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

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

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

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

The unity of the principles of providing medical and preventive care to the urban and rural population: the preventive nature of the district, the mass character, the specialization of medical care, and the general availability.

At present, the level of inpatient medical care for the residents of the village has practically reached the level of the townspeople. At the same time, the level of outpatient medical care for the rural and urban population differs significantly. The same applies to the quality of medical services.

Existing differences in the organization of medical care rural population due to: a peculiar system of population resettlement; small population density; seasonality of agricultural work; significant remoteness of settlements from each other; reduction in the proportion of people of working age; an increase in the proportion of the elderly and old in rural areas; insufficient development of transport links;

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

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

Stage I - earlier - a rural medical station (SVA), 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) feldsher-obstetric station (FAP) c) health centers (if there is an industrial enterprise in the service area). Currently, there is no IED, SVA and district hospitals are branches of the Central District Hospital, FAPs are branches of SVA.

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

FAPs are created for medical care of 400 people or more at a distance of 2 km or more from a medical institution. Serving over 400 people in the states of the FAP, there are: 1 position of a paramedic or midwife or nurse and 0.5 nurse positions. The cost of FAPs - 1.5 -2.0% of the district budget.

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

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

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

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

In case of unprofitable activity of district hospitals, they are closed or converted into rehabilitation departments of district hospitals, and independent rural medical outpatient clinics (SVAs) are opened for medical care of the population, which should include: a general practitioner, dentist, obstetrician-gynecologist, pediatrician.

From the staff standards of the medical personnel of district hospitals: 1. The positions of doctors for the provision of outpatient care to the population are established based on 10,000 population: 8.0 - 0.3 2.5 Dentist

2. Positions of physicians of departments of a hospital are established at the rate of 1 position: - doctor-therapist - for 25 beds; - pediatrician - 20 beds; - surgeon - 25 beds; - dentist - 20 beds. The bed capacity of the rural district hospital is 27-29 beds.

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

organization and implementation of a complex of preventive measures among the population of the site - conducting therapeutic and preventive measures to protect the health of mother and child - studying the causes of general morbidity and morbidity with temporary disability and developing measures to reduce it -

- organization and implementation of medical examinations of the population, primarily children, 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 over the state of industrial and communal premises, water supply sources, children's institutions, public catering establishments; - carrying out therapeutic and preventive measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms

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

Stage II - Territorial Medical Association (TMO). TMO is led by the Chief Physician of TMO (he is also the chief doctor of the Central District Hospital) and his deputies: - Deputy for medical services to the population (he is also the head of the organizational and methodological office); - Deputy for the medical unit (with the number of beds 100 or more);

- Deputy for Medical and Social Expertise and Rehabilitation (if the number of people served is at least 30,000 people); - Deputy for Obstetrics and Childhood (if the number of people served is at least 70,000 people); - Deputy for economic issues; - Vice President for Administration.

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

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

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 first aid to the sick.

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

At this stage, the district pediatrician and the district obstetrician-gynecologist are responsible for organizing medical and preventive care for women and children. With a population of more than 70,000 people, the position of deputy chief physician for childhood and obstetrics is appointed - an experienced pediatrician or obstetrician-gynecologist.

Stage III - the regional hospital and medical institutions of the region. The regional hospital is a large multidisciplinary medical and preventive institution that provides highly qualified highly specialized assistance to the residents of the region in full. 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 paramedical personnel.

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

Baby and female population region receives all types of qualified specialized medical care in the advisory polyclinic. Inpatient care for women is provided in regional maternity hospitals, regional dispensaries and other medical institutions areas.

Chapter 12

Chapter 12

12.1. GENERAL PROVISIONS

In 2008 in rural health Russian Federation there were 1749 central district hospitals, 481 district hospitals, 39,179 feldsher-obstetric stations, 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 the villagers, the system of settlement, low (compared to the city) population density, poor quality, and sometimes the lack of roads, the specifics of agricultural labor 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 with qualified medical personnel, and the possibility of obtaining specialized medical care. These features also dictate the need to develop and introduce differentiated standards for certain types of resources. For example, for rural areas located in large areas with low population density (the Far North, Siberia, the Far East), the population standard for organizing an obstetric station or a center for general medical (family) practice should be significantly lower than that in the south of the country, where the population density is higher, settlements are located close to each other and there are good transport links.

12.2. INTEGRATED THERAPEUTIC AREA

The main feature of providing medical care to the rural population is its staging. Conventionally, there are three stages in the organization of 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 the complex therapeutic area. At this stage, rural residents receive pre-medical care, as well as the main types of medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).

The first medical institution, which, as a rule, a rural resident turns to is feldsher-obstetric station(FAP). It functions as a structural subdivision of the district or central district hospital. FAP should be organized in settlements with a population of 700 or more at a distance to the nearest medical facility over 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.

The feldsher-obstetric station is entrusted with the solution of a large complex of medical and sanitary tasks:

Carrying out activities aimed at preventing and reducing morbidity, injuries and poisoning among the rural population;

Decrease in mortality, especially infant, maternal, working age;

Provision of pre-medical medical care to the population;

Participation in the current sanitary supervision of preschool and school educational institutions, communal, food, industrial and other facilities, water supply and cleaning of populated areas;

Carrying out house-to-house rounds according to epidemiological indications in order to identify infectious patients, persons in contact with them and persons with suspected 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 for the sale of finished dosage forms and other pharmacy products to the public.

The work of the FAP is directly headed by manager. In addition to him, a midwife and a visiting nurse work at the FAP.

Despite the important role of FAPs, the leading medical institution at the first stage of providing medical care to residents

the village serves local hospital, which in its composition may have a hospital and a medical outpatient clinic. The types and volume of medical care in the district hospital, its capacity, equipment, staffing of medical personnel largely depend on the profile and capacity of other medical institutions that are part of the healthcare system of the municipal district (rural settlement). The main task of the district hospital is to provide the population with primary health care.

Outpatient care for the population is the most important section of the work of the district hospital. She may turn out dispensary as part of the structure of the hospital, and independent. The main task of the outpatient clinic is to carry out preventive measures to prevent and reduce morbidity, disability, mortality among the population, early detection of diseases, medical examination of patients. Doctors of the outpatient clinic receive adults and children, make house calls and emergency care. Paramedics can also take part in the reception of patients, however, medical care in the outpatient clinic should mainly be provided by doctors. In the district hospital, an examination of temporary disability is carried out, and if necessary, patients are sent to the MSE.

In order to bring specialized medical care closer to the villagers, doctors from the central district hospital, according to a certain schedule, go to the outpatient clinic to receive patients and select them, if necessary, for hospitalization in specialized institutions. Recently, in many subjects of the Russian Federation, there has been a process of reorganization of district hospitals and outpatient clinics into centers of general medical (family) practice.

12.3. CENTRAL REGIONAL HOSPITAL

Second phase providing medical care to the rural population - these are health care institutions of the municipal district, and among them the leading place is occupied by central district hospital (CRH). The CRH provides the main types of specialized medical care and at the same time performs the functions of a health management body on the territory of the municipal district.

The capacity of the Central Regional Hospital, the profile of specialized departments in its composition depend on the population, structure and level of care.

leftness, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, CRHs have a capacity of 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatrics, infectious diseases and obstetrics and gynecology (if there is no maternity hospital in the area).

The chief physician of the central district hospital is the head of health care of the municipal district, appointed and dismissed by the administration of the municipal district.

An approximate organizational structure of the central district hospital is shown in fig. 12.2.

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas, paramedics of FAPs is carried out by specialists from central district hospitals. Each of them, according to the approved schedule, goes to the complex therapeutic site for medical examinations, analysis of dispensary work, selection of patients for hospitalization.

In order to bring specialized medical care closer to the rural population, regional medical centers. The functions of such centers are performed by large CRHs (with a capacity of 500-700 beds), capable of providing the population of a given municipal district with the missing types of specialized inpatient and outpatient medical care.

The structure of the Central District Hospital has polyclinic, which provides primary health care to the rural population in the direction of paramedics FAPs, outpatient doctors, centers of general medical (family) practice.

The provision of out-of-hospital and inpatient medical and preventive care to children in a municipal district is entrusted to children's consultations(polyclinics) and children's departments of the central regional hospitals. The preventive and curative work of children's polyclinics and children's departments of district hospitals is carried out on the same principles as in city children's polyclinics.

The provision of obstetric and gynecological care to women in the municipal district is entrusted to women's consultations, maternity and gynecological departments of central district hospitals.

The functional responsibilities of medical personnel, accounting and reporting documentation, and the calculation of statistical indicators of the activity of the Central District Hospital do not fundamentally differ from those in city hospitals and APUs.

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

12.4. REGIONAL (TERIOR, REGIONAL, REPUBLICAN) HOSPITAL

Third stage Providing the rural population with medical care is represented by health care institutions of the subject of the Federation, and among them the main role is played by regional (territorial, district, republican) hospitals. At this stage, specialized medical care is provided in all major specialties.

Regional (regional, district, republican) hospital- This is a large multidisciplinary medical institution, designed to provide full specialized assistance not only to rural residents, but to the entire population of the subject of the Russian Federation. It is a center for organizational and methodological management of medical institutions located in the region (krai, district, republic), and is the basis for the specialization and advanced training of doctors and paramedical personnel.

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

The functional responsibilities of medical personnel, the methodology for calculating statistical indicators, and the accounting and reporting documentation of a regional (regional, district, republican) hospital do not fundamentally differ from those in city or central district hospitals. At the same time, the organization of the work of the regional (regional, district, republican) hospital has its own characteristics. One of these features is the presence in the hospital consultative polyclinic, where residents of all municipal districts (urban districts) of a constituent entity of the Russian Federation come for help. For their accommodation, a boarding house or hotel for patients is organized at the hospital.

As a rule, patients are sent to the advisory polyclinic after a preliminary consultation and examination by district (city) specialist doctors. Patients are hospitalized in the inpatient departments of the hospital, as a rule, according to the referrals of specialists from district, city, central district hospitals, ambulance teams and departments of emergency and planned advisory care.

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

Another feature of the regional (regional, district, republican) hospital is the presence in its composition departments of emergency and planned advisory assistance, which, using the means of air ambulance or ground vehicles, provides emergency and advisory assistance with travel to remote settlements. In addition, the department provides delivery of patients to specialized regional and federal medical centers.

The Emergency and Planned Consultative Care Department works closely with regional center disaster medicine. In case of emergencies practical work brigades of specialized medical care of constant readiness carry out sanitary tasks.

Unlike the Central District Hospital, in the regional (regional, district, republican) hospital functions organizational and methodological department much wider. In fact, it serves as an analytical center and scientific and methodological base for the healthcare management body of a constituent entity of the Russian Federation for the introduction of modern medical and organizational technologies into practice.

The organizational activities of the department include holding regional paramedical (nursing) conferences, summarizing and disseminating the best practices of healthcare institutions, organizing medical examinations of the population, scheduled visits of specialists, publishing instructional and methodological materials, etc.

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

Further ways to improve the organization of medical care for rural residents are to develop a network of general medical (family) practice centers, strengthen the material and technical base and equip inter-district centers based on large central district hospitals with modern medical equipment, provide ambulance stations (departments) with sanitary transport and means of communication , development

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

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

Target: Students must know the system of organizing medical care for the rural population; structure and functions of rural medical institutions.

Net medical organizations providing outpatient and inpatient care to the rural population includes all types of health care institutions. However, the factors that determine the differences between the city and the countryside, the nature of the settlement of residents, the radius of service, the seasonality of work, the impact of weather conditions during field work, the specific conditions of the labor process, the disorder of household activities and living conditions, regional and national characteristics and customs, educational and cultural level, etc. influence the organizational forms and methods of work of rural medical institutions:

Organization of medical social assistance in rural areas, its volume and quality depend on the remoteness of medical institutions from the place of residence of patients, staffing with qualified personnel and equipment, the possibility of obtaining specialized medical care, and the possibility of implementing medical and social security standards. Medical assistance to the rural population is based on the same basic organizational principles of public health as to the urban population.

Conventionally, there are 3 stages of providing medical care to rural residents.

First stage- a rural medical district, which includes a medical center (MP), a medical outpatient clinic (VA) and a district hospital (UB). At this stage, rural residents receive pre-medical and qualified medical care (therapeutic, surgical, obstetric and gynecological, dental, etc.).

Second phase- district medical institutions, where the leading institution is the district hospital (RB) and the central district hospital (CRH). Rural residents receive specialized medical care for its main types. There may be inter-district specialized centers, dispensaries, health centers, etc. The head of the health service is the chief doctor of the district (or district medical association), who also heads the central district hospital. The main regional specialists are determined, whose duties include medical-consultative and organizational-methodical work in the specialty.

There is a SSES center in each regional center. The sanitary and anti-epidemic service of the district is headed by the chief state sanitary doctor of the district, who is the chief physician of the center of the State Sanitary and Epidemiological Service.

Third stage- regional hospital, dispensaries, Dental clinic, the regional center of the State Sanitary and Epidemiological Service, etc. At this stage, highly qualified medical care is provided in all specialties.

The structure of the activities of the primary link of medical care to the rural population.

The rural medical district is the link of the first contact of patients in the system of medical care. Its main task is to provide the population of the site with affordable qualified medical care and to carry out sanitary and anti-epidemic measures. The population on the site is from 5,000 to 7,000 people. The nearest medical institution where a villager goes is a medical center. MP is organized in settlements with the number of inhabitants from 700 to 1000, and at a distance of more than 7 km from the settlement - up to 500 inhabitants.

The main tasks of the MP are the provision of medical pre-hospital care and the implementation of sanitary and 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 MP paramedic provides first aid for acute illnesses and injuries, conducts vaccinations, physiotherapeutic measures, etc. The MP midwife conducts outpatient appointments and provides first aid to gynecological patients and pregnant women, conducts registration and obstetric patronage of pregnant women and women in labor and social patronage of women, conducts treatment control, appointed by an obstetrician-gynecologist, delivers healthy women in labor.

The main medical institution in the rural medical area is the district hospital and outpatient clinic. The nature and volume of medical care in the VA and UB are determined by their capacity, equipment, and the availability of specialist doctors. The provision of outpatient and inpatient care to therapeutic and infectious patients, assistance in childbirth, medical and preventive care for children, emergency surgical and trauma care are the direct duties of the doctors of the district hospital, regardless of its capacity. Depending on its capacity, population and distance to the central district hospital, the VA and UB staff may have doctors in the main specialties (general medicine, pediatrics, dentistry, obstetrics, gynecology and surgery).

The main link in the health care of the rural area is CRH, which provides specialized medical care for its main types and organizational and methodological management of all medical institutions of the district. The CRH has the following structural subdivisions: a hospital with main specialized departments, a polyclinic with consultative appointments of specialist doctors, treatment and diagnostic departments, an organizational and methodological office, an ambulance and emergency medical department and other structural subdivisions (mortuary, catering department, pharmacy and etc.).

The organizational and methodological management of the medical and preventive institutions of the district is carried out by the organizational and methodological office of the Central District Hospital. Its functions include: organizing scheduled visits of medical specialists to rural district hospitals for consultations and providing practical assistance to doctors of these institutions on the organization of medical diagnostic and preventive work; study of the main indicators of the work of medical institutions of the district (morbidity, mortality, infant and general mortality, discrepancy between clinical and pathological diagnoses, etc.); development and implementation of the necessary measures. The organizational method is headed by the deputy chief physician of the Central District Hospital for organizational work.

The main criteria for evaluating the effectiveness of the activities of medical institutions in a rural area are: indicators of the incidence of the population (general, with temporary disability, children), primary disability, mortality, infant mortality; the number of complaints from the population, etc.

The regional hospital provides specialized and highly specialized medical care, is a scientific, organizational, methodological and educational center for healthcare. Its main functions are: providing highly qualified, specialized, advisory and inpatient medical care; provision of organizational and methodological assistance to medical and preventive institutions and emergency medical care by means of air ambulance; management and control over statistical accounting and reporting of medical and preventive institutions of the region; analysis of qualitative indicators of the activity of medical and preventive institutions of the region on the basis of consolidated annual reports; study and analysis of indicators of morbidity, disability, general and infant mortality, development of measures aimed at their reduction; carrying out activities for the specialization and improvement of doctors, paramedical personnel.

The structural subdivisions of the regional hospital are: a hospital, a consultative polyclinic, treatment and diagnostic departments, offices and laboratories, an organizational and methodological department with a medical statistics department, an emergency and planned advisory medical care department. The chief specialists of the health committee (chief surgeon, internist, pediatrician) and freelance regional specialists (most often heads of specialized and highly specialized departments) take part in the organizational and methodological work of medical institutions in the region.

Illustrative material: 10 slides in Power Point.

Literature:

1. Akanov A.A., Kurakbaev K.K., Chen A.N., Akhmetov U.I. Health Organization of Kazakhstan. - Astana. Almaty, 2006. - 232 p.

2. Constitution of the Republic of Kazakhstan.1995.

4. Lisitsyn Yu.P. Public health and health care: Textbook. - 2nd ed., revised. and additional - GEOTAR-Media, 2007. - 512 p.

5. On healthcare in the Republic of Kazakhstan: Basic legislative acts. - Almaty: JURIST, 2004. - 182 p.

6. Sagindykova A.N. Constitutional and legal problems of protecting the health of citizens in the Republic of Kazakhstan. - Almaty, 1997. - 167 p.

8. Statistical Yearbook. Kazakhstan in numbers. 2000-2009.

Control questions:

1. The main features of the organization of medical care for the rural population.

2. Organizations providing medical care to rural residents.

3. general characteristics rural medical area.

4. Feldsher-obstetric station, its main tasks.

5. Indicators of the organizational and methodological work of the regional hospital.

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

1. Rural medical station - unites a rural district hospital, a medical outpatient clinic, feldsher-obstetric points, feldsher points, children's preschool institutions, feldsher health centers at enterprises, dispensaries. At this stage, the rural population can receive qualified medical care. Qualified medical care - medical medical care provided to citizens with diseases that do not require specialized methods of diagnosis, treatment and the use of complex medical technologies.

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

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

102 First stage. Rural medical station includes the following medical institutions: a district hospital with an outpatient clinic (polyclinic) or an independent hospital (medical outpatient clinic, FAP, state farm (collective farm) medical dispensaries, pharmacies, dairy kitchens. All medical and preventive institutions that are part of the rural medical district bring closer primary health care for the rural population and contribute to the successful solution of the tasks of providing this assistance in conditions of considerable remoteness of settlements from district and central district hospitals.

The first stage is a rural medical district, where patients receive qualified medical assistance; the second stage - district medical institutions and the leading institution at this stage is the central district hospital, which provides specialized medical care for its main types; the third stage - regional institutions and, in particular, the regional hospital, which provides highly qualified specialized medical care in almost all specialties.

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

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

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

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

The main tasks of the FAP are:

Providing first aid;

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

Timely and in full implementation of doctor's prescriptions;

Organization of patronage of children and pregnant women;

Systematic monitoring of the health status of war invalids and leading specialists Agriculture;

Taking measures to reduce infant and maternal mortality.

The main medical institution in a rural medical area is a district hospital or an independent medical outpatient clinic (polyclinic).

Regardless of the capacity, any district hospital should provide outpatient and inpatient care to therapeutic and infectious patients, assistance in childbirth, preventive care for children, emergency surgical and trauma care, and dental care.

There are four categories of rural district hospitals: I - 75-100 beds, II - 50-75 beds, III - 35-50 beds, IV - 25-35 beds. The specialization of beds in the SUB depends on their number. Thus, category I hospitals (75-100 beds) should have specialized beds for therapy, surgery, obstetrics, pediatrics, infectious diseases, and tuberculosis. As a rule, such hospitals are equipped with clinical diagnostic equipment. Category IV hospitals (25-35 beds) should have beds for therapy, surgery and obstetrics.

At a rural district hospital, as a department, there should be a mobile outpatient clinic to bring medical care closer.

The main functions of the rural medical district are:

Provision of medical and preventive care to the population;

Carrying out sanitary and anti-epidemic work.

Outpatient medical care is provided to the population of the rural medical district in the district hospital and at feldsher-obstetric stations. SUB doctors conduct outpatient appointments for adults and children, provide home care and emergency care. A rural doctor must be a general practitioner (family doctor), he must continue the traditions of a rural doctor.

In the organization of medical care in the SUB, the following features can be distinguished:

There is no clear time limit for outpatient appointments;

The hours of admission of patients should be appointed at the most convenient time for the population, taking into account the seasonality of agricultural work;

The possibility of receiving a patient by a paramedic in the absence of a doctor for one reason or another;

House calls are carried out by a doctor only in the settlement village, house calls in another settlement of the rural medical district are carried out by a paramedic;

On duty in a hospital with the right to stay at home and the mandatory information of the staff about their whereabouts in case of need for emergency care.

103 Second stage. District medical institutions : central district and so-called zonal district hospitals located on the territory of the district with polyclinics and emergency departments, district dispensaries and other medical institutions

The second stage of medical care for rural residents:

District health care institutions: central district hospital, numbered district hospitals, district center for state sanitary supervision, dispensaries, medical units, etc.

The main link in the system of organizing medical care for rural residents is the central district hospital (CRH), which provides specialized assistance for its main types to residents of the entire region, respectively, of all rural medical districts.

The main tasks of the CRH:

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

Operational and organizational methodological management of health care institutions in the region;

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

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

In addition to the CRH, located in the district center, there may be other district hospitals on the territory of the district, the so-called "numbered" ones, which can serve as a branch of the CRH or specialize in certain types of medical care. On the so-called ascribed plot, i.e. on the site located around the CRH, there is no rural district hospital, its functions are performed by the CRH itself.

The chief physician of the CRH is also the chief physician of the district. In his work on the management of the health care of the district and the central district hospital, the chief physician of the Central District Hospital relies on his deputies;

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

Childhood and obstetrics;

On the medical side;

Organizational forms of leadership:

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

2. The activities of the organizational method of the Central District Hospital.

3. Activity of regional specialists.

The organizational method and doctors of the CRH specialists are used by the chief physician for the organizational and methodological guidance of the district health care institutions, which is carried out by:

Organization of scheduled visits of doctors - specialists to rural district hospitals to consult and provide practical assistance to doctors of these institutions on issues of medical diagnostic and preventive work;

Systematic study by the employees of the organizational method of the office of the main qualitative indicators of the work of the medical institutions of the district - the development on this basis of measures to improve the qualifications of medical personnel.

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

At present, the priority direction in the development of rural health care is the strengthening and improvement of outpatient care: new assigned therapeutic and pediatric areas are being organized, different kinds mobile medical care, in particular mobile medical teams, mobile dental offices and prosthetic laboratories. Much attention is paid to emergency and emergency medical care in rural areas, staffing them with doctors and paramedical personnel, equipping them with modern diagnostic and medical equipment.

104 The third stage. Regional medical institutions : a regional hospital with a consultative clinic and an air ambulance department, dispensaries, a dental clinic, a psychiatric hospital, etc.

Third stage medical care for rural residents - regional health care institutions located in the regional center. The regional hospital is the main institution at this stage. It is a medical, scientific-organizational, methodical and educational center of healthcare in the region. The regional hospital performs the following main functions:

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

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

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

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

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

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

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

Participation in the development of measures aimed at their reduction;

Generalization and dissemination of best practices of medical and preventive institutions of the region on the introduction of new organizational forms of providing medical care to the population, the use of modern methods of diagnosis and treatment;

Carrying out activities for the specialization and improvement of doctors and paramedical personnel of medical institutions of the region;

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

At the regional hospital there should be a boarding house for patients coming from the regions of the region, and a hostel for medical workers coming for various types of specialization.

Department of emergency and planned advisory medical care:

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

Provides transportation of patients to specialized medical institutions of the region and outside the region, urgent delivery of various medical preparations and funds necessary to save the lives of patients, as well as for urgent anti-epidemic measures;

Maintains constant communication with teams sent to provide medical care;

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

Examines the volume and nature of the activities of medical institutions of the region;

Provides organizational, methodological and medical advisory assistance to the health authorities and institutions of the region;

Studying the indicators of the health of the population of the region;

Organizes advanced training of personnel;

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

At regional seminars, conferences, ten days;

At workplaces with a complete separation from work;

On intermittent courses with a partial separation from work;

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

Currently, the following tasks of rural health care and ways to solve them can be distinguished:

1. Getting closer to city health facilities and improving the quality of outpatient care through:

Construction of rural outpatient clinics, the work of general practitioners, family;

Development of a network of assigned therapeutic and pediatric sites;

Expansion of mobile types of medical care.

2. Bring specialized care closer by:

Fortifications of the Central District Hospital;

Creation of interdistrict specialized departments;

Creation of mobile dental offices and dental laboratories.

Organization of medical care for individual

population groups.

Teaching aid for students

(IX semester)

Penza, 2005.

Information sheet:

The educational and methodological manual “Organization of medical care for certain groups of the population” was prepared by the Department of Hygiene, Public Health and Health of the Penza state university(head of the department, candidate of medical sciences Dmitriev A.P.).

The following people took part in the compilation: c.m.s. Zubrianova N.S.

The teaching aid was prepared in accordance with the “Program on “Public Health and Health Care” for students of medical faculties of higher medical educational institutions”, developed by the All-Russian Educational, Scientific and Methodological Center for Continuing Medical and Pharmaceutical Education of the Ministry of Health of Russia and UMCPC and approved by the Head of the Department of Educational Medical Institutions and Personnel Policy N.N. Volodin in 2000

This Study Guide has been prepared for students for self-preparation for practical classes on the specified topic.

TOPIC: Organization of medical care for the rural population. Organization of medical care for employees industrial enterprises. Health protection of women and children.

I. Organization of medical care for the rural population

1. Basic principles of organizing medical care for the rural population.
2. FAP, district hospital, independent medical outpatient clinic.
3. Central Regional Hospital.
4. Regional Hospital.

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

1. The main problems of industrial medicine.
2. Medical and sanitary unit (MSCH)
3. Health center.

4. Workshop doctor.

III. Organization of obstetric and gynecological care:

1. Organization of work of women's consultation.
2. The main sections of the work of the local obstetrician-gynecologist
3. Accounting and reporting in the antenatal clinic.
4. Organization of inpatient obstetric and gynecological care.
5. Analysis of the activities of the maternity hospital.

IV.Organization of medical and preventive care for children:

1. Organization of the work of the children's clinic.
2. Preventive work of the children's polyclinic
3. Therapeutic work of the children's clinic
4. Anti-epidemic work of the children's polyclinic
5. Performance indicators of the children's polyclinic
6. Children's preschool institutions. Schools, boarding schools, holiday camps.
7. Organization of inpatient care for children.

V. Medical assistance to women and children living in rural areas.

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

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

Qualification tests in social hygiene and healthcare organization. Ed. O.P. Shchepin and A.I. Vyalkov.

THEORETICAL PART:

I. Organization of medical care for the rural population

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

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

There are the following 3 stages of providing medical care to rural residents :

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

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

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

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

The nearest medical facility where rural residents seek medical assistance is the feldsher-obstetric station (FAP). It plays an important role in common system organization of medical care for the rural population. The presence of FAP is one of the features of rural health care, due to the need to bring medical care closer to the population with a large service radius of the district hospital and a low density of rural residents.

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

Main tasks feldsher-obstetric station in accordance with the order of the Ministry of Health of the USSR No. 1000 (1981) are:

Providing first aid;

Compliance with all doctor's orders in a timely manner;

Organization of patronage of children and pregnant women;

Systematic monitoring of the health status of war invalids and leading agricultural specialists;

Carrying out activities to reduce child and maternal mortality;

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

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

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

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

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

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

The main functions of the rural medical site are the provision of therapeutic and preventive care and the conduct of sanitary and anti-epidemic work.

The most widespread type of medical care is outpatient. Assistance is provided by doctors of the district hospital and paramedics of feldsher-obstetric stations. The doctors of the hospital conduct outpatient appointments for adults and children, provide home care and emergency care. A rural doctor is essentially a general practitioner(family doctor).

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

There is no clear time limit for outpatient appointments;

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

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

Calls to the house in the settlement village (where the district hospital is located) are received by a doctor; in other settlements - a paramedic;

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

On duty in a hospital with the right to stay at home and with the obligatory notification of staff about their whereabouts in case of need for emergency care.

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

The second stage of medical care rural residents includes district health facilities, which include:

Central regional hospital;

Numbered district hospitals;

Center for State Sanitary and Epidemiological Surveillance of a rural area;

TB Dispensary;

Medical department, etc.

As a rule, district medical institutions are located in the district center (city or village). The main link in the system of organization of medical care is central district hospital (CRH), which provides specialized assistance in its main areas to residents of the entire region, respectively, all rural medical districts. In accordance with the order of the Ministry of Health of the Russian Federation No. PO dated April 9, 1998, the CRH was entrusted with the functions of the health management body of the rural administrative district. In addition, the Central District Hospital carries out organizational and methodological management of the district's medical institutions.

Among the main tasks of the CRH should be mentioned:

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

Operational and organized methodological management of health care institutions in the region;

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

Development and implementation of measures to improve the quality of medical assistance and improve the health of the population.

Exists 6 categories of CRH depending on the number of deployed beds (from 400 to 100 beds). Average bed capacity of CRH located in urban settlements, approximately 270 beds, and in rural settlements - 165 beds.

In addition to the CRH located in the district center, there may be other district hospitals on the territory of the district, the so-called number hospitals, which can serve as a branch of the CRH or specialize in certain types of medical care. It should be pointed out that in the so-called ascribed area, i.e. in the area located around the CRH, there is no need for a rural district hospital, since the CRH itself performs its functions.

Chief Physician of the CRH is at the same time the chief physician of the district, whose functions include:

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

Managing the activities of all medical institutions of the district;

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

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

As a rule, under the chief physician of the CRH, medical advice.

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

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

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

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

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

The need for such departments arises if the CRHs of the surrounding areas are not able to provide qualified medical care in this specialty. The assignment of the functions of an inter-district specialized medical and preventive department to the corresponding department of the hospital and the attachment of the corresponding population of rural areas to it is carried out by a higher health authority, taking into account geographical location, economic relations, the state of transport communication.

Currently the priority direction in the development of rural health care is the strengthening and improvement of outpatient care: new assigned therapeutic and pediatric medical sites are being organized, various types of mobile medical care are being developed, in particular mobile medical teams, mobile dental offices and prosthetic laboratories. Much attention is paid to the organization of emergency and emergency medical care, the staffing of doctors and paramedical personnel, the provision of modern diagnostic and medical equipment, the provision of off-road ambulance transport, telephone and radio communications.

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

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

Organizational and methodological assistance to medical and preventive institutions of the region;

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

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

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

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

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

Participation in the development of measures aimed at their reduction;

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

Carrying out activities for the specialization and improvement of doctors and paramedical personnel of medical institutions of the region.

Thus, the regional hospital is a medical, scientific, organizational, methodological and educational center for the health care of the region.

Bed capacity regional hospital depends on the population of the region. There are 5 categories of regional hospitals depending on the bed capacity (from 300 to 800 beds or more). The most profitable regional hospitals for 700-1000 beds with all specialized departments, however, in each hospital, regardless of its capacity, there should be the following structural units: hospital; advisory polyclinic; medical and diagnostic departments; laboratory; organizational and methodological department with an office of medical statistics; department of emergency and planned advisory assistance.

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

Advisory polyclinic should be staffed by experienced highly qualified medical specialists who are able to provide patients referred and .; medical institutions of the region, qualified consultation to establish or clarify the diagnosis, determine further treatment and the need for hospitalization. The work of the advisory polyclinic is planned, for which a certain number of vouchers are sent to the medical and preventive institutions of the region, taking into account the capacity of the polyclinic. The rational distribution of vouchers will make it possible to fill the lack of specialized medical care in the regions.

Patients referred to the advisory polyclinic should be examined as much as possible on the spot with the results of the research being handed over to them. Violation of this rule contributes to the delay of the patient in the regional center. A consultant from the regional hospital leaves on the call of regional specialists in cases where the patient's condition does not allow him to be transported to the regional center

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

The polyclinic systematically analyzes cases of discrepancies in diagnoses, mistakes made by doctors during the examination and treatment of patients on the spot, and also compiles business reviews and information letters to improve medical and diagnostic work in medical institutions of the region.

Department of Emergency and Planned Consultative Medical Care provides on-site assistance on calls from the districts and provides transportation of patients to specialized medical institutions not only in the region, but also outside it, urgent delivery of various medical preparations and funds necessary to save the lives of patients, as well as for urgent anti-epidemic measures. In addition, the department maintains constant communication with the teams sent to provide medical care. To do this, use the means of air ambulance or ground transport - depending on the severity of the disease, distance, road conditions, weather, season, etc.

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

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

Each department plays the role of an organizational and methodological center for the medical and preventive institutions of the region. Organizational and methodological work, which is an integral part of the activities of all departments of the hospital, is coordinated by the organizational and methodological department, which, in addition, studies the scope and nature of the activities of the medical institutions of the region, provides organizational, methodological and medical advisory assistance to the health authorities and institutions of the region; studies the indicators of the health of the population of the region; organizes professional development of personnel.

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

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