outpatient care for the population according to the district principle allows achieving the goals:
- The patient is treated by one specialist for a long time.
- The doctor carries out systematic monitoring of patients, provides assistance to families.
- The specialist is fully acquainted with the working conditions and life of the population at his site.
- Clinic services are studying the incidence rate, identifying patients in need of medical examination.
- Preventive, educational, anti-epidemic measures are being implemented at the serviced site.
- The sanitary and hygienic level and public awareness are being strengthened.
Tasks
The system of organization of outpatient care for the population performs a number of functions and is designed to solve some of the problems:
- Providing primary specialized assistance to citizens in a clinic and at home.
- Assistance in acute conditions, injuries, emergency cases, regardless of the registration of the patient.
- Planned and urgent hospitalization of patients in need of intensive treatment and observation (round-the-clock or day hospital in the clinic, hospital).
- Expert opinions and examinations on occasions of temporary incapacity for work, exemption from work, referral of patients with persistent signs of disability to medical and social examination.
- Organization, implementation and implementation of a set of preventive measures at the serviced site and at the enterprises covered, aimed at reducing mortality, morbidity, and disability.
- Promotion and conduct of professional examinations of target population groups.
- Regular medical check-ups. Each specialist determines the list of patients subject to the procedure.
- Referral of groups of patients for treatment to spa facilities.
- Organization of agitation and promotion of a healthy lifestyle, implementation of projects on sanitary and hygienic education and upbringing.
Outpatient departments
To provide qualified medical services, the organization of outpatient care for the adult population is carried out by admitting patients in structural units.
The main departments of clinics:
- Leadership and administration.
- Reception (including a reference desk).
- Medical and preventive (surgery, therapy, ophthalmology, dentistry, traumatology, neurology, etc.). It also includes specialized rooms and services. Offices - physical therapy, infectious diseases, antenatal clinics, etc. Services - paramedic, ambulance and emergency care, dispensary, etc.
- Diagnostic department - rooms for X-ray, functional diagnostics, laboratory, endoscopy, etc.
- Supporting departments - medical statistics, business unit, accounting office, etc.
By decision of the institution’s management, the organization of outpatient care for the urban population can be supplemented depending on needs. So, there may appear departments of a day hospital, alternative care, patient schools, health centers, self-supporting units, etc.
The functions and tasks of the therapist
The organization of outpatient care for the adult population is implemented according to the district principle, where the main burden rests with the therapist. The district doctor is the first specialist to organize the health care system in the primary area. In fact, the district therapist is a general practitioner who is required to provide:
- Qualified and timely medical assistance to each resident of the attached site (in a medical facility, at home).
- Providing emergency care to patients, regardless of place of residence, in the event of acute conditions, poisoning, injuries.
- Planned (with a preliminary examination) or emergency hospitalization of patients.
- Consultation of patients according to their profile, and, if necessary, the organization of consultative admission by doctors of narrow specialties (surgeon, otolaryngologist, endocrinologist, etc.) within their institution or in other hospitals.
- The use of modern methods in treatment, prevention, diagnosis (including therapy, rehabilitation, rehabilitation).
- Examination of disability (temporary).
- Organization, implementation of a system of measures for medical examination of the population, analysis of the effectiveness of measures taken and the quality of the process.
- Vaccination, deworming of the population of the site.
- Organization of anti-epidemic work (early detection, transmission of information about infectious patients and cases of mass infectious poisoning in everyday life, at production facilities in SES, etc.).
- Further training, including a nurse.
- Organization and implementation of medical education at the site.
The activity of the local general practitioner is the alternation of outpatient and inpatient visits, visiting patients at home. The work schedule is approved by the head physician.
For children
The organization of outpatient care for children is basically similar to the principles and objectives of the clinic for adults, but has some specifics. In children's medical institutions, children are served from birth to 17 years.
Main tasks:
- Providing the full range of necessary medical care for children in a clinic, outpatient clinic or at home.
- Organization, implementation, implementation of preventive measures.
- Organization of planned or emergency hospitalization of children, adolescents in hospitals, specialized institutions (kindergartens, nurseries, schools), motels, etc.
- Organization and implementation of medical and preventive measures in educational institutions.
- Implementation of anti-epidemic measures.
- Participation in the legal protection of the child population.
The organization of outpatient care for adolescents and children also works on a district basis. On average, there are about 800 patients per pediatrician in the age category from 0 to 17 years.
For the successful implementation of preventive measures, a nurse is assigned to each site, who has more responsibilities than similar work in an adult clinic. Her task includes the implementation of preventive, educational measures aimed at creating a healthy lifestyle for the younger generation, as well as providing patients with the prescribed specialized care at home and much more.
Prevention and education
One of the most important tasks in serving children and adolescents is the organization of a healthy child department. The structure’s task is to promote a healthy lifestyle, its formation in children, parent education (sleep, nutrition, education, training in the basics of care and hardening, etc.), prevention of developmental abnormalities, and prevention of morbidity.
In children's clinics and outpatient clinics, the role of the leading specialist is assigned to the pediatrician. Its main functional tasks:
- Patronage from the antenatal period, professional examinations of children living on the site, examination of the child before entering a nursery, kindergarten, school, etc.
- Coverage of health education of parents and children. Advocacy and education of a healthy lifestyle.
- Anti-epidemic measures (routine vaccination, detection of infectious diseases and their registration, rehabilitation measures, etc.).
- Treatment of children in the clinic and at home.
Assistance to citizens living in rural areas
The organization of outpatient care to the population in rural areas is based on the principles of accessibility, mass character, precinct, and qualification of health workers.
Features:
- Phased provision of health care.
- Field teams of doctors.
Primary assistance to the rural population is provided in stages:
- Medical site. The structure includes - a district outpatient clinic, a clinic, an independent hospital, medical dispensaries, etc.
- District medical organizations - the central, district (zone) hospital with outpatient and dispensary departments, emergency and emergency departments.
- Medical institutions of regional significance - a hospital with departments of advisory-polyclinic and dispensary services, a dental clinic, air ambulance, a psychiatric clinic, etc.
The stage of the provision of medical care reaches its goals - coverage of the entire population with medical care, providing the patient with the necessary spectrum of treatment.
A bit about hospital care
The organization of hospital care in modern conditions provides for the planned provision of care to the patient, as well as emergency evacuation. Hospital care is provided in hospitals, where about 20% of all patients receive treatment. As a rule, patients with a severe course of the disease are hospitalized, requiring round-the-clock monitoring and treatment under the supervision of a specialist.
Indications for hospitalization are:
- Sharp, urgent, emergency indications.
- The need for intensive care methods.
- Conducting a series of complex studies.
- Unsatisfactory living conditions for the patient.
The leading inpatient institution is a multidisciplinary hospital, whose functions include:
- Implementation of treatment and rehabilitation measures (diagnosis, treatment, rehabilitation, recovery, emergency care).
- Preventive work (reducing the number of diseases and mortality, prevention of infectious lesions, etc.).
- Educational and research activities.
Emergency hospitalization is carried out immediately upon detection of threats to the patient's life. Hospitalization in a planned manner is carried out in the direction of the attending physician of the outpatient clinic. In this case, the patient must have an established diagnosis, the results of preliminary studies. Upon admission, the patient is examined by a reception specialist on duty.
Indications for hospitalization are:
- The patient's condition, requiring active therapeutic measures.
- Patient condition requiring close dynamic monitoring.
The organization of hospital care for urban and rural settlements provides the patient with the following services:
- Inspection by a treating specialist.
- Registration of necessary documentation, outpatient records of a patient, referral to inpatient treatment (hospitalization).
- The full scope of the mandatory examination provided for planned hospitalization.
- A full range of treatment, prophylactic, anti-epidemic and other measures at each stage of medical care.
- Transportation of the patient to the place of hospitalization in case of emergency and urgent situations, organization of escort if necessary.
- In cases where absolute indications for hospital treatment are determined, outpatient studies are carried out for 3 days.
Relative indications for inpatient treatment allow you to agree on the duration of the diagnosis with the patient. Also, the patient is provided with coordination of the time of hospitalization, special types of research, examination of disability, examination in the areas of medical and social examination organizations.
Patients admitted to the hospital are accommodated in the wards, with emergency admission, placement in the corridor is possible (no more than 2 days). Patients admitted for planned hospitalization are placed in the ward for 1 hour after arrival at the inpatient ward of the hospital.
Stages of providing assistance in Moscow
The organization of outpatient care in Moscow is regulated by order of the Department of Health of the capital No. 983. It is based on the territorial-district principle, phasing, and staff qualifications.
Patients receive medical care at three levels:
- Primary. Assistance is provided in district clinics and dispensaries on a territorial basis. In institutions of this level, the patient receives pre-medical, primary, health care, primary specialized, diagnostic assistance. The task of institutions of the first level includes the organization, implementation, implementation of preventive measures. They are also involved in the early detection of diseases, pregnancy management, all types of emergency care in the event of acute illness, poisoning, accidents, injuries.
- The second (specialized) level. The patient is provided with medical diagnostic, consultative, medical specialized assistance on a district basis. Second-level medical facilities accept patients with the aim of carrying out special methods of diagnosis, counseling and treatment according to the narrow profile of the disease.
- The third (specialized) level. The patient is provided with medical, diagnostic, consultative assistance, including high-tech. Services are provided on the basis of hospitals (including day stays) on the principle of administrative districts. The task of medical institutions of the third level is to provide services using resource-intensive diagnostic technologies and scientific and technical potential in hospitals.
The organization of outpatient care for the urban population of the Russian Federation and residents of the countryside is constantly being improved, and patients are being provided with more and more opportunities for treatment, diagnosis and consultation with the best specialists.