home Audience 12 System for organizing medical care in outpatient settings. Outpatient clinical care. Inpatient medical care

System for organizing medical care in outpatient settings. Outpatient clinical care. Inpatient medical care

Outpatient clinical care

This is community-acquired health care, provided to persons coming to see a doctor at the clinic and at home. It is the most widespread and publicly accessible, and is of paramount importance for medical care to the population. Outpatient clinics are the leading link in the system of organizing health care; they include outpatient clinics and clinics that are part of hospitals and medical units, independent city clinics, incl. children's clinics, dispensaries, antenatal clinics, health centers, rural medical outpatient clinics and medical and obstetric centers.

Outpatient care includes preventive, therapeutic, diagnostic and rehabilitation measures aimed at reducing morbidity, disability and mortality. Important integral part This includes preventive examinations, clinical examination, as well as hygienic education of the population and propaganda healthy image life.

To receive medical care in outpatient setting You must contact the medical organization at your place of residence or stay (territorial clinic). When exercising the right to choose a medical organization (attachment to a medical organization upon application) - to the selected medical organization.

Consultative and diagnostic assistance in advisory clinics is provided upon the referral of the attending physician of the territorial clinic.

Procedure and conditions for providing outpatient care to the population

The document has become invalid or cancelled.

Order of Rosstat dated September 4, 2015 N 412 “On approval of statistical tools for the organization of federal statistical observation in the field of healthcare by the Ministry of Health of the Russian Federation”

Section III. Activities of a medical organization to provide medical care in an outpatient setting

A visit is a patient’s contact with a doctor of a medical organization or unit providing medical care on an outpatient basis for any reason, followed by an appointment with the " Medical card patient receiving medical care on an outpatient basis" (form N 025/u), including complaints, anamnesis, objective data, diagnoses: main, background, competing and concomitant diseases, injuries, poisonings with their codes according to ICD-10, health group, prescribed treatment, examination, as well as examination results and dynamic observation.

The following visits are subject to recording:

Doctors of any specialties who provide outpatient appointments, including consultative appointments (therapists, pediatricians, surgeons, obstetricians-gynecologists, urologists, otolaryngologists, etc., including heads of departments), in medical organizations and outside medical organizations;

Doctors of emergency medical care points (departments) at home;

Doctors at health centers, shop therapists, obstetricians-gynecologists and others who conduct outpatient appointments at health centers during hours specially allocated for outpatient appointments;

Doctors providing medical care on specially designated days for appointments on an outpatient basis, when traveling to other medical organizations (district hospitals, district hospitals, outpatient clinics, medical and obstetric centers);

Psychotherapists during group sessions (the number of visits is taken into account according to the number of patients studying in the group);

Visiting a patient or a patient's relative to refill a prescription (for malignant neoplasms, diabetes mellitus and other diseases);

Infectious disease doctors conducting door-to-door visits during an outbreak of infectious diseases, examining contacts in the outbreak (family) infectious disease;

Consultations of patients on an outpatient basis by doctors of a unit providing medical care in an inpatient setting, for registration of which the “Coupon for a patient receiving medical care on an outpatient basis” (hereinafter referred to as the Coupon) (f. N 025-1/u) is filled out separately for each specialty of the doctor ;

Cases of providing medical care in the emergency departments of medical organizations to patients who are not subject to hospitalization, for the recording of which, in addition to recording in the “Register of admission of patients and refusals of medical care in inpatient conditions” (f. N 001/u), a coupon is filled out;

Consultations by doctors of a unit providing medical care on an outpatient basis to patients undergoing treatment in units providing medical care in an inpatient setting.

Preventive examinations of children in nurseries preschool institutions, schools, preventive examinations of the population, including periodic examinations of workers of industrial enterprises, employees of other enterprises (institutions), regardless of whether they are carried out within the walls of a unit providing medical care on an outpatient basis, or directly at enterprises (institutions);

To the doctors of the draft commissions.

Visits by a patient to the same doctor during the day are counted as one visit.

The following are not counted as doctor visits:

Cases of medical care provided by emergency medical service station (department) personnel;

Examinations in X-ray rooms, laboratories and other auxiliary departments (offices);

Cases of medical assistance in the classroom physical culture, educational and sports events;

Consultations and examinations conducted by medical commissions (MC) in accordance with Article 48 Federal Law dated November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”;

Visits to doctors in auxiliary departments (offices), with the exception of cases of “management” of the patient by a doctor of these departments (offices): prescription of treatment with an appointment in the primary medical records, monitoring and dynamics of the patient’s condition during and after completion of the course of treatment (radiation, physiotherapy, etc.).

Medical visits include:

Visits when the patient is diagnosed with diseases classified in ICD-10 classes I - XX;

Visits to adjust treatment;

Visiting patients under treatment dispensary observation during remission;

Visits to patients in connection with registration on MSEC, health resort card, opening and closing a certificate of incapacity for work, obtaining a certificate of illness of the child, referral for an abortion for medical reasons, regarding the pathology of pregnancy, after abortions for medical reasons, as well as for consultations with specialists, if the doctor has established a diagnosis in his specialty.

To visits from for preventive purposes include conditions classified in class XXI ICD-10.

If intern doctors conduct appointments under the guidance of a specialist doctor and in his presence, then information about visits is taken into account only in the line corresponding to the position of the specialist doctor.

In cases where interns independently see patients, the information is shown in line 122, regardless of the specialty in which the doctor is undergoing internship.

Visits to doctors in auxiliary departments and offices ( radiation therapy, physiotherapeutic, physical therapy, endoscopy, functional diagnostics etc.) are not taken into account in table 2100. The work of auxiliary departments and offices is shown in the corresponding tables of the Form.

Table 2106 shows requests for diseases, injuries, poisoning and some other consequences of exposure external reasons(ICD-10 codes: A00 - T98), as well as for preventive and other purposes (ICD-10 codes: Z00 - Z99).

An appeal includes one or more visits to a patient, as a result of which the purpose of the appeal is achieved.

An appeal as a complete case in primary health care and primary specialized health care is one appeal and one or more visits to the patient, as a result of which the purpose of the appeal is achieved. If the purpose of the appeal is not achieved and the Ticket is closed, the case is considered not completed.

Information for table 2400 “Maternity care at home” is taken from the “Logbook of recording obstetric care at home” (registration form N 032/u).

Table 2402. To fill out lines 6 and gr. 3 use “Medical death certificates” (registration form N 106/u-08). Acute disorders cerebral circulation(codes 160 - 164) and myocardial infarction (codes 121 - 122) are included in table 2402 only if they are selected as the underlying cause of death. A medical organization reports only on death certificates issued by this medical organization.

Table 2510. Information about those subject to and examined during medical examinations includes by category: children 0 - 14 years old inclusive (of which: up to 1 year), children 15 - 17 years old inclusive and adult population(18 years and older), examined periodically (order of the Ministry of Health and Social Development of Russia dated April 12, 2011 N 302n, registered with the Ministry of Justice of the Russian Federation on October 21, 2011 N 22111) and others medical examinations.

Table 2510 is filled out only by those medical organizations that organize the examination of the relevant contingents and are responsible for its implementation, and is not filled out by specialized (dermatovenerological, anti-tuberculosis, etc.) organizations that may take part in this work.

Those to be inspected and inspected include: individuals only once a year, regardless of how many times a year they were subject to inspection and were inspected. The planned numbers of those subject to examination by category are approved by order of the head of the medical organization and adjusted at the end of the reporting period. The number of those examined must be equal to the number of those subject to inspection or be less than this number.

In the domestic healthcare system, as already mentioned, there is outpatient care to the population(from lat. ambulatory- mobile). Outpatient clinics are designed to provide assistance to incoming patients, as well as patients at home.

Brief historical outline of the development of outpatient care in Russia

For the first time, outpatient care for patients in Russia began to be used in the 11th century. In 1089 Kievan Rus“free healing” for visiting patients was made the responsibility of “hospitals located at churches.” Outpatient “reception” of patients was also conducted by healers and healers, to whom ordinary people turned for help. Until the 16th century. medical affairs were not subject to the jurisdiction of the state, since Rus' was fragmented into feudal principalities, on the territory of which, although sanitary and quarantine measures were introduced (under the control of a prince or monastery), both Russian and foreign doctors were invited to serve, there was no single organization or health service was. And only after the creation of a centralized Russian state under the rule of Moscow became possible the organization of state medical institutions and publication of relevant regulations on medical matters. Thus, by decree of Ivan the Terrible, the so-called Tsareva, or Court, pharmacy was established (1581), which performed the functions of providing medical assistance to the tsar, his family, and fellow boyars. Soon, a Pharmacy Order was established to manage the medical affairs of the state.

In 1620, the first secular outpatient clinics appeared, where doctors treated patients. The organization of outpatient care was accelerated by severe epidemics of smallpox, plague, and cholera.

Peter's reforms gave rise to the reorganization of the entire medical business: instead of the boyar order system, a state administration was created, including the Medical Office instead of the Pharmacy Order. In 1738, the position of a doctor for the poor was established at the main pharmacy of St. Petersburg; this was the first free outpatient clinic in Europe.

In 1804, for the first time in the history of Russia, outpatient practice was introduced into the teaching program in medical faculties universities. As a rule, outpatient care in cities was provided at hospitals. Independent institutions of this type began to develop only in the 80s. XIX century, which was facilitated by the development of zemstvo and factory medicine.

The zemstvo reform created a system of medical care, including local service, traveling medical assistance, provision of paramedics.

Outpatient care has received intensive development in our country since the 20s. XX century, i.e. during the formation years of the domestic healthcare system. Thus, by agreement of the People's Commissariat of Health of the RSFSR and the All-Union Central Council of Trade Unions, medical aid stations, outpatient clinics, and hospitals began to be created at enterprises. In 1929, the Decree of the Central Committee of the All-Union Communist Party of Bolsheviks “On medical care workers and peasants”, in which the main attention was paid to the organization of medical care, including outpatient care. An important method prevention, medical examination was announced, which at that time, due to many objective reasons, was reduced to registration of diseases and medical examinations. The system of maternal and child health care has been improved, and the network of children's clinics and antenatal clinics has increased significantly. On the eve of the war, despite mistakes and miscalculations, repressions that claimed thousands of lives of healthcare professionals, a state healthcare system was built, which assumed a preventive focus, planning, accessibility, etc. By 1950, even taking into account the enormous damage caused national economy country during the war (40,000 hospitals and clinics were destroyed), the number of medical institutions not only reached pre-war levels, but also increased. In those years, medical examinations began to be carried out rural population, preparations are underway for medical examination at the clinic. From 1961 to 1983, outpatient care focused on clinical examination.

Organization of work of clinics and outpatient clinics

Currently, outpatient care is provided in a wide network of outpatient clinics and clinics that are part of hospitals, in independent city clinics and rural medical outpatient clinics, dispensaries, specialized clinics, antenatal clinics, health centers, first aid stations, etc. In these In institutions, approximately 80% of all patients begin and complete treatment, and only 20% of patients are subject to hospitalization.

Thus, outpatient care is the most widespread type of treatment and preventive care for the population.

The types of out-of-hospital care institutions were approved in 1978 by the USSR Ministry of Health. The leading ones are clinics and outpatient clinics.

Clinic(from Greek polis- city and clinic- healing) is a multidisciplinary medical and preventive institution designed to provide medical, including specialized, care to patients, and, if necessary, to examine and treat patients at home.

The clinic sees doctors of various profiles (therapists, cardiologists, gastroenterologists, ophthalmologists, surgeons, etc.), and also has diagnostic rooms (X-ray, endoscopic, laboratory, physiotherapy room, etc.).

The basic principle of the clinic is territorial-precinct, when a local general practitioner and nurse are assigned an area with a certain number of residents. The local doctor and nurse are responsible for carrying out all medical and preventive measures in the territory this area. The territorial-precinct principle is also observed in relation to doctors of “narrow” specialties when they make house calls (as prescribed by the local therapist).

Outpatient clinic - This is a medical and preventive institution, which, like a clinic, is intended to provide medical care to patients coming to the outpatient clinic and to patients at home.

The operating principle of an outpatient clinic is also local, but an outpatient clinic differs from a clinic in that it has a smaller volume of work and capabilities. In outpatient clinics, usually located in rural areas, admission is only available in a small number of specialties (no more than five): therapy, surgery, obstetrics and gynecology, pediatrics. Job nurse in an outpatient clinic resembles the work of a district nurse in a clinic, but only an outpatient nurse is more independent.

Main tasks of the clinic are:

provision of qualified specialized medical care to the population in clinics and at home;
organizing and conducting medical examinations of the population;
organization and implementation of preventive measures among the population in order to reduce morbidity, disability, and mortality;
examination of temporary disability;
organizing and carrying out work on sanitary and hygienic education of the population, promoting a healthy lifestyle.

Polyclinics can be independent or combined with a hospital, general or specialized, for example dental, spa, etc.

Main structural units of the city clinic

IN composition of the clinic includes the following divisions:

registry;
prevention department;
medical departments;
diagnostic department (laboratory, x-ray room, ultrasound diagnostic room, etc.);
statistical office;
administrative divisions ( chief physician, Deputy Chief Physician for Work Capacity Examination).

Registry ensures registration of patients for appointments with doctors and registration of doctor's house calls, timely selection and delivery of documentation to doctors' offices, information to the population about the time of doctors' appointments and the rules for calling a doctor at home, preparation of sheets and certificates of temporary disability.

Prevention department includes a pre-medical control room, a women's examination room, etc. Patients from the registry who come to see a doctor for the first time are sent to the prevention department. In the pre-medical control room, patients are systematized, various certificates are issued, and preliminary examinations are carried out.

IN compound medical departments includes local therapists and doctors of “narrow” specialties. Each department is headed by a department head. The head of the clinic is the chief physician of the clinic (the clinic is an independent medical and preventive institution) or the deputy chief physician of the clinic (when the clinic is combined with a hospital).

IN statistical office polyclinics process and record documentation, analyze the performance indicators of the structural divisions of the polyclinic.

Organization of the work of a local therapist in a city clinic

Local therapist plays a leading role in the public health system (in the future this will be family doctor). The complex work of a local doctor combines medical and organizational activities (organization of prevention, treatment, medical examination, rehabilitation, sanitary education work). A local doctor is essentially a front-line healthcare organizer.

It is the activities of the local general practitioner and local nurse that most closely come into contact with the work of organs social protection and is largely medical and social. The local doctor and local nurse have an important influence on solving the client’s medical and social problems in professional activity social worker. It is the local doctor who, if necessary, should be contacted by a social work specialist in case of difficulties of a client’s medical and social nature.

The work of a local general practitioner is usually organized in such a way that every day he sees patients in the clinic (about 4 hours) and makes calls to patients at home (about 3 hours). The doctor not only carries out calls made by the patient himself or his relatives, but also, if necessary (without calling), visits the patient at home. These calls are called active calls. The local doctor should visit chronically ill patients, lonely elderly people, and the disabled at least once a month, regardless of whether the patient called the doctor or not. When performing a call, the doctor not only treats the patient, but also performs elements social work: finds out the social and living conditions of the patient, contacts, if necessary, with social protection authorities, the RCCS department, pharmacies, etc.

The nurse also takes a direct part in the reception of patients (prepares the documentation necessary for the reception, writes prescriptions for medicines as directed by the doctor, fills out referral forms for examination, measures arterial pressure, body temperature, etc.) and carries out doctor’s orders at the site (does injections, puts mustard plasters, enemas, checks patients’ compliance with the prescribed regimen, etc.). If necessary, the activities of the doctor and nurse at the site can be organized as a hospital at home, when the doctor visits the patient at home every day, and the nurse carries out medical prescriptions at home.

Clinical examination

Clinical examination is the main means of prevention in the domestic healthcare system.

Clinical examination is an active, dynamic monitoring of the health status of certain populations (healthy and sick), registering population groups for the purpose of early detection of diseases, periodic monitoring and complex treatment sick, improving the health of work and life, to prevent the development of the disease, restore ability to work and prolong the period of active life.

Clinical examination involves examination and treatment of patients without exacerbation of the disease.

Clinical examination (or clinical examination method) consists of several stages. At the registration stage, patients are identified (based on the results of medical examinations or by appeal, and the first one is preferable). At the next stage, the patient is examined, his state of health is assessed, and working and living conditions are studied. At the third stage, a plan of preventive and therapeutic measures is drawn up and documentation is drawn up. Then the patient is actively and systematically monitored, individual preventive treatment, recreational activities at the execution stage. Sanitary educational work, the formation of a healthy lifestyle, state and public measures to combat health risk factors are carried out at final stage(preventive actions).

Outpatient doctor's appointment

The provision of outpatient medical care is carried out on a territorial basis. The procedure for organizing outpatient appointments in municipalities providing outpatient care provides for:

Extraordinary provision of outpatient care without prior appointment, regardless of the territorial principle, to all those who apply for emergency indications;

Availability of a queue when patients regularly apply for appointments with a doctor, diagnostic tests, consultations with specialists.

The operating hours of the medical department, the organization of appointments (pre-registration and various types of self-registration of patients for outpatient appointments), the schedule of doctors' appointments, the procedure for calling a doctor at home (indicating the telephone numbers by which doctor's house calls are registered, convenient operating hours of the reception desk) are regulated by internal work rules MO approved in accordance with the established procedure.

For outpatient clinics, it is recommended to establish a uniform operating hours from 8.00 to 20.00. At feldsher-midwife stations, if there is one specialist position, a working day is introduced with the shift divided into parts (with a break in work of more than 2 hours and additional pay) to be able to receive patients in the morning and evening hours.

Medical records of an outpatient patient (hereinafter referred to as the outpatient record) are stored in the medical institution providing outpatient care at the place of residence.

Medical care at home

Medical care at home is provided when the patient is unable to visit a medical facility providing outpatient care:

for health,

according to epidemiological indications.

In addition, at home the following is carried out:

patronage of children under 1 year of age;

observation until recovery of children under 1 year of age;

observation of children with infectious diseases until recovery;

patronage (active calls) by medical workers (doctor, nurse, paramedic) of patients with restrictions in independent movement.

The house call must be handled by a health worker on the day the patient contacts.

Medical care in a day hospital

In the day hospital, medical care is provided to patients if they need complex treatment using modern medical technologies, including a course of infusion therapy, therapeutic and diagnostic manipulations on an outpatient basis in the absence of the need for round-the-clock medical supervision.

The referral of the patient for treatment in a day hospital is carried out by the attending physician.

The day hospital provides:

Bed for the period of treatment;

Medicines in accordance with the List of vital and essential medicines and medical products necessary for the provision of inpatient medical care, as well as ambulance and emergency medical care (Appendix No. 4 to the Program) at the expense of the Ministry of Defense;

Physiotherapeutic procedures;

Examinations and consultations of specialists.

The criterion for completing a stay in a day hospital is the availability of the possibility/need for treatment at other stages (during outpatient admission, in a 24-hour hospital).

Medical care in a hospital at home

In a hospital, medical care is provided to patients at home if, in the absence of the need for round-the-clock medical supervision, the patient’s condition does not allow him to visit the clinic, and home conditions (social, material, moral) allow him to organize the necessary care for the patient at home.

The decision on inpatient treatment at home is made by the attending physician in consultation with the head of the clinic department.

Medicines are provided in accordance with the List of vital and essential medicines and medical products necessary for the provision of inpatient medical care, as well as ambulance and emergency medical care (Appendix No. 4 to the Program) at the expense of the Ministry of Defense, as well as at the expense of personal funds citizens, with the exception of drug provision for persons with benefits established by the legislation of the Russian Federation and the Republic of Karelia.

The criterion for the completion of a stay in a day hospital is the availability/necessity of treatment at other stages (outpatient treatment, in a 24-hour hospital).

The procedure and conditions for the provision of medical care in hospitals

Medical assistance in 24-hour hospitals

Medical care in 24-hour hospitals can be planned and emergency.

Indications for emergency hospitalization are conditions life threatening and demanding emergency assistance medical care in a 24-hour hospital.

According to emergency indications, patients are hospitalized in the direction of a doctor / paramedic of the ambulance service and specialists of the Moscow Region, as well as in case of self-treatment.

Indications for planned hospitalization are conditions that require the implementation of diagnostic and therapeutic measures in a round-the-clock hospital, which can be delayed. The waiting time for planned hospitalization cannot exceed 30 days.

Planned hospitalization is carried out in the direction of the attending physician.

Nutrition of the patient, carrying out therapeutic and prophylactic manipulations, drug provision is carried out from the moment of admission to the hospital. Patients are accommodated in wards for 4-8 people.

The criteria for the completion of the stay at the stage of round-the-clock treatment are clinical recovery or improvement in the patient's condition, in the absence of the need for round-the-clock medical supervision.

One of the parents (other legal representative) or another family member is granted the right, in the interests of the child's treatment, to be with him in a hospital during the entire time of his stay, regardless of the age of the child.

When children are hospitalized, regardless of age, if there are medical indications for individual care, the mother is provided with a bed and food according to established standards.

Medical care in day hospitals

Hospitalization in a day hospital is carried out to provide medical care to patients who do not need round-the-clock medical supervision.

The referral to the day hospital is carried out by the attending physician.

Medicine provision for patients in a day hospital is carried out at the expense of the Ministry of Defense.

The criterion for completing a stay in a day hospital is the availability of the possibility/need for treatment at other stages (outpatient, in a 24-hour hospital).

Nutrition of the patient, carrying out therapeutic and prophylactic manipulations, drug provision is carried out from the moment of admission to the day hospital.

Conditions and procedure for provision

emergency medical services

Emergency medical care is provided by emergency medical stations and departments to residents of the Republic of Karelia and other persons located on its territory, free of charge, around the clock in conditions that threaten human life or health, caused by sudden diseases, exacerbations of chronic diseases, accidents, injuries and poisoning, complications pregnancy and childbirth.

Calls are serviced as they arrive. The time allotted for servicing a call is determined by the current regulations. In the absence of the required number of free teams, the order in which calls are serviced is determined by their significance. Ambulance teams are not engaged in the delivery of patients from the Moscow Region home, the systematic treatment of patients and medical procedures prescribed by doctors of the Moscow Region providing outpatient care.

Conditions and procedure for providing medical care

outside the Republic of Karelia

In cases where specialized, including high-tech, medical care cannot be provided in medical organizations of the republic, the question of whether it is appropriate to send a patient for treatment outside the republic to federal healthcare institutions is being decided.

The decision on the need for referral is made by the commission of the Ministry of Health and Social Development of the Republic of Karelia for the selection and referral of patients for treatment outside the republic. The list of healthcare institutions of federal subordination is determined by a joint order of the Ministry of Health and Social Development of the Russian Federation and the Russian Academy of Medical Sciences.

Appendix No. 3 to the Program (abbreviated)

implementation of the right of extraordinary medical care established by the legislation of the Russian Federation

Republic of Karelia and municipalities

1. This Procedure defines the rules for the extraordinary provision of medical care under the Program in healthcare institutions of the Republic of Karelia to disabled veterans of the Great Patriotic War and other categories of citizens specified in Articles 14-19 and 21 of the Federal Law of January 12, 1995 No. 5-FZ "On Veterans" ( hereinafter referred to as citizens).

2. Extraordinary provision of medical care to citizens is carried out if citizens have medical indications.

3. Outpatient medical and inpatient medical care is provided to citizens on an extraordinary basis by medical organizations at the place of residence or work to which they were attached during the period of work before retirement (hereinafter referred to as territorial medical organizations) upon presentation of a document confirming membership in a preferential category of citizens , and includes:

Extraordinary receipt of a coupon for outpatient appointments and provision of outpatient medical care on an extraordinary basis;

Extraordinary provision of inpatient medical care;

Extraordinary diagnostic tests.

4. Referral of citizens to a state health care institution of the Republic of Karelia to provide them with emergency medical care is carried out on the basis of the conclusion of a medical commission by a territorial medical organization with detailed statement from medical records and an indication of the purpose of the referral.

Appendix No. 4 to the Program (abbreviated)

SCROLL

vital and essential medicines

and medical products necessary to provide

inpatient medical care, as well as ambulance and emergency medical care

Outpatient medical care (lat. ambulatory - mobile, walking; Greek polis - city, clinic- the art of healing, caring for bedridden patients) is carried out outside of hospital conditions.

Currently, about 80% of patients are provided with medical care in outpatient clinics. The outpatient clinic link (the so-called first contact zone) provides for the examination and treatment of patients at the clinic and, if necessary, at home, as well as clinical examination (health monitoring) of the population.

The principle of operation of the outpatient clinic link is territorial-area (the main structural element of the outpatient clinic link of healthcare is the territorial therapeutic area), which implies the permanent assignment of a certain number of residents of the corresponding area to the local therapist and nurse.

The goals and objectives of the outpatient clinic link are as follows:

Qualified medical care in the clinic and at home.

Clinical examination.

Preventive measures (reducing morbidity, disability and mortality).

Examination of temporary disability.

Sanitary and hygienic education of the population.

Outpatient clinic(lat. ambulatory - mobile, walking) - a medical and preventive institution designed to provide out-of-hospital medical care to the population small village urban type, small industrial enterprise or rural area. In rural areas, outpatient care can be provided by feldsher-midwife stations, which act as the main structural unit of rural healthcare. The local principle of work makes it possible to actively identify patients, provide them with qualified medical care, study morbidity, and carry out preventive and sanitary educational work.

An outpatient clinic differs from a clinic in a certain limitation of the medical care provided and a small number of staff (as well as the number of patients served). As a rule, an outpatient clinic is located in a rural area and provides services to the population with the required minimum number of specialists (no more than five) - a therapist, a surgeon, an obstetrician-gynecologist and a pediatrician.

Medical units provide medical care in large areas industrial enterprises. They may include a hospital, a clinic, a health center and a dispensary.

health center- a unit of a medical unit or clinic, organized at industrial enterprises, construction sites, higher and secondary educational institutions, schools. Along with providing first aid for injuries, sudden illnesses and poisonings, the health center carries out planned sanitary, hygienic and therapeutic measures to prevent and reduce morbidity. A medical health center is headed by a doctor, a paramedic health center is headed by a paramedic or a nurse.

Women's consultation- a medical and preventive institution in which treatment and prevention are carried out gynecological diseases, as well as monitoring of pregnant women. A mid-level medical worker - a midwife - assists the doctor during appointments, provides patronage to pregnant women, and teaches them how to care for newborns and personal hygiene. The midwife carries out doctor's orders and carries out health education work.

Ambulance stations provide the population with medical care in emergency situations, working around the clock. The team can be led by a paramedic who independently responds to calls, provides first aid and hospitalizes patients. Specialized medical care, which requires higher qualifications, is provided by a team led by a doctor, and a paramedic assists him in providing assistance and transporting patients. Many ambulance stations have vehicles with modern equipment, which makes it possible to provide emergency highly qualified and specialized assistance and carry out resuscitation measures at home and on the way to the hospital.

Additionally, it should be noted that modern domestic healthcare pays great attention the service of a family doctor (general practitioner) as a promising link in the provision of primary health care. Order of the Ministry of Health of the Russian Federation No. 237 (dated August 26, 1992) provides for the creation of special medical offices (premises) family medicine equipped with modern diagnostic equipment, and the staff of such a family medicine office is regulated (a family doctor and three secondary medical worker, including laboratory assistant and paramedic). In fact, the general practitioner acts as the legal successor of the local therapist.

Inpatient medical care

If the patient's condition requires systematic monitoring, the use of complex diagnostic and treatment procedures, and specialized medical care, he is sent to a hospital-type hospital.

Hospital (lat. stationarius - standing, motionless) - structural subdivision medical and preventive institution (hospital, medical unit, dispensary), intended for examination and treatment of patients in a 24-hour environment (with the exception of day hospital) their stay in this institution under the supervision of medical personnel.

Day hospital- an intermediate link between outpatient and inpatient medical care. This is an inpatient-substituting form of organizing medical care for the population, a structural unit of an outpatient clinic or hospital institution, designed to provide therapeutic, rehabilitation, diagnostic and preventive measures to patients who do not require round-the-clock medical supervision during the daytime.

Dispensary(lat. dispense- distribute) - a special specialized treatment and preventive institution operating according to the dispensary method. The dispensary is designed for active early detection and registration of patients with certain groups of diseases, systematic dynamic monitoring of them, provision of specialized medical care, developing recommendations for improving the health of work and life of these patients, as well as for studying morbidity and its causes, developing and implementing measures to prevent diseases, and carrying out sanitary educational work.

Thus, a dispensary is an independent specialized medical and preventive institution designed to provide medical and preventive care to a certain group of patients. Currently, the domestic healthcare system provides the following types dispensaries: cardiological, anti-tuberculosis, oncological, dermatovenerological, psychoneurological, narcological, anti-goitrous, endocrinological, medical and physical education.

The goals and objectives of the dispensary are the following::

Active early detection patients of the corresponding profile.

Monitoring of identified patients (patronage).

Specialized medical care.

Rehabilitation of patients.

Prevention of disease.

Study of morbidity and conditions for the development and spread of the disease.

Sanitary educational work.

The importance of patient care cannot be overestimated. Accurate implementation of the doctor’s instructions, carrying out all activities that help preserve and restore the patient’s strength, alleviate his suffering, carefully monitor the functions of all organs, prevent possible complications, sensitive attitude towards the patient - all this is included in the concept of caring for the patient. And if the doctor treats, then the nurse takes care of you.

Strict compliance with doctor's instructions, strict adherence dietary, drinking and hygienic regimes, the creation of favorable physical and psychological conditions can restore health even in seemingly hopelessly ill people, and, conversely, poor care, the careless attitude of a nurse to her duties can not only delay the patient’s recovery, but also aggravate the severity his condition.

IN Everyday life caring for a patient is understood as providing assistance to him in meeting various needs: food, drink, toilet, movement, physiological functions, etc. Care also means creating for the patient optimal conditions stay in medical institution or at home: peace and quiet, a comfortable bed, clean linen, Fresh air etc. In this volume, care is usually carried out by the younger medical personnel and relatives of the patient. F. Nightingale wrote: “If by proper care eliminate all the conditions complicating the disease, then the disease will take its natural course, and everything side, artificial, caused by mistakes, frivolity or ignorance of others, will be eliminated.

In medicine, the concept of "care for the sick" is interpreted more broadly. Here it stands out as an independent discipline and represents a whole system of measures, including the correct and timely implementation of various medical appointments, conducting diagnostic measures, preparing the patient for certain studies, monitoring the patient's condition, providing the first first aid, maintaining the necessary medical care. documentation.

Patient care affects the effectiveness of treatment and is an integral part of it. The quality of patient care is inextricably linked with the results of treatment of the disease, its prognosis. So, with the successful management of a patient with myocardial infarction, you can “lose” the patient due to unscrupulous performance necessary activities care: for example, the lack of constant supervision can lead to a violation of the patient's strict bed rest in the first days of myocardial infarction and the development, in particular, of such complications as fatal heart rhythm disturbances and progression of heart failure. Another Example: Inadequate Cleanliness Control bed linen and condition skin in conditions of hypodynamia can lead to the formation of bedsores. That is why patient care is an essential component of treatment, influencing the course of the disease and the patient’s recovery.

There are two main areas of care for patients - general and special care:

· General care - implementation general events care, regardless of the nature of the disease ( general examination, measuring body temperature, changing linen, etc.).

· Special care- implementation of specific care measures depending on the diagnosis of the disease (for example, preparing the patient for cholecystography, catheterization of the bladder).