Home Wisdom teeth Work plan of the local doctor of the clinic. Organization of activities of a local physician-therapist

Wisdom teeth

Work plan of the local doctor of the clinic. Organization of activities of a local physician-therapist

We are publishing the full text of the Appeal from 18 local therapists about the failure of the “Moscow Standard Polyclinic” project in the 4th branch of State Budgetary Institution No. 180.

To the head doctor
GBU GP 180 DZM
Vechorko V.I.

Collective appeal

We, doctors and nurses of the State Budgetary Institution 180 DZM, draw your attention to the fact that the Moscow Standard Polyclinic project, implemented under the pretext of “health care optimization” in the State Budgetary Institution 180 DZM, in fact led to a catastrophic situation with the quality of medical care. Changes within the framework of the above project led to the destruction of the fundamental principles of the functioning of the outpatient clinic, namely:

1. The local principle of providing medical care has been destroyed - assigning doctors to certain areas. Caring for a patient by one doctor allows you to effectively assess the dynamics of the clinical condition, monitor the effectiveness of therapy and be completely immersed in a specific case. The abolition of this principle is destructive, since patients, including with “acute pathology” they come for an appointment with the doctor on duty, who often sees them for the first and last time.

2. As part of the project, recording was introduced through the EMIAS system on the “all to all” principle, visits to patients at home by dedicated “mobile teams” were organized, which led to the fact that the patient is often monitored and treated during the course of the disease different people, the overall picture of perceiving the course of the disease and tracking the dynamics of the condition disappears, which leads to a decrease in the effectiveness of treatment and a negative reaction from patients who are not always able to make an appointment with their doctor who is treating a specific case of the disease.

3. The participation of a local nurse in the process of receiving a local therapist is regulated by the provisions of the order of the Minister of Health and social development dated June 21, 2006 No. 460 “On the organization of the activities of a district nurse.” According to the order, the local nurse, among other things, organizes an outpatient appointment with the local general practitioner, prepares equipment and instruments for work, and provides assistance in the preparation and maintenance of relevant documentation. The participation and assistance of a nurse in the admission process allows the local therapist to focus on working with the patient and increase the efficiency of using working time. We also draw your attention to the fact that the participation of m/s is an integral, integral part healing process both in each specific case and throughout working hours. However, within the framework of the project, all the working hours of the district nurse are devoted to routing patients, the work of the duty administrator, the work of a consultant at the terminal, and work at the reception desk to collect the cards of patients who have previously made an appointment with doctors, which does not leave time for managing the medical area together with the doctor. - local therapist. This not only contradicts employment contracts and the nurse’s job responsibilities, but also radically affects the effectiveness of the work of the local physician.

4. I remind you that in our institution there are standards of 12 minutes per patient appointment, during which it is extremely difficult to simultaneously devote time to both the patient and the independent preparation of medical documentation. Please note that the workload standards for doctors introduced by Order No. 5/1 of 01/09/2015 at City Clinic No. 180 do not correspond to the standards approved by the Ministry of Health of the Russian Federation, and therefore must be changed and brought into line with the standards approved by Order No. 290n.

5. There are no regulations for working with patients with limited mobility. Before the project, the local physician at EMIAS was allocated 2 hours of working time per day to handle calls and monitor low-mobility patients at home.

6. At the same time, within the framework of the “mobile teams” project, since June 2015 they have been working at home with acute cases, periodically visiting patients with limited mobility, not calling a doctor, not provided. The allocation of time to local doctors for (1 hour every 2 days) patronage of patients with limited mobility began only in February 2016.

With such an organization of the treatment process, in addition to a radical decrease in efficiency, there is a decrease in the population’s satisfaction with the quality of the medical services provided, and other risks arise and are realized:

1. District nurses, with appropriate education and special skills, on the preparation of which both their personal time and public funds were spent, in fact, are engaged in tasks that do not require special skills and knowledge, which leads to a feeling of decreased self-worth and professional degradation. The elimination of the “registry” with the transition to the work of nurses in the format of a nursing station reduces the “protection of personnel” and makes it impossible to comply with the law on medical confidentiality. As a result, there were cases of spitting, humiliation, threats, and the use of measures physical impact from the patients... In addition, nurses are the “first line” when communicating with patients, not protected by windows, which imposes additional “biological” risks. Quantitatively, one nurse at a nursing station processes ~100 people in 6 hours of work, which leads to a constant stressful workload.

2. District doctors work within strict time limits (12 minutes per appointment for 1 person, taking into account the preparation of appropriate medical documentation). At the specified time, without the help of a nurse, it is impossible to devote the necessary time to the patient and at the same time complete high-quality medical documentation, which can lead to a deterioration in the quality of the process. No additional time is allocated for work. As a result of heavy workloads, there have been a few cases of emergency calls for employees during working hours, followed by emergency hospitalization. As of 02/24/2016, in branch No. 4 the number of local doctors is 12 people (including 2 heads) for 22 sites, excluding those on training, on vacation and on sick leave.

There are violations of current legislation and current regulations:

1. Actual job responsibilities nurses contradict the provisions of the order of the Minister of Health and Social Development of June 21, 2006 No. 460 “On the organization of the activities of a district nurse” and the current job descriptions.

2. The actual organization of “nursing posts” leads to a violation of the Constitution of the Russian Federation, Part 1, Article 23, Part 2, Article 24; Part 1 of Article 150 of the Civil Code of the Russian Federation; Article 4, as well as paragraph 7.5 of Article 19 of the Federal Law Russian Federation dated November 21, 2011 “Law on protecting the health of citizens in the Russian Federation.” since patients will have to publicly, in the presence of other patients, tell the medical staff, whose workplace is organized in the corridor, about the state of their health. In addition, organizing workplaces in corridors is an infringement of the rights of staff.

3. The standard size of the population supervised by a doctor has been violated, no more than 1900 people per site. The approximate number of the population attached to the branch is 65 thousand people per 10 local physicians, which is more than 3 times the standard load

4. Cases of lengthening the appointment time to 8 hours a day or more transfer the local doctor to the category of a doctor who provides exclusively outpatient appointments. In accordance with the Decree of the Government of the Russian Federation of February 14, 2003 No. 101 “On the working hours of medical workers depending on their position and (or) specialty,” the following reduced working hours are established for medical workers conducting outpatient visits, depending on from their position and (or) specialty: 33 hours per week - according to the list according to Appendix No. 2.

The above process optimization and constant stress load led to a 2-fold reduction in the number of local physicians in the example of branch No. 4 based on the results of the last 12 months.

In connection with the above, we demand that the work regulations of the district physician and district nurse be brought into compliance with the current ones regulations, namely:

1. Take measures to eliminate violations of the law in the State Budgetary Institution “City Clinic No. 180 DZM”
2. Issue an order bringing the standards for patient admission in accordance with the requirements of the Ministry of Health.
3. Restore joint appointments between the district physician and the district nurse
4. Establish an appointment based on the duration of the working week of 33 hours in accordance with the Decree of the Government of the Russian Federation of February 14, 2003 No. 101 “On the duration of working hours of medical workers depending on their position and (or) specialty”, for medical workers leading outpatient appointment, the following reduced working hours are established depending on their position and (or) specialty: 33 hours per week - according to the list in accordance with Appendix No. 2.
5. For violation of labor laws - bring the perpetrators to justice officials to disciplinary liability
6. For violation of the rights of citizens to provide quality medical care, bring the guilty officials to appropriate disciplinary liability
7. Bring numbers into line medical personnel according to the number of sites and assigned patients based on common sense and in accordance with current regulations.
8. Ensure mandatory daily allocation of time for the local physician to visit low-mobility patients according to the plan
9. Provide the local physician with separate time for maintaining medical records

Please send your response in writing to the chairman of the trade union committee of the primary trade union organization MPRZ "Action" Chatskaya E.A. during 14 calendar days by the address:

Signatures of 18 employees of the 4th branch of the State Budgetary Institution 180 DZM on 2 sheets.

Appointments at the clinic and home visits by a therapist are carried out in accordance with a schedule that should ensure the availability of medical care, including on holidays and weekends. The schedule includes hours for outpatient visits, home care, preventive and other work.

The local physician is, as a rule, the first doctor to whom the population of the district turns for medical help. He is obliged to provide ( content of the work of a local therapist):

Timely qualified therapeutic assistance in the clinic and at home;

Timely hospitalization of therapeutic patients with mandatory examination during planned hospitalization;

If necessary, consultation of patients with the head of the department and doctors of other specialties;

Examination of temporary disability;

Organization and implementation of a set of medical examination measures;

Issuing conclusions to those undergoing a medical examination;

Organization and implementation of preventive vaccinations and deworming of the population;

Emergency medical care for patients regardless of their place of residence.

Infectious diseases department of the clinic. Sections and methods of work of a doctor in the office of infectious diseases.

The main tasks (sections and methods of work) of the infectious diseases office:

Ensuring timely and early detection and treatment of infectious patients;

Study and analysis of the dynamics of infectious morbidity;

Dispensary observation of convalescents and bacteria carriers;

Promoting knowledge on the prevention of infectious diseases.

The procedure for obtaining and storing vaccination preparations. Upon receipt of applications, the Center for State Examination draws up a consolidated updated plan for preventive vaccinations for given year for all medical and preventive institutions in the region. The clinic receives bacterial medications from the Center for State Examination in accordance with the submitted application. Vaccines must be strictly registered and stored under certain conditions, regulated by the instructions attached to each drug.

Basic documentation of the infectious diseases office:

a) accounting:

Control card of dispensary patient 030/u;

Emergency Notice about an infectious disease, acute occupational poisoning, an unusual reaction to vaccination 058/u;

Journal of infectious diseases 060/у;

b) reporting:

Report on preventive vaccinations f. No. 5 – submitted to the Center for State Examination;

Report on the movement of vaccination preparations f. No. 20 – submitted to the Center for State Examination;

Report on the movement of infectious diseases;

A report on the examination of patients for diphtheria is submitted to the Center for State Examination.

Preventive work of the clinic. Organization of preventive examinations. Dispensary method in the work of the clinic, its elements. Control card of dispensary observation, information reflected in it.

A distinctive feature of medical care provided in clinics is the organic combination of therapeutic and preventive work in the activities of all doctors of this institution.

3 main directions in preventive doctor:

a) sanitary education work- when communicating with each patient, the principles of a healthy lifestyle and regime for a specific disease, the basics of rational and therapeutic nutrition, the harm of smoking and alcohol abuse and other sanitary and hygienic aspects should be explained to him; The doctor also gives lectures in clinics and at enterprises, issues health bulletins and other information materials, etc.

b) grafting work- carried out under the guidance of immunologists by infectious disease specialists and local therapists of the clinic (in last years There is an urgent need for universal vaccination of the adult population against diphtheria)

V) clinical examination (dispensary method) is a method of active dynamic monitoring of the health status of the population, aimed at strengthening health and increasing working capacity, ensuring proper physical development and preventing diseases through a complex of therapeutic and health-improving and preventive measures. The dispensary method of operation of health care facilities most fully expresses the preventive orientation of health care.

Contingents subject to medical examination, include both healthy and sick people.

Group 1 (healthy) includes:

Persons who, due to their physiological characteristics, require systematic monitoring of their health (children, adolescents, pregnant women);

Persons exposed to adverse factors in the working environment;

Decreed contingents (food workers, public utility workers, public and passenger transport workers, personnel of children's and medical institutions, etc.);

Special contingents (persons affected by the Chernobyl disaster);

Disabled people and participants of the Great Patriotic War and contingents equivalent to them.

Clinical examination healthy aims to preserve health and ability to work, identify risk factors for the development of diseases and their elimination, prevent the occurrence of diseases and injuries through the implementation of preventive and health-improving measures.

Group 2 (patients) includes:

Sick chronic diseases;

Convalescents after some acute diseases;

Patients with congenital (genetic) diseases and developmental defects.

Clinical examination sick provides for early detection of diseases and elimination of the causes contributing to their occurrence; prevention of exacerbations, relapses, complications; preservation of working capacity and active longevity; reducing morbidity, disability and mortality through the provision of comprehensive qualified medical care, health and rehabilitation measures.

Medical examination tasks:

identification of persons with risk factors and patients with early stages diseases by conducting annual preventive examinations of mandatory contingents and, if possible, other groups of the population;

active monitoring and rehabilitation of patients and persons with risk factors;

examination, treatment and rehabilitation of patients according to their appeal, dynamic monitoring of them;

creation of automated information systems and data banks for dispensary registration of the population.

Stages of clinical examination:

1st stage. Registration, examination of the population and selection of contingents for registration at the dispensary.

a) registration of the population by area by conducting a census of the average medical worker

b) survey of the population to assess health status, identify risk factors, and early detection of patients.

Identification of patients is carried out during preventive examinations of the population, when patients seek medical care in health care facilities and at home, during active calls to the doctor, as well as during special examinations regarding contacts with an infectious patient.

Distinguish 3 types of preventive examinations.

1) preliminary- carried out to persons entering work or study in order to determine the suitability (suitability) of workers and employees for their chosen job and identify diseases that may be contraindications for work in this profession.

2) periodic- carried out to persons in a planned manner at a specified time for certain groups of the population and with the current appeal for medical help to medical institutions.

To contingents subject to mandatory periodic inspections, relate:

Workers of industrial enterprises with harmful and dangerous working conditions;

Workers of leading professions in agricultural production;

Decreed contingents;

Children and teenagers, young men of pre-conscription age;

Students of vocational schools, technical schools, university students;

Pregnant women;

Disabled people and participants of the Great Patriotic War and equivalent contingents;

Persons affected by the Chernobyl disaster.

For the rest of the population, the doctor must use each patient's appearance at a medical facility to conduct preventive examination.

3) target- carried out for early detection of patients certain diseases(tuberculosis, malignant neoplasms, etc.)

The main forms of preventive examinations are

A. individual- are carried out:

According to the population’s appeal to health care facilities (for a certificate, for the purpose of obtaining a sanatorium-resort card, in connection with a disease);

When actively calling persons served by the clinic for dispensary examination to the clinic;

When doctors visit patients with chronic diseases at home;

Among persons undergoing treatment in a hospital;

When examining persons who were in contact with an infectious patient.

This is the main form of medical examinations of the unorganized population.

b. massive- are carried out, as a rule, among organized groups of the population: children of preschool and school institutions, young men of pre-conscription age, students of secondary specialized institutions and university students, workers and employees of enterprises and institutions. Mass preventive examinations, as a rule, are comprehensive and combine periodic and targeted ones.

Inspections of organized teams are carried out on the basis of agreed schedules and are regulated by relevant orders of the Ministry of Health.

Data from medical examinations and the results of examinations performed are recorded to medical records(“Medical record of an outpatient”, “ Individual card pregnant and postpartum women”, “History of child development”).

Based on the results of the examination, a conclusion is given on the state of health and a determination is made. observation group:

a) group “healthy” (D1)– these are persons who do not complain and whose history and examination do not reveal any deviations in their state of health.

b) group “practically healthy” (D2) – persons with a history of chronic diseases without exacerbations for several years, persons with borderline conditions and risk factors, often and long-term illnesses, convalescents after acute diseases.

c) group “chronic patients” (D3):

Persons with a compensated course of the disease with rare exacerbations, short-term loss of ability to work, which does not interfere with the performance of normal labor activity;

Patients with a subcompensated course of the disease, who experience frequent annual exacerbations, prolonged loss of ability to work and its limitation;

Patients with a decompensated course of the disease who have stable pathological changes, irreversible processes leading to permanent loss of ability to work and disability.

When a disease is detected in the person being examined, the doctor fills out a statistical coupon (form. 025/2-u); makes notes about the state of health in the medical record of an outpatient (f.025/u). Persons classified in the third health group are registered at the dispensary by a local doctor or medical specialist. When taking a patient to the dispensary register, a control card of dispensary observation (f.030/u), which is kept by the doctor performing dispensary observation of the patient. The control chart indicates: name of the doctor, date of registration and deregistration, reason for deregistration, disease for which he was taken under dispensary observation, number outpatient card the patient, his last name, first name, patronymic, age, gender, address, place of work, doctor’s attendance, records of changes in the initial diagnosis, concomitant diseases, a set of treatment and preventive measures.

Conducting a preventive examination without subsequent therapeutic, health-improving and preventive measures does not make sense. Therefore, for each dispensary patient, a dispensary observation plan is drawn up, which is noted in the dispensary observation control chart and in the outpatient medical record.

2nd stage. Dynamic monitoring of the health status of those being examined and carrying out preventive and therapeutic measures.

Dynamic observation of the person being examined is carried out differentiated according to health groups:

a) monitoring of healthy people (group 1) - carried out in the form of periodic medical examinations. Mandatory populations undergo annual examinations according to the plan within the established time limits. In relation to other contingents, the doctor must make the most of any patient’s appearance at the medical facility. In relation to this group of the population, health-improving and preventive measures are carried out aimed at preventing diseases, promoting health, improving working and living conditions, as well as promoting a healthy lifestyle.

b) monitoring of persons classified in group 2 (practically healthy) is aimed at eliminating or reducing risk factors for the development of diseases, correcting hygienic behavior, increasing the compensatory capabilities and resistance of the body. Monitoring patients who have suffered acute diseases is aimed at preventing the development of complications and chronicity of the process. The frequency and duration of observation depend on the nosological form, the nature of the process, possible consequences(after acute tonsillitis, the duration of medical examination is 1 month). Patients with acute diseases, having high risk chronicity and development severe complications: acute pneumonia, acute tonsillitis, infectious hepatitis, acute glomerulonephritis and others.

c) observation of persons classified in group 3 (chronic patients) is carried out on the basis of a plan of treatment and health measures, which provides for the number of clinical visits to the doctor; consultations with specialist doctors; diagnostic studies; drug and anti-relapse treatment; physiotherapeutic procedures; physical therapy; dietary food, Spa treatment; sanitization of foci of infection; planned hospitalization; rehabilitation measures; rational employment, etc.

Dispensary group of patients with chronic diseases, subject to dispensary observation by general practitioners are patients with the following diseases: Chronical bronchitis, bronchial asthma, bronchiectasis, lung abscess, hypertonic disease, NCD, IBS, peptic ulcer stomach and duodenum, chronic gastritis with secretory insufficiency, chronic hepatitis, cirrhosis of the liver, chronic cholecystitis and cholelithiasis, chronic colitis and enterocolitis, nonspecific ulcerative colitis, urolithiasis disease, chronic glomerulonephritis, chronic pyelonephritis, osteoarthritis, rheumatism, rheumatoid arthritis, often and for a long time ill. If there are doctors of narrow specialties in the clinic, specialized patients, depending on age and stage of compensation, can be under dispensary observation from these specialists.

A group of dispensary patients subject to dispensary observation by a surgeon, are patients with phlebitis and thrombophlebitis, varicose veins veins of the lower extremities, post-resection syndromes, chronic osteomyelitis, endarteritis, trophic ulcers, etc.

During dynamic observation, planned activities throughout the year are carried out, adjusted, and supplemented. At the end of the year, a staged epicrisis is filled out for each person undergoing medical examination, which reflects the following points: the initial condition of the patient; carried out medical and recreational activities; dynamics of the disease; final assessment of health status (improvement, deterioration, no change). The epicrisis is reviewed and signed by the head of the department. For convenience, many health care facilities use special forms such as “dispensary observation plan-epicrisis”, which are pasted into the medical record and can significantly reduce the time spent on documentation.

3rd stage. Annual analysis the state of dispensary work in health care facilities, assessing its effectiveness and developing measures to improve it (see question 51).

Carrying out clinical examination of the population is regulated by the following documents:

1. Order of the Ministry of Health of the Republic of Belarus No. 10 dated January 10, 1994 “On mandatory medical examinations of workers employed in harmful and dangerous working conditions” (Appendix 1).

2. Order of the Ministry of Health of the Republic of Belarus No. 159 dated October 20, 1995 “On the development of integrated prevention programs and improvement of the clinical examination method” (Appendix 2).

3. Order of the Ministry of Health of the Republic of Belarus No. 159 dated June 27, 1997 “On the implementation of the integrated prevention program non-communicable diseases(CINDY) in the Republic of Belarus."

Related information.

Provides qualified medical care in its specialty, using modern methods of prevention, diagnosis, treatment and rehabilitation, approved for use in medical practice. local doctor clinic

Determines the tactics of patient management in accordance with established rules and standards.

Develops a plan for examining the patient, clarifies the scope and rational methods of examining the patient in order to obtain complete and reliable diagnostic information in the shortest possible time.

Based on clinical observations and examination, anamnesis, data from clinical, laboratory and instrumental studies, establishes (or confirms) a diagnosis.

In accordance with established rules and standards, appoints and supervises necessary treatment, organizes or independently carries out the necessary diagnostic, therapeutic, rehabilitation and preventive procedures and measures.

Makes changes to the treatment plan depending on the patient's condition and determines the need for additional examination methods.

Provides advisory assistance to doctors of other departments of health care facilities in their specialty.

Supervises the work of the nursing and junior medical personnel subordinate to him (if any), assists them in the performance of their official duties.

Monitors the correctness of diagnostic and medical procedures, operation of tools, apparatus and equipment, rational use reagents and medications, compliance with occupational safety and health regulations by nursing and junior medical personnel.

Participates in conducting training courses for medical personnel.

Plans his work and analyzes his performance indicators.

Ensures timely and high-quality execution of medical and other documentation in accordance with established rules.

Conducts sanitary education work.

Complies with the rules and principles of medical ethics and deontology.

Participates in the examination of temporary disability and prepares Required documents for medical and social examination.

Qualifiedly and timely executes orders, instructions and instructions from the management of the institution, as well as regulations in its own way professional activity.

Complies with internal regulations, fire and safety regulations, and sanitary and epidemiological regulations.

Promptly takes measures, including timely informing management, to eliminate safety, fire and safety violations sanitary rules posing a threat to the activities of a healthcare institution, its employees, patients and visitors.

Systematically improves his skills.

Participation of a doctor in the work of a medical commission:

Determines signs of temporary disability based on assessment and state of health, nature and working conditions, social factors;

Determines the period of incapacity for work;

Issues a certificate of incapacity for work;

Timely refers the patient to a medical commission for consultation and extension of the certificate of incapacity for work;

Identifies signs of permanent disability and promptly refers for medical and social examination;

Analyzes the causes of PVD and initial disability, takes part in the development and implementation of measures to reduce them.

Number of patients under medical supervision by a doctor:

table 2

Table 3.

Structure of dispensary patients

Figure 2. Dynamics of the number of patients under dispensary registration.

Conclusion: Based on the presented data, we see the dynamics of a decrease and then an increase in the number of patients registered at the dispensary, in the structure of dispensary patients, a large number are accounted for by cardiovascular diseases, then urinary, respiratory, digestive systems and blood diseases, respectively.

Figure 3. Structure of diseases of dispensary patients.

Sanitary educational work of the local physician-therapist:

Every month, the local general practitioner gives two lectures on site and two to four lectures in the clinic. Or publishes one health bulletin per month. Individual explanatory conversations with the patient are also carried out, patients are introduced to new drugs using advertising booklets, conversations promoting a healthy lifestyle and rational nutrition.

The local doctor is obliged to: prescribe laboratory, X-ray and other tests to the patient, conduct appropriate preparatory treatment, consult the patient with the head therapeutic department and from doctors of other specialties. The test results must be transferred to the hospital along with the “outpatient medical record” or with an extract from it.

A local general practitioner studies the conditions and lifestyle of the residents of his district: when visiting them at home and at an appointment at a clinic, finding out whether there are bad habits in patients - smoking, alcohol, drugs; nutritional balance; place of work, working conditions and recreation. It is also important to identify contacts of patients with infectious patients and various chemical and biological reagents. An assessment of living conditions can be partially carried out when visiting patients at home, noting the arrangement of the area and the interior of the patient’s home.

Documentation maintained by the local general practitioner

Table 4.

	Form name		Shelf life
	Outpatient medical record
	Dispensary observation checklist
	Card of preventive fluorographic examinations
	Vaccination card
	Vaccination log book
	Book of doctors' house calls
	Help for obtaining a voucher
	Sanatorium-resort card
	Medical certificate (to be presented to the relevant territorial division of the State Traffic Safety Inspectorate of the Ministry of Internal Affairs of the Russian Federation)
	Notebook for recording work at home for a local (patronage) nurse (midwife)
	Record sheet of medical visits in outpatient clinics, at home
	Referral to hospitalization rehabilitation treatment, examination, consultation
	Referral to ITU
	Extract from the medical record of an outpatient or inpatient patient
	Procedure log
	Emergency notification of an infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination
	Notification of a patient diagnosed for the first time in his life: syphilis, gonorrhea, trichomoniasis, chlamydia, uronetile herpes, anogenital warts, microsporia, favus, trichophytosis, mycosis of the feet and hands, onycomycosis, scabies.
	Logbook clinical expert work clinics
	Journal of clinical expert work of the clinic (medical and social examination)
	Book of registration of certificates of incapacity for work
	Medical death certificate (with counterfoil)		Certificate stubs 3 years
	Prescription form
	Prescription form
	Prescription form
	A prescription for the right to receive a medicine containing a narcotic substance
	Logbook of prescription forms form No. 107/у in the clinic
	Logbook for special prescription forms for narcotic drugs and psychotropic substances
	Logbook of prescription forms form No. 148-1/u-88 in the clinic
	Register of prescription forms, form No. 148-1/u-04(l)
	Register of admission of patients and refusal of hospitalization
	Inpatient medical record
	Patient card of a day hospital of a polyclinic, hospital at home, hospital day stay hospital
	Temperature sheet
	Statistical map of those leaving the hospital
	Sheet for recording the movement of patients and hospital beds
	Referral to consultation and auxiliary rooms
	Journal of sanitary education work
	Medical opinion on transfer of a pregnant woman to another job
	Passport of the medical district of citizens entitled to receive a set of social services
	Information on medicines prescribed and dispensed to citizens entitled to receive social services
	Medical certificate for applicants to universities, colleges, colleges
	Map of dynamic monitoring of patients with arterial hypertension
	Outpatient voucher

A local general practitioner analyzes the morbidity rate of the population of his district as follows:

Market report - incidence rates for three years;

Accounting for attendance and morbidity of the population of the site - indicators for 1 month.

Increasing the amount of time per patient;

Improving the material and technical base, in particular the provision of transport when providing assistance at home, the introduction of a common computerized base for the population served.

Key performance indicators of a local physician-therapist

Average population per 1 therapeutic area

For 2012 = 2195 people

For 2011 = 2183 people

Conclusion: from 2011 to 2013 there was a positive population growth, and therefore, the average population in one area increased from 2183 to 2200 people

Average number of doctor visits per 1 resident

For 2012 = 4.7 visits

For 2011 = 4.6 visits

Conclusion: from 2011 to 2013, there is a trend towards an increase in medical visits per 1 resident, and the average number of medical visits per 1 resident is significantly higher than the norm (with the norm being 2.7)

Staffing level (only for full-time positions of doctors)

For 2012 = 97%

For 2013 = 95.4%

Conclusion: from 2011 to 2013, there was an increase in staffing (from 95.4% to 98.2%), due to the employment of young specialists. Staffing levels are above normal, a good indicator for a district clinic.

For 2012 = 4404 visits

For 2011 = 4567 visits

Conclusion: from 2011 to 2013, there was a decrease in the number of visits, due to the unloading of medical positions by young specialists.

Participation in appointments with local general practitioners

For 2012 = 80%

For 2011 = 82%

Conclusion: from 2011 to 2013, there was a decrease in the frequency of visits to local general practitioners.

Local home care for local physicians and therapists

For 2012 = 98%

For 2011 97.4%

Conclusion: From 2011 to 2013, home care coverage remained at 98%.

Complete coverage of the population with medical examinations

For 2012 = 96%

For 2011 = 95%

Conclusion: From 2011 to 2013, there was an increase in the coverage of the population with medical examinations, which indicates an improvement in the work of the local doctor

Share of preventive visits to the clinic

For 2012 = 10%

For 2011 = 11%

Conclusion: From 2011 to 2013 there was an increase specific gravity preventive visits to the clinic, needs to be increased

Complete coverage of the population with dispensary observation

Conclusion: from 2011 to 2013, the completeness of population coverage with dispensary observation remains unchanged and in this case is optimal.

Lecture on the topic: “Rational human nutrition”

local doctor clinic food

Since ancient times people have understood great value nutrition for health. I. I. Mechnikov believed that people age prematurely and die due to poor nutrition and that a person who eats rationally can live 120-150 years. Health and nutrition are closely interconnected. Substances that enter the body with food affect our state of mind, emotions and physical health. Our food largely depends on the quality of our food. physical activity or passivity, cheerfulness or depression. And it was not for nothing that the ancients said that “a person is what he eats.” Everything that we are - our appearance, the condition of our skin, hair, etc. - is determined by the combination of various substances that make up our body

Biological laws of nutrition

Medical science has revealed the biological laws of nutrition, developed and substantiated the concept of rational human nutrition, taking into account its social activity and allowed, taking into account age, gender and nature of work, to recommend a balanced diet. The adult working population is divided into five groups depending on the intensity of physical labor (energy consumption), identified age groups populations differing in nutritional needs, the nutritional and energy needs of pregnant women and nursing mothers are substantiated. Based on these ideas, recommendations on optimal diets for various groups population. A reasonable diet is justified. For sick people, diets are proposed that take into account the causes and characteristics of the development and course of diseases. In order to ensure the harmlessness (safety) of food products, regulations on permissible (safe) content have been established harmful substances V food products, methods for detecting and determining these substances in food have been developed, and a system of hygienic supervision over the quality and safety of food products has been created.

Basic principles of rational, balanced nutrition

Throughout life, the human body continuously undergoes metabolism and energy. The source of building materials and energy necessary for the body are nutrients coming from external environment mainly with food. If food does not enter the body, a person feels hungry. But hunger, unfortunately, will not tell you what nutrients and in what quantities a person needs. We often eat what is tasty, what can be prepared quickly, and do not really think about the usefulness and good quality of the products we eat.

Rational nutrition is nutrition that is sufficient in quantity and complete in quality, satisfies the energy, plastic and other needs of the body and provides required level metabolism. Rational nutrition is based on gender, age, nature of work activity, climatic conditions, national and individual characteristics.

The principles of rational nutrition are:

1) compliance of the energy value of food entering the human body with its energy expenditure;
2) the intake of a certain amount of nutrients into the body in optimal proportions;
3) correct mode nutrition;
4) variety of food products consumed;
5) moderation in food.

Adverse consequences of excess nutrition against a background of low physical activity allow us to believe that one of the basic principles of rational nutrition during intellectual work there should be a reduction in the energy value of food to the level of energy expenditure or an increase in physical activity to the level of calorie content of food consumed.

The biological value of food is determined by the content of essential nutrients needed by the body - proteins, fats, carbohydrates, vitamins, mineral salts. For normal human life, it is necessary not only to supply him with an adequate (according to the needs of the body) amount of energy and nutrients, but also to observe certain relationships between numerous nutritional factors, each of which has a specific role in metabolism. A diet characterized by an optimal ratio of nutrients is called balanced.

A balanced diet provides the optimal ratio for the human body of proteins, amino acids, fats, fatty acids, carbohydrates, and vitamins in the daily diet.

According to the balanced nutrition formula, the ratio of proteins, fats and carbohydrates should be 1: 1.2: 4.6. At the same time, the amount of protein in the diet is 11 - 13% of the daily energy value, fat - on average 33% (for the southern regions - 27 - 28%, for the northern - 38 - 40%), carbohydrates - about 55 %.

Squirrels. These are high-molecular nitrogen compounds consisting of amino acids, the main plastic material from which body tissues are built. Proteins from which body cells are built have a complex structure and high chemical activity. Proteins are divided into simple and complex. The first are built only from amino acids. The latter, in addition to amino acids, also includes various nitrogen-free components (phosphoric acid residues, carbohydrates and other substances). Protein substances include enzymes - the most important accelerators of biochemical reactions in the body.

The main functions of protein in the body

PLASTIC. Proteins make up 15-20% of the wet weight of various tissues and are the main building material of cells, organs and intercellular substance.

CATALYTIC. Proteins are the main component of all currently recognized enzymes. And ordinary enzymes are purely protein compounds. Enzymes play a decisive role in the assimilation of nutrients by the human body and in the regulation of all intracellular metabolic actions.

HORMONAL. A significant part of hormones by their nature are proteins. These include insulin, pituitary hormones, etc.

SPECIFICITY FUNCTION. The extreme abundance and uniqueness of personal proteins provide tissue individuality and species specificity.

TRANSPORTATION Proteins are involved in the transport of oxygen, fats, carbohydrates, certain vitamins, hormones and other substances in the blood.

FATS. These are substances consisting of glycerol and fatty acids connected by ester bonds. According to their saturation with fatty acids, fats are divided into two groups: solid (lard, butter), which contain saturated fatty acid, and liquid fats (sunflower, olive oil, from nuts, seeds, etc.), containing mainly unsaturated fatty acids. Fats are the most powerful source of energy. In addition, fat deposits (“fat depot”) protect the body from heat loss and bruises, and fat capsules internal organs serve as support and protection from mechanical damage. Deposited fat is the main source of energy in acute diseases, when appetite decreases and food absorption is limited.

CARBOHYDRATES. Carbohydrates are compounds of carbon, hydrogen and oxygen, with hydrogen and oxygen in a 2:1 ratio, as in water, hence their name. Carbohydrates are divided into simple - monosaccharides (glucose, galactose, fructose) and complex - polysaccharides. Individual monosaccharides combine with each other to form more or less complex carbohydrates. Disaccharides are formed from two molecules, and polysaccharides are formed when their number is greater. All monosaccharides and disaccharides have a sweet taste, but the degree of sweetness varies. The sweetest monosaccharide is fructose. Polysaccharides are widely distributed in nature. Most often these are complex compounds of several hundred molecules. Polysaccharides include starch - a carbohydrate contained in plant cells, glycogen - a carbohydrate in animal tissues, as well as fiber, which is part of the membranes plant cells. None of the polysaccharides have a sweet taste. Carbohydrates serve as the body's main source of energy and help our muscles work. They are necessary for normal metabolism of proteins and fats. In combination with proteins, they form certain hormones, enzymes, secretions of salivary and other mucus-forming glands and other important compounds.

Sources of nutrients are animal food and plant origin, which are conventionally divided into several main groups.

The first group includes milk and dairy products (cottage cheese, cheeses, kefir, yogurt, acidophilus, cream, etc.); the second - meat, poultry, fish, eggs and products made from them; third - bakery, pasta and confectionery products, cereals, sugar, potatoes; fourth - fats; fifth - vegetables, fruits, berries, herbs; sixth - spices, tea, coffee and cocoa.

Each group of products, being unique in its composition, is involved in the primary supply of certain substances to the body. Therefore, one of the basic rules of balanced nutrition is variety. Even during fasting, using a wide range of plant products, you can provide the body with almost everything you need.

There are no ideal food products in nature that would contain a complex of all the nutrients necessary for humans (the exception is mother's milk). With a varied diet, that is, mixed food consisting of products of animal and plant origin, the human body usually receives quite enough nutrients. The variety of foods in the diet has a positive effect on its nutritional value, since different foods complement each other with missing components. In addition, a varied diet promotes better absorption of food.

The concept of diet includes the frequency and time of food intake during the day, its distribution according to energy value and volume. The diet depends on the daily routine, the nature of work activity and climatic conditions. Regularity of food intake is of great importance for normal digestion. If a person always takes food at the same time, then he develops a reflex to excrete at this time gastric juice and conditions are created for better digestion of it.

It is necessary that the intervals between meals do not exceed 4-5 hours. The most favorable is four meals a day. At the same time, breakfast accounts for 25% of the energy value of the daily diet, lunch - 35%, afternoon snack (or second breakfast) - 15%, dinner - 25%.

Poor eating habits play a negative role in health. It manifests itself in a decrease in the number of meals per day from four to five to two, incorrect distribution of the daily diet into separate meals, an increase in dinner to 35-65% instead of 25%, an increase in the intervals between meals from 4-5 to 7-8 hours. The commandments of folk wisdom about nutrition are forgotten: “Shorten your dinner, lengthen your life”; “Eat wisely and live long.” All nature lives in precise rhythms: the rotation of the planets, the seasons, day and night, life and death. Rhythm is characteristic to the human body, its individual organs and systems. Therefore, the organization and strict adherence to a daily routine, which includes the transition from wakefulness to sleep and vice versa, the implementation of hygiene procedures, different kinds activities, rest, eating at the same time in accordance with age characteristics create the best conditions for the life of the body. Physiologically, the daily routine is justified by the development of conditioned reflexes, which over time are reinforced for life in the form of stable skills and habits and have...

Hygiene: textbook for universities / Ed. acad. RAMS G.I. Rumyantseva. - 2nd ed., revised. and additional - M.: "GEOTAR-Media", 2008. - 607 p.: ill.

Medical and biological statistics / Glanz S.; translated from English Yu.A.Danilov, ed. N.E. Buzikashvili, D.V. Samoilova. - M.: Praktika, 1999. - 459s

Public health and healthcare: a textbook for students. honey. universities / L. A. Alekseev [and others], ed. V.A. Minyaeva, N.I. Vishnyakova. - 4th ed. - M.: MEDpress-inform, 2006. - 520 p.

The local physician is, as a rule, the first doctor to whom the population of the district turns for medical help. He is obliged to provide ( content of the work of a local therapist):

Timely qualified therapeutic assistance in the clinic and at home;

Timely hospitalization of therapeutic patients with mandatory examination during planned hospitalization;

If necessary, consultation of patients with the head of the department and doctors of other specialties;

Examination of temporary disability;

Organization and implementation of a set of medical examination measures;

Issuing conclusions to those undergoing a medical examination;

Organization and implementation of preventive vaccinations and deworming of the population;

Emergency medical care for patients regardless of their place of residence.

Infectious diseases department of the clinic. Sections and methods of work of a doctor in the office of infectious diseases.

The main tasks (sections and methods of work) of the infectious diseases office:

Ensuring timely and early detection and treatment of infectious patients;

Study and analysis of the dynamics of infectious morbidity;

Dispensary observation of convalescents and bacteria carriers;

Promoting knowledge on the prevention of infectious diseases.

The procedure for obtaining and storing vaccination preparations. Upon receipt of applications, the Central State Examination Center draws up a consolidated updated plan for preventive vaccinations for a given year for all medical institutions in the district. The clinic receives bacterial medications from the Center for State Examination in accordance with the submitted application. Vaccines must be strictly registered and stored under certain conditions, regulated by the instructions attached to each drug.

Basic documentation of the infectious diseases office:

a) accounting:

Control card of dispensary patient 030/u;

Emergency notification of an infectious disease, acute occupational poisoning, unusual reaction to vaccination 058/u;

Journal of infectious diseases 060/у;

b) reporting:

Report on preventive vaccinations f. No. 5 – submitted to the Center for State Examination;

Report on the movement of vaccination preparations f. No. 20 – submitted to the Center for State Examination;

Report on the movement of infectious diseases;

A report on the examination of patients for diphtheria is submitted to the Center for State Examination.

Preventive work of the clinic. Organization of preventive examinations. Dispensary method in the work of the clinic, its elements. Control card of dispensary observation, information reflected in it.

A distinctive feature of medical care provided in clinics is the organic combination of therapeutic and preventive work in the activities of all doctors of this institution.

3 main areas of preventive medicine:

b) grafting work- carried out under the guidance of immunologists by infectious disease specialists and local therapists at the clinic (in recent years, there has been an urgent need for universal vaccination of the adult population against diphtheria)

V) clinical examination (dispensary method) is a method of active dynamic monitoring of the health status of the population, aimed at strengthening health and increasing working capacity, ensuring proper physical development and preventing diseases through a set of therapeutic, health-improving and preventive measures. The dispensary method of operation of health care facilities most fully expresses the preventive orientation of health care.

Contingents subject to medical examination, include both healthy and sick people.

Group 1 (healthy) includes:

Persons who, due to their physiological characteristics, require systematic monitoring of their health (children, adolescents, pregnant women);

Persons exposed to adverse factors in the working environment;

Decreed contingents (food workers, public utility workers, public and passenger transport workers, personnel of children's and medical institutions, etc.);

Special contingents (persons affected by the Chernobyl disaster);

Disabled people and participants of the Great Patriotic War and equivalent contingents.

Group 2 (patients) includes:

Patients with chronic diseases;

Convalescents after some acute diseases;

Patients with congenital (genetic) diseases and developmental defects.

Medical examination tasks:

identifying people with risk factors and patients in the early stages of diseases by conducting annual preventive examinations of mandatory contingents and, if possible, other groups of the population;

active monitoring and rehabilitation of patients and persons with risk factors;

examination, treatment and rehabilitation of patients according to their appeal, dynamic monitoring of them;

creation of automated information systems and data banks for dispensary registration of the population.

Stages of clinical examination:

1st stage. Registration, examination of the population and selection of contingents for registration at the dispensary.

a) registration of the population by area by conducting a census by a paramedical worker

b) survey of the population to assess health status, identify risk factors, and early detection of patients.

Distinguish 3 types of preventive examinations.

2) periodic- carried out to persons in a planned manner at a specified time for certain groups of the population and with the current appeal for medical help to medical institutions.

To contingents subject to mandatory periodic inspections, relate:

Workers of industrial enterprises with harmful and dangerous working conditions;

Workers of leading professions in agricultural production;

Decreed contingents;

Children and teenagers, young men of pre-conscription age;

Students of vocational schools, technical schools, university students;

Pregnant women;

Disabled people and participants of the Great Patriotic War and equivalent contingents;

Persons affected by the Chernobyl disaster.

For the rest of the population, the doctor must use every patient visit to a medical facility to conduct a preventive examination.

3) target- carried out for early detection of patients with certain diseases (tuberculosis, malignant neoplasms, etc.)

The main forms of preventive examinations are

A. individual- are carried out:

According to the population’s appeal to health care facilities (for a certificate, for the purpose of obtaining a sanatorium-resort card, in connection with a disease);

When actively calling persons served by the clinic for a medical examination at the clinic;

When doctors visit patients with chronic diseases at home;

Among persons undergoing treatment in a hospital;

When examining persons who were in contact with an infectious patient.

This is the main form of medical examinations of the unorganized population.

Inspections of organized teams are carried out on the basis of agreed schedules and are regulated by relevant orders of the Ministry of Health.

Data from medical examinations and the results of examinations performed are recorded to medical records(“Medical record of an outpatient”, “Individual record of a pregnant and postpartum woman”, “History of the child’s development”).

Based on the results of the examination, a conclusion is given on the state of health and a determination is made. observation group:

a) group “healthy” (D1)– these are persons who do not complain and whose history and examination do not reveal any deviations in their state of health.

c) group “chronic patients” (D3):

Persons with a compensated course of the disease with rare exacerbations, short-term loss of ability to work, which does not interfere with normal work activities;

Patients with a subcompensated course of the disease, who experience frequent annual exacerbations, prolonged loss of ability to work and its limitation;

Patients with a decompensated course of the disease, having persistent pathological changes, irreversible processes leading to permanent loss of ability to work and disability.

When a disease is detected in the person being examined, the doctor fills out a statistical coupon (form. 025/2-u); makes notes about the state of health in the medical record of an outpatient (f.025/u). Persons classified in the third health group are registered at the dispensary by a local doctor or medical specialist. When taking a patient to the dispensary register, a control card of dispensary observation (f.030/u), which is kept by the doctor performing dispensary observation of the patient. The control chart indicates: doctor's surname, date of registration and deregistration, reason for deregistration, disease for which he was taken under dispensary observation, number of the patient's outpatient card, his surname, first name, patronymic, age, gender, address, place of work, doctor's attendance, records of changes in the initial diagnosis, concomitant diseases, a set of treatment and preventive measures.

2nd stage. Dynamic monitoring of the health status of those being examined and carrying out preventive and therapeutic measures.

Dynamic observation of the person being examined is carried out differentiated according to health groups:

b) monitoring of persons classified in group 2 (practically healthy) is aimed at eliminating or reducing risk factors for the development of diseases, correcting hygienic behavior, increasing the compensatory capabilities and resistance of the body. Monitoring patients who have suffered acute diseases is aimed at preventing the development of complications and chronicity of the process. The frequency and duration of observation depend on the nosological form, the nature of the process, and possible consequences (after acute tonsillitis, the duration of medical examination is 1 month). Patients with acute diseases that have a high risk of chronicity and the development of severe complications are subject to dispensary observation by a general practitioner: acute pneumonia, acute tonsillitis, infectious hepatitis, acute glomerulonephritis and others.

c) observation of persons classified in group 3 (chronic patients) is carried out on the basis of a plan of treatment and health measures, which provides for the number of clinical visits to the doctor; consultations with specialist doctors; diagnostic studies; drug and anti-relapse treatment; physiotherapeutic procedures; physical therapy; dietary nutrition, sanatorium-resort treatment; sanitization of foci of infection; planned hospitalization; rehabilitation measures; rational employment, etc.

Dispensary group of patients with chronic diseases, subject to dispensary observation by general practitioners are patients with the following diseases: chronic bronchitis, bronchial asthma, bronchiectasis, lung abscess, hypertension, NCD, coronary artery disease, gastric and duodenal ulcers, chronic gastritis with secretory insufficiency, chronic hepatitis, liver cirrhosis, chronic cholecystitis and cholelithiasis, chronic colitis and enterocolitis, nonspecific ulcerative colitis, urolithiasis, chronic glomerulonephritis, chronic pyelonephritis, osteoarthritis, rheumatism, rheumatoid arthritis, often and long-term illness. If there are doctors of narrow specialties in the clinic, specialized patients, depending on age and stage of compensation, can be under dispensary observation from these specialists.

A group of dispensary patients subject to dispensary observation by a surgeon, are patients with phlebitis and thrombophlebitis, varicose veins of the lower extremities, post-resection syndromes, chronic osteomyelitis, endarteritis, trophic ulcers, etc.

3rd stage. Annual analysis of the state of dispensary work in health care facilities, assessment of its effectiveness and development of measures to improve it (see question 51).

Carrying out clinical examination of the population is regulated by the following documents:

3. Order of the Ministry of Health of the Republic of Belarus No. 159 dated June 27, 1997 “On the implementation of the program for the integrated prevention of non-communicable diseases (CINDI) in the Republic of Belarus.”

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 authority of Moscow, the organization of state medical institutions and the publication of relevant regulations on medical matters became possible. 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 at medical faculties of 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 for workers and peasants” was published, 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 to the national economy of the 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, paramedic-midwife stations, etc. In these institutions, approximately 80% of all patients begin and end 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 therapeutic and preventive measures in the territory of this site. 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, located, as a rule, in rural areas, appointments are provided for only a small number of specialties (no more than five): therapy, surgery, obstetrics and gynecology, pediatrics. The work of a nurse in an outpatient clinic resembles the work of a district nurse in a clinic, but only the 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, propaganda healthy image life.

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 examination of work ability).

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 composition of 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 a 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 are most closely related to the work of social protection authorities and are largely medical and social. The local doctor and local nurse provide important influence to solve the client’s medical and social problems in the professional activities of a 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 referral, with the former being 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 for preventive and therapeutic measures, draw up documentation. Then the patient is actively and systematically monitored, individual preventive treatment is carried out, and health-improving measures are carried out 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 the final stage (preventive measures).