Improving medical care for the population of the Russian Federation at. Organization of medical care at the present stage
Chapter 22
Chapter 22
The consistent implementation of the state policy in the field of healthcare, the implementation of federal and regional medical and social programs have made it possible to achieve certain results in preserving the health of the inhabitants of the Russian Federation and improving the performance of the healthcare system. The interest of state authorities, heads of organizations and enterprises of the region in solving the problems of protecting the health of citizens has increased. However, despite the measures taken, a number of unresolved problems remain in the health care of Russia. Among them, there is a continuing discrepancy between the state's obligations to provide citizens of Russia with free medical care and financial resources allocated for these purposes. There is a lack of access to medical care, especially for the poorest segments of the population, and a high differentiation of municipalities in terms of public health and the provision of health care with the necessary resources. The commercialization of state and municipal health care is growing, one of the reasons for which is the lack of effective existing mechanisms for state regulation in this area. Despite the additional financial and material and technical resources allocated by the state for the development of health care, the effectiveness of their use remains low. The lack of a system of labor motivation adapted to market mechanisms does not allow full use of the available reserves of health workers to improve the volume and quality of medical care provided to the population. A number of issues remained unresolved related to the training and retraining of qualified health workers, the development of a set of measures for their social protection.
Most of the population lacks a motivated value attitude towards their own health as a necessary
life resource, which, in turn, turns out to be the main factor preventing the formation of healthy lifestyle life. Behavioral factors and bad habits still have a great influence on the state of public health: the prevalence of alcoholism, smoking, lack of interest in physical education among a significant part of the population.
Despite the emerging positive trend, the average life expectancy in the Russian Federation remains at a low level (men - 61.8; women - 74.2 years) and lags behind a number of developed countries. For example, in Japan this indicator is 78.6 for men, 85.6 for women, 77.8 and 82.8 in Norway, respectively, and 78.5 and 82.9 in Sweden.
The mortality rate of the population of working age remains high, primarily due to cardiovascular diseases, malignant neoplasms, and traffic accidents. In the morbidity of the population, the proportion of neurotic and mental disorders is increasing, due to the use of alcohol, psychotropic substances, there is an increase in occupational morbidity associated with unsatisfactory working conditions, violation of sanitary and hygienic norms and rules.
The differentiation of health indicators of the population continues, depending on the social and property status. The incidence of infectious and socially significant diseases remains high, the prevalence of which is still significantly affected by the inadequate standard of living of the majority of the population (low wages and pensions, deterioration of living conditions, work, rest, environmental conditions, quality and structure of nutrition and etc.).
Medical and social diagnostics and analysis of problems that characterize the current state of public health, as well as the study of the social demands of society in the field of healthcare, allowed the authors to develop, scientifically substantiate and present to the Ministry of Health and Social Development of the Russian Federation a set of measures to improve healthcare at the regional level. These measures, in particular, were included in the set of measures for the development of healthcare in the Russian Federation for the period up to 2020, which were considered and approved by the II Congress of the Russian public organization "Russian Society for the Organization of Health and Public Health".
Thus, the priority areas for improving the healthcare system are as follows:
1. Reducing the gap in population health indicators between individual regions of the Russian Federation and economically developed countries.
2. Improving the health of children, adolescents, women.
3. Maintaining the health of the elderly.
4. Reducing the level of socially significant diseases.
5. Reducing the prevalence of infectious diseases.
6.Providing a healthy and safe living environment.
7. Formation of a healthy lifestyle.
8. Improving the mechanisms of state guarantees in providing the population with free medical care.
9. Increasing the efficiency of the healthcare management and financing system.
10. Creation of the necessary conditions for the innovative development of health care.
11.Modernization of the system of training and retraining of personnel in health care.
12. Improvement legislative framework healthcare.
1. Reducing the gap in population health indicators between individual regions of the Russian Federation and economically developed countries
The current gap in the health indicators of the population of Russia and economically developed countries is primarily due to the lack of evidence-based state policy in the field of protecting the health of citizens, insufficient resource support for the industry, as well as the imperfection of mechanisms for the effective use of material, technical, financial, allocated for health care needs. personnel and other resources.
To solve this problem, it is necessary, first of all, to implement the following measures:
Development and implementation (at the federal, regional and municipal levels) of an effective state policy in the field of protecting the health of citizens;
Introduction of the Humanitarian Development Index as a criterion for assessing the socio-economic development of regions;
Conducting an analysis of the causes of the identified differences in the health indicators of the population from different socio-economic groups;
Introduction of monitoring and evaluation of the effectiveness of measures taken to eliminate the existing differences in population health indicators in certain socio-economic groups;
Ensuring greater accessibility of medical and social assistance for low-income groups of the population through a flexible system of benefits, allowances, etc.
2. Improving the health of children, adolescents, women
The answer to the question whether Russia will be able to overcome the demographic crisis in the foreseeable future or not depends largely on the implementation of this priority area of healthcare development. That is why it is necessary to set and solve strategic tasks to reduce the infant mortality rate on average in the Russian Federation to 7.5? (in the constituent entities of the Russian Federation that have reached this value - a decrease in this indicator to the average European level); a reduction by at least 50% of the mortality and disability associated with accidents and acts of violence among children; reducing the number of children born weighing less than 2500 g by at least 20%; a decrease in the maternal mortality rate on average in the Russian Federation to 18.5 per 100 thousand live births (in the constituent entities of the Russian Federation that have reached this value, this indicator has decreased to the average European level).
The most important targets are to reduce the incidence of mortality and disability among schoolchildren and adolescents (associated with acts of violence and accidents) by at least 50%; reducing the number of young people who are characterized by harmful behaviors associated with the use of drugs, tobacco and alcohol by 30%; reduce the number of pregnancies among adolescent girls by at least 25%.
To achieve these objectives, the following set of measures is required:
Expansion and intensification of preventive activities, including clinical examination of children of all ages;
Increasing the volume of specialized and high-tech medical care for children;
The introduction of high-tech methods for the diagnosis and prevention of hereditary diseases and birth defects development in children;
Creation of a network of modern perinatal centers in the country;
Provision of maternity hospitals with modern medical equipment and special sanitary transport;
Development of family planning and safe motherhood services;
Integration obstetric institutions with a general medical and specialized network;
Implementation of WHO principles for integrated management of childhood illnesses;
Implementation of WHO criteria for assigning the status of "Baby Friendly Hospital";
Approximation of primary health care services to the conditions of everyday life of schoolchildren and adolescents (home environment, schools and other educational institutions, places of recreation);
Development and implementation of regional medical and social programs to improve the health of adolescents, including young men of pre-conscription and military age;
Development and implementation of interdepartmental programs on drug addiction, suicide, alcohol consumption, accident prevention;
Implementation of the WHO concept on the formation of schools that promote health;
Implementation of WHO criteria for assigning the status of "Adolescent Friendly Hospital", etc.
3. Maintaining the health of the elderly
This priority direction, of course, has not only medical and social, but also political significance. People who have worked for decades and have reached old age have the right to demand a higher level of medical care from society. In this case, the public health challenges are to increase the average life expectancy by at least 5-7%, as well as to increase by 30-50% the number of people at the age of 80 with a level of health that allows them to maintain independence. , self-respect and a proper place in society.
Achieving these results is, of course, not the task of the health system alone. To solve them, an intersectoral approach is required with the implementation of the following set of measures:
Coordination of activities of health and social protection services;
Development of primary health care, taking into account the real needs of older people;
Systematic preventive measures aimed at improving hearing, mobility (replacement of the head of the hip joint), vision, prosthetics;
Organization of geriatric service in all subjects of the Russian Federation;
Improving the quality and accessibility of rehabilitation assistance;
Training of specialists in the field of palliative care;
Development of a network of hospitals for incurable patients (hospice);
Creation of conditions for the worthy departure of elderly sick people from life (providing the opportunity to die in the place that they choose, and surrounded by the people they wanted to see, if possible without pain and torment), etc.
4. Reducing the level of socially significant diseases
For many years, this priority in health care has remained more of a political declaration than a system of targeted, results-oriented actions, as evidenced by the analysis of the prevalence and socioeconomic consequences of socially significant diseases presented in section 2.3.3. Conducting an in-depth study of the structure and level of "sociopathies", identifying their main trends and cause-and-effect relationships make it possible to scientifically substantiate a set of interrelated tasks for their prevention and reduction. These tasks, first of all, include the need to reduce mortality rates associated with cardiovascular diseases by an average of 40%; reduction in mortality from malignant neoplasms various localizations by at least 15% and a 25% reduction in mortality due to lung cancer; 30% reduction in amputations, blindness, kidney failure and other serious disorders associated with diabetes. Among this set of tasks, the most important are also the reduction of morbidity, disability and mortality associated with chronic respiratory diseases, musculoskeletal disorders and other common diseases. chronic diseases; prevention of mental disorders and reduction in the number of suicides by at least 30%; reduction of death and disability due to road traffic accidents and other accidents by at least 30%. ensuring a reduction in the prevalence and mortality rates associated with HIV infection, AIDS and other sexually transmitted diseases, etc.
To solve these problems and achieve specific results, it is necessary to implement a set of measures, differentiated for each of the socially significant diseases separately.
Prevention and treatment of cardiovascular diseases:
Development and implementation of modern medical preventive technologies for high-risk groups for the development of cardiovascular complications;
Development of modern methods of prevention, diagnosis and treatment of arterial hypertension and its complications;
Development of evidence-based programs for the organization of rehabilitation treatment of patients with stroke and acute myocardial infarction;
Creation of an effective system for the prevention of arterial hypertension and its complications;
Creation of a control system over the course of implementation of measures for the prevention and treatment of arterial hypertension;
Improving the system of the state register of patients with arterial hypertension;
Improving the methods of rehabilitation of patients with arterial hypertension, etc.
Prevention and treatment of diabetes mellitus:
Conducting research to study the causes and mechanisms of development of diabetes mellitus, its complications;
Improving the methods of prevention, diagnosis and treatment of diabetes mellitus;
Equipping diabetological units of specialized healthcare institutions with the necessary equipment;
Organization of the work of schools for the education of patients with diabetes mellitus;
Monitoring diabetes mellitus and its complications;
Ensuring the functioning of the state register of persons with diabetes mellitus;
Creation of mobile medical and preventive modules, introduction of modern medicines and diagnostic systems into clinical practice, etc.
Prevention and treatment of malignant neoplasms:
Construction and reconstruction of specialized medical institutions providing assistance to the population with oncological diseases;
Conducting research in the field of etiology and pathogenesis of malignant neoplasms;
Conducting scientific research in the field of prevention, diagnosis and treatment of malignant neoplasms;
Information support of the national register of substances, products, production processes, domestic and natural factors that are carcinogenic to humans;
Ensuring the functioning of the state register of patients with malignant neoplasms;
Improving the provision of specialized medical care to patients with malignant neoplasms, etc.
Prevention and treatment of mental disorders and their consequences:
Improving the psycho-emotional climate at home and at work;
Systematic training of local doctors, general practitioners on the diagnosis and treatment of depressive conditions;
Development of the system of psychiatric wards emergency care;
Conducting fundamental and applied research on the study of factors affecting mental health;
Teaching the population rational behavior in extreme and stressful situations, etc.
Prevention of injuries and deaths as a result of road traffic accidents and accidents:
Improving the modern system of sanitation and transportation of victims as soon as possible to the place of specialized medical care;
Development and implementation of standards for the provision of medical care to victims of road accidents;
Organization of training for personnel of life support services (Ministry of Internal Affairs, Ministry of Emergency Situations, etc.) in providing first aid;
Ensuring interaction, in the provision of emergency medical care to victims of road accidents and emergencies, of health services, the Ministry of Internal Affairs, the Ministry of Emergency Situations, federal and regional executive authorities;
Equipping with modern medical equipment, sanitary transport, communication facilities of healthcare organizations involved in the provision of specialized medical care to victims of road accidents, accidents, etc.
Fighting HIV Infection:
Implementation of programs for the exchange of used injection needles for new ones for intravenous drug injectors;
Ensuring wide access to condoms and other personal protective equipment;
Ensuring blood safety through proper screening and testing of donated blood and blood products;
Providing effective, anonymous treatment for persons with sexually transmitted diseases, etc.
Prevention and treatment of tuberculosis:
Active detection of TB patients through microscopic examination of sputum and targeted fluorographic examinations;
Implementation of a TB control program based on the DOTS strategy at the national level and in accordance with WHO recommendations;
Regular and uninterrupted supply of all essential anti-tuberculosis drugs;
Development of special monitoring services for the population from such risk groups as migrants, persons without a fixed place of residence, HIV-infected, etc.
5. Reducing the prevalence of infectious diseases
Despite significant progress in the prevention, early detection and treatment of infectious diseases, there are sufficient reserves in the health system, and every year there are new opportunities to further reduce the prevalence of infectious diseases. Taking into account the latest scientific achievements in the field of epidemiology of infectious diseases, it is quite realistic to achieve the following results in the next decade:
Carrying out a complex of anti-epidemic measures to prevent the spread of influenza A / HI NI;
Reducing the prevalence of diphtheria to a level of no more than 0.1 cases per 100,000 population;
Reducing the number of new cases of hepatitis B virus transmission by at least 80%;
Reducing the prevalence of mumps, whooping cough and invasive infections caused by haemophilus influenzae type b, up to a level of no more than 1 case per 100,000 population;
Reducing the prevalence of congenital syphilis and rubella to no more than 0.01 cases per 1000 live births;
Fulfillment in full national calendar vaccination, etc.
6. Ensuring a healthy and safe living environment
Solving the problem of ensuring a healthy and safe human environment is becoming increasingly important due to the increased number of man-made disasters, environmental pollution, and the threat of ecological imbalance. This problem, along with the problem of forming a healthy lifestyle, is decisive in maintaining and improving the health of the population and should be addressed at the state level with the participation of institutions. The most important role in its solution is assigned to the service of Rospotrebnadzor. The population of the country should live in a safe environment, in which the impact of factors hazardous to health does not exceed those provided by international standards. Significant reductions in the levels of physical, chemical and microbial pollutants in water, air, waste and soil that pose a threat to health need to be ensured. At the same time, it is necessary to provide the population with universal access to sufficient supplies of drinking water of satisfactory quality. The priority task of national security is the prevention of natural and man-made disasters and the fight against their consequences.
To solve these problems, first of all, it is necessary to implement the following set of measures:
Improving social and hygienic monitoring integrated into the structure of executive authorities and local self-government;
Creation of a geoinformation system that reflects the spatial and temporal relationships of environmental and health factors;
Reducing the risk of morbidity by 1.2-1.4 times, depending on the intensity of the sanitary and epidemiological situation, subject to a decrease in anthropogenic load by 1.0%;
Creation of a mechanism for predictive analysis of the consequences of political decisions in the field of hygienic safety;
Zoning of the habitat with hygienic ranking of territories according to the degree of danger of a negative impact on health;
Protection of the biosphere according to the criteria of permissible anthropogenic load on the environment, etc.
7. Formation of a healthy lifestyle
The health status of the population, as is known, is more than 50% dependent on the lifestyle of a person, therefore, the formation of a healthy lifestyle among the population is the key to solving many problems associated with a decrease in morbidity, disability, mortality, and an increase in the average life expectancy.
Unfortunately, we have to state that the problem of forming a healthy lifestyle in recent decades has practically fallen out of the system of public and state priorities, which, as a result, has had a negative impact on the health status of citizens of the Russian Federation. It will take many years for the population to form behavioral strategies for adherence to a healthy lifestyle, the emergence of a dominant value attitude towards their health. But this work must begin now, with the setting of specific tasks and the definition of realistically achievable results. What tasks for the formation of a healthy lifestyle among the population seem to be necessary to solve in the next decade? First of all, it is necessary to achieve an increase, at least by 25-30%, in the number of people systematically engaged in physical culture, a decrease in the prevalence of overweight by 20-30%, an expansion of the range and availability of food that is safe for health. To minimize the negative impact on health, especially children, of bad habits, it is necessary to take measures to increase the proportion of non-smokers among people over 17 years of age, at least up to 50%, and up to 95% among people under 15 years of age; reducing alcohol consumption per capita to 10 liters per year and eliminating cases of alcohol consumption by persons under 15 years of age. Similar priorities should include reducing the prevalence of psychoactive drug use by at least 25% and related deaths by at least 50%.
Of course, these are the priority tasks of various public and social institutions, the state as a whole, but health care
neniya in their solution should play an important role. At the same time, the priority measures with the participation of healthcare in solving the tasks set include the following:
Development and adoption of the "Code of a healthy lifestyle";
Formation of behavioral strategies for adherence to a healthy lifestyle among the population;
Creation of conditions for increasing the value attitude of the population towards their health;
Training of specialists in promoting a healthy lifestyle;
Teaching citizens a healthy lifestyle with the help of information programs specially adapted to different age and social groups of the population;
Organization of schools of patients (patients bronchial asthma, diabetes, hypertension and etc.);
Development of anonymous treatment services for alcoholics and drug addicts;
Development of a network of specialized institutions on the formation of a healthy lifestyle, including the training of relevant specialists, etc.
8. Improving the mechanisms of state guarantees in providing the population with free medical care
As noted earlier, one of the painful problems of modern health care is the continuing discrepancy between the state's obligations to provide Russian citizens with free medical care and the financial resources allocated for this purpose. Achieving such compliance by improving the mechanisms of state guarantees in providing the population with free medical care should be a priority for the activities of state authorities and local governments. To solve this problem, it is advisable to implement the following set of measures:
Improving legislation to ensure equal rights of citizens to receive free medical care, the same in volume and quality, in all subjects of the Russian Federation;
Increasing the responsibility of state authorities and local self-government bodies for providing the population with guaranteed free medical care;
Development of standards (protocols) for managing patients that are uniform for all subjects of the Russian Federation;
Improving the legal framework governing the division of free and paid medical services in state and municipal healthcare organizations;
Wide awareness of citizens about the rights to receive free medical care, etc.
9. Improving the efficiency of the health management and financing system
In modern conditions, one of the most important areas of healthcare reform is the formation new system management. A system that ensured, above all, the efficient use of material, technical, financial, human and other resources allocated to the industry. Without solving this problem, further building up the resource potential of the healthcare system will not be effective. The task of delimiting powers in the field of healthcare at the federal, regional and municipal levels of healthcare management remains relevant. Without this, it is impossible to avoid the endless duplication of functions of health authorities and individual medical institutions (federal, regional, municipal) in the provision of certain types of medical care, especially high-tech ones.
The work begun by the Ministry of Health of the Russian Federation in the 90s of the last century on standardization requires further continuation. Improving the management of the industry, improving the quality of medical care, and the efficient use of resources are inconceivable without the development and establishment of relevant standards, rules, requirements, technological regulations for the production of medical goods and services.
The development of evidence-based approaches to the formation of standards (protocols) for managing patients for various types of medical care at all stages of its provision requires special attention. The introduction of high-tech medical services, the creation of new medical centers that will reduce waiting times and ensure the availability of high-tech types of medical care to patients, regardless of their place of residence, require the rapid development of clinical protocols for managing patients with these types of medical care.
Fundamentally new approaches should be introduced to implement such critical management functions as planning and
forecasting. These approaches should be based, first of all, on an in-depth study of the health of the population, modern methods collection and processing of information, effective technologies for making managerial decisions.
First of all, it is necessary to develop and implement organizational, legal and economic mechanisms for the efficient use of financial and other resources. The creation of such mechanisms is seen as possible only on the basis of the organization of a unified system of medical and social insurance and the transition to a single-channel system of financing health care.
Certain prospects for improving the efficiency of industry management are associated with the development of legal and organizational mechanisms for public-private partnerships in healthcare. This concerns, first of all, the creation of conditions for the participation of healthcare organizations of private forms of ownership in the implementation of territorial programs of state guarantees, state support for venture innovation funds that finance high-tech and science-intensive projects in healthcare, support for the development of business associations in healthcare, etc.
Undoubtedly, the solution of this number of problems of improving the management and financing of health care requires the implementation of a whole range of organizational and legal measures in each of the above areas.
1. Public health administration reform:
Increasing the effectiveness of interaction between state authorities, local governments and civil society in the field of healthcare;
Introduction of anti-corruption mechanisms in the activities of public authorities and local governments in the field of healthcare;
Modernization of the information support system for state executive authorities, local governments in the field of healthcare;
Optimization of the structure and number of federal and regional health authorities;
Development and implementation of administrative regulations (mandatory requirements) for the order, procedures and administrative and management processes that ensure the execution of powers in the healthcare sector;
Improving the system of state control and supervision, licensing, conducting state examinations, issuing various permits and approvals in the field of healthcare;
Improving the efficiency of the procurement system for public health needs;
Development of mechanisms for public expertise, holding state-public consultations at the early stages of preparation and adoption of managerial decisions in the healthcare sector, as well as ensuring the publicity of the decisions made;
Creation of elements of "electronic government" in the healthcare management system, including ensuring information openness, development of electronic document management systems, access to national information resources related to public health, the activities of the healthcare system, etc.
2.Further delimitation of powers in the healthcare sector:
Implementation of the powers of federal government bodies to provide the population with high-tech medical care and supervision in the field of healthcare and human well-being;
Implementation of the powers of state authorities of the constituent entities of the Russian Federation to provide specialized medical care in dermatovenerological, anti-tuberculosis, narcological, oncological dispensaries and other specialized medical institutions (except federal ones), to provide specialized (sanitary and aviation) emergency medical care; organization of compulsory medical insurance for the non-working population;
Implementation of the powers of local governments to organize the provision of emergency medical care (with the exception of sanitary and aviation), primary health care in outpatient clinics and hospitals, medical care for women during pregnancy, during and after childbirth, etc.
3.Development of a standardization system in healthcare:
Creation of a unified system for assessing quality indicators and economic characteristics of medical services, establishing scientifically based requirements for their nomenclature and volume;
Establishment of requirements for the conditions for the provision of medical care, as well as technological compatibility and interchangeability of processes, equipment, materials, medicines and other components used in the provision of medical care for the accreditation of medical institutions, certification of specialists;
Creation and information support of classification, coding and cataloging systems in healthcare;
Normative provision of metrological control in healthcare;
Development and implementation of medical standards (patient management protocols), including those harmonized with international standards;
National system of accreditation in healthcare and ensuring recognition at the international level of domestic medical organizations accredited in it;
Monitoring the registration and analysis of cases of harm to health due to violation of the requirements of technical regulations in healthcare;
Formation of a unified information system for technical regulation in healthcare, including an information fund of technical regulations and standards, etc.
4. Improving the efficiency of planning and forecasting in healthcare:
Studying the structure, level of morbidity and related real needs of the population in all types of medical care;
Development of standards (norms) for providing the population with certain types of medical care;
Development of standards (norms) for providing healthcare organizations with the necessary material, technical, financial and other resources;
Evidence-based formation of a network of healthcare institutions at the federal, regional and municipal levels;
Development of federal and regional medical and social targeted programs;
Forecasting indicators of health and performance of the health care system in the whole of the Russian Federation and for each subject of the Russian Federation, etc.
5.Raising the level of state health and healthcare statistics:
Formation of publicly available electronic databases relating to public health and healthcare activities, in the context of individual regions, healthcare organizations;
Application of international statistical standards and classifications in the formation of the national system of statistical indicators and methods for their calculation in health care;
Conducting (periodically, once every 5-7 years) all-Russian comprehensive studies of the health status of the population;
Conducting (periodically, once every 3-5 years) regional comprehensive studies of the health status of the population;
Methodological support for the calculation of indicators for forecasting the development of healthcare, assessing the medical, social, and economic efficiency of the healthcare system (organization) activity;
Introduction of the system of national accounts as the basis for the integrated construction of health statistics;
Development of a system of statistical indicators to assess the effectiveness of health interventions, especially in relation to socially significant diseases;
Development of integral indicators for assessing the state of health of the population, medical and economic activities of the system (individual organizations) of health care;
Creation of public information databases on the rating of individual healthcare organizations, medical workers, etc.
6.Improving the organization of various types of medical care.
6.1. Ensuring priority development of primary health care with an emphasis on disease prevention:
Improving consultative and diagnostic services;
Development of medical and social rehabilitation and therapy departments, day hospitals, outpatient surgery centers and medical and social assistance services;
Implementation of regional programs for the development of general medical (family) practices;
Priority equipping with modern diagnostic equipment of municipal polyclinics, hospitals, stations (department
leniya) emergency medical care, centers of general medical (family) practice, feldsher-obstetric stations, etc.
6.2.Reorganization of inpatient care:
Development of a network of hospital institutions, taking into account the intensity of the treatment and diagnostic process:
Intensive treatment - up to 20%;
Rehabilitation treatment - up to 45%;
Long-term treatment of patients with chronic diseases -
up to 20%;
Medical and social assistance - up to 15%;
Reducing the excess number of hospital beds with their re-profiling into hospitals (departments) for rehabilitation treatment and medical and social assistance;
Wider use of day forms of stay of patients in hospitals;
Division of inpatient care into emergency, planned, etc.
6.3.Improving the organization of work of emergency and emergency medical care:
Systematic renewal of the fleet of ambulance stations (departments), including the purchase of reanimobiles, medical equipment and modern means of communication;
Improving the air ambulance service and the system for transporting victims as soon as possible to the place of specialized medical care;
Separation of ambulance and emergency medical services;
Equipping federal highways with helipads and emergency medical aid stations, etc.
6.4.Development of high-tech medical care:
Increasing the availability of high medical technologies in cardiac surgery, oncology, traumatology and, above all, for the treatment of children;
Reconstruction and re-equipment of existing centers of high medical technologies, construction of new centers, primarily in the constituent entities of the Russian Federation in the territories of Siberia and the Far East;
Development of a network of interregional and interdistrict specialized medical centers and etc.
6.5.The development of industrial healthcare:
Integration of departmental medical institutions into the general health care system on a single regulatory and legal basis, taking into account their regional and sectoral characteristics;
Development (rehabilitation) of medical and sanitary units for organization of prevention, providing highly qualified medical care, reducing the incidence and disability of the working population;
Involvement of departmental medical institutions in the implementation of compulsory and voluntary medical insurance programs, etc.
6.6.Improving rural health care:
Formation of treatment and diagnostic complexes on the basis of large central district hospitals, including separate municipal medical institutions;
Development of mobile forms of medical diagnostic and advisory assistance;
Formation of a rural medical site as part of a district (district) hospital, a center for general medical (family) practice, FAP, based on a population of 5-7 thousand people and a plot radius of 5-10 km;
Preservation (opening of new) FAPs in settlements with a population of 300-800 people;
Development of the CRH as centers for the provision of qualified and specialized medical care;
Creation of inter-district specialized departments, clinical diagnostic centers on the basis of large CRHs;
Development of regional (territorial, district, republican) hospitals as centers for the provision of highly qualified and highly specialized medical care;
Development of departments of emergency and planned advisory medical care (air ambulance);
Development of mobile forms of providing medical care to rural residents (mobile clinics, mobile dental offices, fluorographic installations, etc.);
Widespread adoption modern technologies telemedicine, etc. 7. Improving the health care financing system:
Development and adoption of the legislative framework for the development of the system of medical and social insurance;
Formation of a unified system of medical and social insurance with the transition to a single-channel financing system;
Completion of the transfer of the compulsory medical insurance system and the healthcare industry as a whole to insurance principles;
A phased increase in public spending on health to 6% of GDP;
Increasing the share of health care expenditures in the consolidated budget of a constituent entity of the Russian Federation up to 20%;
Improving the mechanism of medium-term and long-term financial planning;
Introduction of mechanisms for program-targeted budgeting;
Implementation of a system for monitoring the socio-economic efficiency of healthcare spending;
Introduction of mechanisms of responsibility of public authorities and local governments for the ongoing budgetary policy in the healthcare sector;
Expanding the financial independence of health care institutions;
Transition from estimated financing of the budgetary network of healthcare institutions to the principles of payment depending on the volume and quality of medical services provided;
Transition to the system of state (municipal) assignments for healthcare organizations for the provision of medical services;
Improving methods for developing tariffs for individual medical services;
Introduction of a unified system of payments for the provision of medical care provided to the population under the State Guarantees Program throughout the Russian Federation;
Creation of conditions for the development of competition of insurance medical organizations;
Granting the right to the insured to independently choose an insurance medical organization;
Improving the legislative framework for the development of voluntary medical insurance;
Introduction of the principle of normative per capita financing of medical organizations, which provides for linking the amount of allocated funds with the volume and quality of medical services provided to the population;
Formation of a legislative framework for the transformation of budgetary healthcare institutions into other organizational and legal forms, etc.
8. Development of the market sector in healthcare:
Creation of conditions for the participation of healthcare organizations of private forms of ownership in the implementation of territorial programs of state guarantees;
Development of innovative infrastructure, including the creation of technology and innovation zones, medical clusters;
State support for the activities of venture innovation funds that finance high-tech and science-intensive projects in healthcare;
Introduction and improvement of the efficiency of leasing mechanisms in healthcare;
Using public development banks to attract long-term investments in priority healthcare projects;
Formation of sectoral and regional plans for private-public partnerships that help increase the efficiency of the use of funds allocated for the development of professional medical education programs, research and development work;
Support for the development of business associations in healthcare, etc.
10. Creation of necessary conditions for innovative development of health care
Improving medical care for the population is possible only if the innovative development of healthcare is based on the achievements of fundamental science, the creation and implementation of new effective medical technologies. The innovative model of healthcare development provides for close interaction between the healthcare system and medical science, planning of scientific medical research depending on the needs of health care, active implementation of scientific results in medical practice, as well as targeted training of specialists capable of ensuring the implementation of these scientific achievements.
To switch to an innovative path of healthcare development, it is necessary to implement the following priority measures:
Holding fundamental research aimed at studying the health of the population in relation to environmental factors
habitation, way of life, activities of the health care system;
Concentration of financial resources and human resources in priority and innovative areas of development of medical science and healthcare;
Formation of state assignments for the development of new medical technologies for the prevention, diagnosis, treatment of diseases and rehabilitation of patients;
Creation on the basis of the achievements of biotechnologies and nanotechnologies of fundamentally new effective means of preventing, diagnosing and treating diseases;
Increasing the equipment of research institutions, laboratories with modern medical equipment and the level of qualification of the medical personnel working in them;
Creation of a system for the implementation of scientific results in practical healthcare, monitoring the evaluation of their effectiveness, etc.
11. Modernization of the system of training and retraining of personnel in health care
The implementation of the whole range of measures to solve the above tasks is impossible without profound changes in the system of training and retraining of medical and pharmaceutical personnel based on a well-thought-out, evidence-based personnel policy.
The purpose of implementing such a personnel policy should be the training and retraining of specialists with modern knowledge and able to ensure the medical, social and economic efficiency of the medical technologies used, as well as modern methods of preventing and diagnosing diseases, treating and rehabilitating patients.
In addition, these specialists must have a high level of competitiveness not only in the domestic but also in the international labor market.
Another direction of an effective personnel policy should be the creation of conditions for motivated, high-quality work of medical personnel using economic, organizational, legal, psychological and social mechanisms.
The task of optimizing the structure and number of health care workers, with bringing the ratio of doctors and paramedical workers to 1:3, remains relevant.
It is necessary to return to the practice of forming a personnel reserve for heads of government bodies and healthcare institutions, with the creation of conditions for the professional growth of literate, gifted specialists, and excluding the possibility of incompetent careerists occupying leadership positions.
The main criteria for the effectiveness of such a personnel policy, medical education and a system of stimulating the work of medical workers are the quality and availability of medical care provided to the population. To implement these tasks, the following set of measures is proposed:
Improving continuous medical education in the system: secondary specialized education - higher education - postgraduate training;
Completion of the formation of the system of medical and pharmaceutical education in accordance with international requirements;
Formation by health authorities of target orders for the training of specialists and the conclusion of relevant tripartite agreements with them, including an educational institution, an applicant, an employer;
Formation of the state order for the training of personnel for healthcare based on differentiated standards for the need for specialists in various fields, taking into account the regional characteristics of the organization of work, the location of the network of medical institutions and the medical and demographic situation;
Development of qualification characteristics (job models) for specialists of all profiles;
Introduction of mechanisms of material and professional interest for work in health care institutions in rural areas and hard-to-reach areas;
Support for a unified information database on the availability of vacancies in healthcare organizations of the constituent entities of the Russian Federation;
Creation of a distributed database (at the federal, regional, municipal levels of healthcare management) of a reserve of heads of healthcare bodies and institutions;
Improving the unified national quality control system for training specialists at all stages of continuous medical education;
Development of modern federal state educational standards of the third generation using a credit-modular system;
Revision of the regulatory documents in force in the industry on labor protection of health workers and bringing them into line with modern safety requirements;
Certification of workplaces in healthcare organizations for compliance with labor safety standards;
Improving the system of remuneration of health workers, taking into account the volume and quality of medical services provided;
Providing healthcare workers with compensations and benefits provided for by law in full;
Creation of a system of state social liability insurance in case of professional error and in the presence of a risk of medical intervention;
Introduction of distance learning methods for healthcare workers based on telecommunication technologies;
Revising the list of approved USE subjects and providing an opportunity for medical universities to conduct additional tests to identify a more career-oriented group of applicants.
12. Improving the legal framework for healthcare
In recent decades, the reform of the socio-economic structure of society, the emergence, along with the state and municipal, of the private healthcare sector, have necessitated radical changes in the current system of legal regulation of public relations related to medical activities. In this regard, in recent years, the regulatory legal framework in the healthcare sector has changed significantly: new federal laws, Decrees of the President of the Russian Federation, decrees of the Government of the Russian Federation, orders of the Ministry of Health and Social Development of the Russian Federation have come into force. The legal situation in the medical community itself has also changed - medicine has become more accessible to patients' claims and lawsuits.
However, these changes were not enough, and it should be recognized that one of the problems that the level of domestic healthcare lags far behind the world is the imperfection of the legislative framework, the lack of real legal mechanisms for ensuring the protection of the health of citizens, social and legal insecurity
schennost, both the patient, and the doctor. Equally, the reasons for this are legal nihilism and ignorance by doctors of the basic legal norms governing their professional activities. At the same time, legal and medical practice convincingly shows that the higher the legal culture of medical workers, the better they perform their professional duties, the higher the efficiency and quality of medical care, the more effectively the rights and legitimate interests of citizens in the field of health protection are ensured.
The development and adoption of new regulations would create the necessary legal framework for modernizing the health care system, improving the quality and accessibility of medical care to citizens of the Russian Federation.
Public health and health care: a textbook / O. P. Shchepin, V. A. Medic. - 2011. - 592 p.: ill. - (Postgraduate education).
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Decree of the Government of the Russian Federation of 05-11-97 1387 ON MEASURES TO STABILIZE AND DEVELOP HEALTH AND MEDICAL SCIENCE IN... Relevant in 2018
III. Improving the organization of medical care
The main directions in improving the organization of medical care are the development of primary health care on the basis of municipal health care, the redistribution of part of the volume of care from the inpatient sector to the outpatient sector.
Primary health care is the main link in the provision of medical care to the population.
A special role is given to the development of the institution of a general (family) practitioner. Consultative and diagnostic services should be developed in polyclinics. On their basis, departments of medical and social rehabilitation and therapy, care services, day hospitals, centers for outpatient surgery and medical and social assistance, etc. can be deployed.
The reorganization of inpatient care will ensure a reduction in the duration of the hospital stage. To do this, it is necessary to provide for the distribution of the number of beds depending on the intensity of the treatment and diagnostic process as follows: intensive treatment - up to 20 percent;
rehabilitation treatment - up to 45 percent;
long-term treatment of patients with chronic diseases - up to 20 percent;
medical and social assistance - up to 15 percent.
Wider use of day forms of stay of patients in hospitals.
It is necessary to revive inter-regional and inter-district specialized medical centers.
For high-quality medical care, it is necessary to ensure the continuity of the diagnostic and treatment process at all stages of treatment. Here, a clear division of functions at each stage of the provision of medical care, as well as between various types medical institutions. This implies the creation of a higher level of financing and management of health institutions.
Improving the quality of medical care will be facilitated by the introduction of standards for diagnosing and treating patients both in outpatient clinics and in hospitals.
It is necessary to take effective measures to develop the maternal and child health service, while concentrating efforts on improving primary health care for children and adolescents, developing family planning and safe motherhood services, and integrating obstetric institutions with the general medical network.
It is necessary to carry out comprehensive measures for the further development of psychiatric and narcological assistance to the population, the fight against tuberculosis and sexually transmitted diseases.
Measures to introduce modern technologies in intensive care units, cardiology and cardiac surgery, oncology, diagnostics and treatment of socially significant diseases require state support.
It is necessary to strengthen the ambulance service, make it more mobile and equipped modern means for emergency medical care and emergency hospitalization of patients.
It is necessary to increase the role of scientific centers and research institutes in the development and implementation of effective medical technologies, the use of unique diagnostic and treatment methods.
It is necessary to take measures of state support to improve rehabilitation assistance, the development of sanatorium-resort organizations of the healthcare system, health-improving institutions and organizations.
To improve the quality and accessibility of medical care to the rural population, it is necessary to form treatment and diagnostic complexes on the basis of central district hospitals, including municipal rural medical institutions, develop mobile forms of treatment, diagnostic and advisory assistance, and create inter-district clinical and diagnostic centers.
It is necessary to integrate departmental medical institutions into the general health care system on a single regulatory and legal basis, taking into account their industry specifics and location.
While maintaining the dominant role of state and municipal health care, the emerging private sector will play an important role. Creation of conditions for its development is the most important element of structural reforms in health care.
It is necessary to provide medical organizations, persons engaged in private medical activities, state and municipal organizations with equal rights to work in the system of compulsory medical insurance and participate in the implementation of state and municipal targeted programs. Participation of medical organizations of various forms of ownership in the implementation of state health programs, municipal orders should be carried out on a competitive basis.
State and municipal medical institutions that perform functions that are not related to the framework of a single technology for the provision of medical care should have broad powers in matters of the use of property and remuneration of personnel.
Organization of medical care to the population
The tasks of organizing medical care for the population at the present stage are to effectively and economically use the available health care resources, increase the availability and improve the quality of medical services.
Improving the organization of medical care at the prehospital and hospital stages in recent years has led to significant changes in the structure of the outpatient and inpatient stages of providing medical care to the population.
The reform of the management and financing of healthcare in the Russian Federation, the introduction of medical insurance for citizens presented new requirements for a doctor providing primary medical care in prehospital treatment, regardless of the form of ownership, territorial subordination and departmental affiliation.
The system for organizing the assessment of the activities of district therapists and the conditions in which they found themselves did not contribute to the development of the district physician as a good family doctor. With his mistakes in diagnosis and treatment, the inspection authorities did not pay attention to the low qualifications of the doctor, but considered the main reason for his mistakes that he did not refer the patient for a consultation with a specialist. The local therapist later began to refer patients to other specialists, even in cases where he himself believed that this was not necessary. Today, the local therapist is not directly responsible for the health of the patient, has no incentives to improve the quality of work and preventive measures, does not seek to expand the range of his activities, to use resource-saving medical technologies.
The transition to family medicine is natural and very important. It should not be considered only as the most economical and rational way of organizing medical care. This is a mechanistic approach. The transition to family medicine is not only a search for the most effective and economical forms of organizing medical care, but the need for an integral vision of a person, his health and illness. General medical practice creates favorable conditions for structural and personnel changes in outpatient and inpatient healthcare. According to surveys, almost 70% of the population believe that it is necessary to develop family medicine.
A General Practitioner (GP) provides personal health care to both individuals and their families. A clear distinction between primary and secondary levels of care creates best conditions interactions between primary care physicians and specialists working in hospitals. This is one of the tasks of a general practitioner, a family doctor.
A GP has a wider range of tasks than a medical specialist. This is due, first of all, to its closer connection with the population. GPs are constantly faced with a wider range of medical and social problems than doctors of other specialties. He needs broader knowledge in the field of prevention, psychology, sociology, public health and other related disciplines.
The uniqueness of general medical (family) practice is determined by the fact that the doctor deals with diseases at an early stage of their manifestation, uses available technology in diagnosis, is responsible for the health of the attached population, ensures continuity in medical care, and his activities have a preventive focus.
In his work, the GP makes the primary decision on all the problems that appear to him as a doctor, constantly monitors patients with chronic diseases and those in a terminal state, is aware of his responsibility to the population and local authorities, works in cooperation with colleagues and non-medical specialties .
Over the past 2 years, a lot of organizational and methodological work has been carried out to form not only the attitude of the public to the work of a general (family) practice doctor, but also to develop scientific, methodological and organizational and technological support for general medical (family) practices.
Currently, 5,293 doctors have been trained in clinical residency and various advanced training courses in medical universities and institutions of postgraduate professional additional education in the specialty "General Medical Practice (Family Medicine)". The specialty "general medical practice" has been approved, a network of faculties and departments of family medicine has been developed.
More than 20 constituent entities of the Russian Federation are developing models of general medical practices, taking into account various organizational and legal forms of activity.
Rural medicine is of particular importance for the introduction of the institution of a general (family) practitioner. There is such experience in the Republic of Karelia, where the law "On General Medical (Family) Practice" was adopted and for 5 years work has been carried out on the principle of a general practitioner in two district hospitals and in 9 medical outpatient clinics. The work is carried out according to the "team" principle - at the head of the doctor, he has a rehabilitation nurse, family nurse, nurse of medical and social assistance, as well as sisters - instructors of schools for patients with bronchial asthma, diabetes, etc.
The All-Russian Association of General (Family) Practitioners has been created and is operating, and the professional journal "Russian Family Doctor" is being published.
At the same time, there has been no real reform of primary health care in a number of regions of the Russian Federation.
Rural outpatient clinics, whose work is actually organized on the principle of a general (family) practice outpatient clinic, due to the lack of such an institution as "General medical (family) practice" in the nomenclature of medical institutions, do not have licenses for this type of medical activity.
Only 15 out of 38 general practitioners work in the Arkhangelsk region, 10 out of 29 work in the Republic of Mordovia, 20 out of 45 in the Republic of Dagestan, 49 out of 72 trained specialists work in the Republic of Buryatia.
The introduction of the service of a general (family) practitioner is hampered due to the lack of implementation mechanisms in the field of reforming primary health care, in the absence of unified approaches to this problem at the regional level.
It is necessary to develop a mechanism for the transition from foreign "pilot" projects to support the reform of primary health care at the regional level to the development of mechanisms for the phased introduction of the general medical (family) practice service throughout Russia.
The training of general practitioners should be carried out taking into account high qualification requirements, and be accompanied by the creation of additional training centers for general practitioners.
In 2002, the Ministry of Health of Russia held a Collegium that considered the issues of improving outpatient care for the population and determined the strategy for its development. The Ministry of Health of Russia issued an order "On the improvement of outpatient care for the population of the Russian Federation", which developed regulations on the Centers for a General Practitioner, a General Practitioner, a General Practitioner Nurse.
The development of primary medical care on the principle of a general practitioner is the most promising direction for Russian healthcare and will solve a number of problems: redistribute the volume of medical care between hospitals and outpatient clinics, allocate available funds for the development of general medical (family) practice, increase wages highly qualified specialists.
An analysis of the implementation of the sectoral program "General Medical (Family) Practice" showed the need to develop a systematic approach to improve regulatory legal, socio-economic, financial, logistical, organizational, methodological and managerial mechanisms that determine the features of the organization and functioning of the general medical (family) service practices in the structure of primary health care in Russian health care.
Improving the organization of medical care in hospital stage remains one of the major health challenges. The inpatient service continues to be the most resource-intensive health sector. The Ministry of Health of Russia attaches extreme importance to this issue.
One of the main directions for increasing the efficiency of using the bed fund is the introduction of low-cost technologies and the development of hospital-replacing forms of organizing and providing medical care to the population, redistributing part of its volume from the inpatient sector to the outpatient sector.
The program of state guarantees provided for a reduction of almost 20% in the volume of inpatient care due to the development of inpatient care forms, and it was also planned to increase the share of expenses for outpatient care.
An analysis of the implementation of the Program of State Guarantees showed that disproportions in the volume of medical care at different stages of its provision remain, and the development of hospital-replacing forms of organization of medical care is carried out very slowly.
Network restructuring is carried out in almost all regions, but very slowly and superficially. Over the past 5 years, out of 1,657,319 beds, 100,228 beds or 6% have been reduced.
It did not give positive results in the provision of inpatient care. The increase in hospitalization continues in 2001. 22.4, in 1997 20.5 per 100 inhabitants, and the reduction was mainly in the beds in the countryside, since it was very simple to do this: hospitals are low-capacity, understaffed. The Ministry of Health of Russia believes that, first of all, it is necessary to deal not with a formal reduction in the number of beds, but with an economically justified restructuring with a differentiated approach to the introduction of beds of varying intensity of treatment. In other words, there is a need to form a program "Restructuring the health care network", we are obliged to prepare such a draft sectoral program for the next final board.
Emergency medical care, as a type of medical care, has its own characteristics, which include: accessibility (non-failure nature of provision); the determining value of the time factor ("golden hour"); diagnostic uncertainty (the need for post-syndromic diagnosis and therapy); versatility; stages of rendering; continuity of care between stages; high resource intensity. These features were the reason for the creation of emergency medical institutions in our country.
During the time after the release of the order of the Ministry of Health of Russia dated March 26, 1999 No. 100 "On improving the organization of emergency medical care for the population of the Russian Federation," a lot of work has been done to strengthen the organizational and methodological management of emergency medical care. For the first time, by order of the Minister of Health of the Russian Federation, a chief freelance specialist of the Ministry of Health of Russia for emergency medical care was appointed. The Advisory Council of the Ministry of Health of Russia on emergency medical care was created under the chairmanship of the First Deputy Minister of Health of the Russian Federation, which included leading experts and scientists in this field from all regions of the Russian Federation. The main purpose of creating this council is to develop proposals for the further development and improvement of the quality of emergency medical care throughout the country.
Order of the Ministry of Health of Russia dated March 14, 2002 No. 265 "On the organizational and methodological department of the ambulance station" regulates the activities to coordinate and ensure the interaction of services of the constituent entity of the Russian Federation that provide emergency medical care.
In the current legislative, regulatory legal acts of the Russian Federation, the provision of emergency medical care is considered as a type of medical care, which is a pre-hospital stage.
At the same time, a system of emergency medical care has been formed in our country, which includes independent stations and emergency departments, emergency hospitals, the Moscow Research Institute of Emergency Medicine named after. N.V. Sklifosovsky, St. Petersburg Research Institute of Emergency Medicine. I.I. Dzhanelidze.
The system of emergency medical care that has developed in our country is also recognized abroad. Until now, many countries use a 2- and 3-level system for providing emergency medical care.
The number of independent stations (branches) has increased over the last period and amounts to 3212 (3172 in 1995). The number of emergency hospitals and the number of beds in them has decreased.
At the same time, the number of hospitalizations for emergency medical care in recent years tends to increase, both in the city and in rural areas, for example, the Chelyabinsk region. In some regions, such as the Krasnoyarsk Territory, the Novosibirsk Region, the Moscow Region, the hospitalization rate ranges from 25.5 to 54.8 per 1000 population.
Currently, there is a decrease in the number of general medical and paramedic ambulance teams. Employment of staff units for medical personnel was 90.5% with an indicator of availability individuals only 58.5%. Employment of jobs for middle and junior medical personnel amounted to 97.0 and 93.7%, respectively.
Despite changes in the number of stations and hospitals for emergency medical care, in dynamics there is a constant increase in the number of requests for emergency medical care, in 1999. medical assistance was provided in 347.5 cases per 1000 population, in 2001. - 362.7 per 1000 population.
So, according to St. Petersburg and a number of other large cities (Chelyabinsk, Novosibirsk, Perm, Omsk), every fourth resident seeks emergency medical care every year, and every 12th is hospitalized for emergency reasons. This is clearly evidenced by such figures that more than 40% of those injured as a result of emergencies are subject to hospitalization.
The reduction of emergency hospitals has led to the fact that the emergency departments of hospitals are often unable to provide timely and high-quality reception of seriously ill patients and injured, the connection between the pre-hospital and hospital stages of emergency medical care has been destroyed.
Well-known are some functions performed by stations and emergency departments that are not characteristic of them. These are the functions of polyclinics, emergency departments and even "microspecialized" departments of hospitals, social security services. The problem is exacerbated by the lack of some heads of health authorities, heads of services prehospital stage, chief specialists of a clear, unified understanding of the tasks of these services and the distribution of functions between them.
At the same time, only in emergency hospitals can diagnostic manipulations be carried out around the clock already in the emergency department, including laboratory diagnostics, X-ray diagnostics, ultrasound, etc.
In most regions of the Russian Federation (Krasnoyarsk Territory, Novosibirsk, Chelyabinsk, Moscow, Tver Regions) there are no emergency medical centers serving the rural population, although the rate of accessibility of rural residents to emergency medical care is not lower, and often higher than that of urban residents and is Moscow region 368.4 per 1000 population, Tver region - 332.1; Novosibirsk region - 479.0.
The decline in the standard of living of the population, the increase in the level of injuries, primarily road traffic and criminogenic, the weakening of the preventive focus of health care, the limited availability of medicines for the majority of the elderly requires adjustments to be made to the further development of emergency medical care in Russia.
Despite the fact that emergency medical care is in the first place in the “Program of State Guarantees for Providing Citizens of the Russian Federation with Free Medical Care”, which implies the priority of its financing, it is financed with a deficit. The average standard cost of a call in the Russian Federation in 2001 is . - 358.9 rubles, with a call rate of 318 (per 1,000 people). The resource provision of medical care stations almost everywhere (from 65 to 100%) complies with the standards approved by the order of the Ministry of Health of Russia dated March 26, 1999 No. 100. planned hospitalized patients, which does not correspond to the principles and volumes of emergency medical care.
The increase in the number of victims of man-made accidents and catastrophes, natural disasters, terrorist acts also dictate the need to improve the organization of emergency medical care for the population of the Russian Federation. It is necessary to develop a systematic integrated approach to improve the regulatory legal, socio-economic, financial, logistical, organizational, methodological and managerial mechanisms that determine the features of the organization and functioning of emergency medical care in the structure of primary health care in Russian health care.
At the same time, it should be recognized that there are currently many problems in the activities of emergency medical care that the Ministry should solve only together with the health authorities of the constituent entities of the Russian Federation and the health authorities of municipalities.
These problems are primarily associated with a significant decrease in the prestige of the profession, a sharp increase in the workload, low wages and social vulnerability of ambulance workers. The outflow of qualified personnel from the service continues.
In the system of undergraduate education, both doctors and paramedical workers do not receive the necessary theoretical and practical training. There is no exercise equipment.
Considering that over the past 20 years there has been a technological re-equipment of medicine, highly effective and at the same time extremely expensive diagnostic and treatment methods have come into practical healthcare: endovideosurgery, ultrasound, computed tomography, etc. All these technologies are in great demand in emergency medicine in the early stages of treatment.
The main direction of improving emergency medical care should be the concentration of emergency medical care on the basis of well-equipped intensive care hospitals, with the functional unity of the pre-hospital and hospital stages.
The condition that ensures the concentration of patient flows and an increase in the efficiency of resource use is the intensification of the treatment and diagnostic process at all levels, the reduction in the length of stay of patients in the hospital and the increase in bed turnover.
A systematic and comprehensive solution to the most complex tasks of reforming emergency medical care is possible only on the basis of program-targeted planning - the development and adoption of the sectoral target program "Improving emergency medical care." In Russia, a number of regions have developed and are operating their own territorial programs for reforming this type of assistance (Vladivostok, St. Petersburg, Bashkortostan, etc.). Their first results testify to the high efficiency of investments in this health sector.
The Ministry of Health of Russia has developed and will approve the draft of the Industry Target Program "Improvement of emergency medical care in the Russian Federation". At the same time, a direction is being developed that allows creating unified methodological approaches to the organization of emergency medical care in the Russian Federation, including the functional unity of the hospital and pre-hospital units.
The main goal of creating and implementing the Sectoral Program is to create conditions for improving the quality and efficiency of emergency medical care at the prehospital and hospital stages, leveling the conditions for its provision, ensuring equal accessibility of modern medical technologies for the population in the Russian Federation, creating the basis for further structural and functional healthcare reform throughout the country.
Organization of the provision of high-tech (expensive) types of medical care in healthcare institutions of federal subordination. Every year, the Ministry of Health of Russia, together with the Russian Academy of Medical Sciences, approves the order "On the organization of the provision of high-tech (expensive) types of medical care in healthcare institutions of federal subordination." The order defines the procedure for referring patients for consultation and treatment to federal healthcare institutions that provide timely, highly qualified medical care to patients.
This order for 2002 determined the List of high-tech (expensive) types of medical care (117 items) and the List of healthcare institutions providing them (73 institutions).
In 2002, the federal healthcare institutions of the system of the Ministry of Health of the Russian Federation and the Russian Academy of Medical Sciences provided high-tech medical care to 128,847 patients, which is 60% more than in 2001.
The volume of financing of high-tech (expensive) types of medical care of health care institutions of federal subordination of the system of the Ministry of Health of Russia in 2002 amounted to 2297.3 million rubles. more by 1561.6 million rubles.
In the 2003 budget, the Ministry of Health of Russia provides 2996.0 million rubles for the provision of high-tech types of medical care.
To fully satisfy and bring this assistance closer to the population, it is necessary to increase the volume of high-tech (expensive) types of medical care, and first of all in research institutes in centers located in the Urals, Siberian and Far Eastern federal districts of the Russian Federation.
Clinical expert activity is a priority for quality management of medical care.
The number of cases of temporary disability due to diseases per 100 employees is 64.0 cases.
The average duration of one case of illness with temporary disability has increased and is 14.1 days (as of 01.01.2001 -13.8).
The greatest losses of temporary disability are in the group of diseases of the respiratory system and is 23.8 cases per 100 workers, which is lower than in 2000. (26.6), while more than half of the cases are acute respiratory infections(15.4 cases per 100 workers).
The second place is still occupied by diseases of the musculoskeletal system - 8.2 cases per 100 employees, which is an increase compared to 2001. (7.4). This is followed by injuries and poisonings, which account for 6.8 cases per 100 workers (in 2001 - 6.4).
There is a steady increase in the number of cases of temporary disability due to diseases of the circulatory system - 5.3 cases per 100 workers (in 2000 - 4.1; in 2001 - 4.6), as well as for some long-term and often occurring diseases (diseases of the digestive system). , nervous systems s and sense organs).
Indicators of morbidity with temporary disability do not reflect the true state of health of workers, since the deterioration of the financial and economic situation of enterprises, forced and long holidays and shutdowns of production, the threat of unemployment reduce the number of workers seeking medical help when their health deteriorates.
The number of persons recognized as disabled for the first time in 2001 amounted to 1199761 people, which is 82.8 per 10 thousand population. Number of persons recognized as disabled for the first time in 1995 amounted to 1.3 million, in 1999 - 1.0 million, in 2000. - 1.1 million people.
The largest number of disabled people is registered in the Central Federal District - 97.4 per 10 thousand of the population, the number of disabled people is significantly lower in the Urals (59.9) and Far Eastern Federal Districts (66.8).
The first place among the diseases that caused the primary exit to disability are diseases of the circulatory system - 40.0 per 10 thousand of the population, followed by malignant neoplasms - 10.3 per 10 thousand of the population, diseases of the musculoskeletal system and connective tissue - 5, 7 per 10 thousand, the consequences of injuries, poisoning - 5.1 per 10 thousand of the population.
There is an increase in the indicators of primary disability among the working population; in recent years, one in five (20%) among those newly recognized as disabled have lost their ability to work at the age of under 45 (women) and 50 years (men).
There are a number of problems in the clinical and expert work on the examination of the quality of medical care: the lack of a systematic approach to the examination of temporary disability as a type of medical activity; lack of formation of the temporary disability examination service as a managed link in the healthcare organization system; lack of structural organization in the system of examination of temporary disability; poorly formed single information field; imperfection of the regulatory legal framework in matters of examination of temporary disability.
These problems indicate the expediency of creating a unified, modern system of accounting, analysis, and, consequently, operational management of temporary disability, linked to the quality system of treatment even at the stage of an unfinished case of temporary disability. Its creation will make it possible to quickly manage the state of examination of temporary disability and the quality of treatment, and, consequently, will lead to a reduction in the payment of benefits for temporary disability, and the saved funds will be used for the rehabilitation of patients.
At present, such a situation has developed in healthcare, when the existing medical and economic standards of compulsory medical insurance dictate the volume and terms of treatment without taking into account the average periods of temporary disability for various diseases, while medical institutions often unreasonably exceed the duration of treatment by 1.5-2 times, and there is no interest of MHI structures in regulating issues of temporary disability.
At the same time, decisions on the choice of the form, intensity and duration of treatment, rehabilitation, and prevention are made without taking into account the costs of paying benefits for temporary disability. At the same time, when calculating temporary disability benefits, social insurance uses outdated approaches based on the legislative framework developed and adopted back in the USSR.
The current situation dictates the urgent need to introduce a single insured event, both in compulsory medical insurance and in social insurance.
In addition, there are private issues that make it difficult to examine temporary disability:
there is an acute problem of continuity in the treatment of patients between medical and preventive institutions, this issue is relevant in connection with the possibility of citizens receiving disability certificates in various medical institutions, the doctors of which do not have information about the previous treatment of the patient and the timing of his temporary disability;
the problem of statistics of morbidity with temporary disability is relevant, largely due to the absence of a disease code in the disability certificate, which does not allow analyzing the level of morbidity with temporary disability, the dynamics of morbidity and the duration of one case of temporary disability for various nosological forms. There are no developments of temporary disability by industry.
In order to improve the work on the examination of temporary disability in the Russian Federation, a draft order of the Ministry of Health of Russia and the Social Insurance Fund of Russia "On approval of the Instructions on the procedure for issuing documents certifying temporary disability of citizens" was prepared and approved Methodological recommendations "Accounting, evaluation and analysis of clinical and expert activities medical institutions". In order to implement the Decree of the Government of the Russian Federation dated 10/15/2001 "On the procedure for providing benefits for compulsory state social insurance to persons sentenced to deprivation of liberty involved in paid work", a draft order of the Ministry of Health of Russia, the Social Insurance Fund of Russia, the Ministry of Justice of Russia "On approval of the procedure for conducting an examination temporary incapacity for work of persons sentenced to deprivation of liberty, involved in paid work, and execution by them of documents certifying temporary incapacity for work.
The main factors affecting the level of occupational morbidity are: unfavorable working conditions, the socio-economic and political situation in the country, the social insurance system and others.
The weighting effect of labor factors on the development of general somatic diseases, primarily of cardio-vascular system and musculoskeletal system, oncological diseases.
Increasing psycho-emotional loads (stress factor) with the formation of chronic fatigue syndrome, borderline neurosis-like disorders, and neuropsychiatric disorders have a negative impact on employees.
The growth of occupational morbidity places a heavy economic burden on society as a whole due to the high cost of compensatory costs for the loss of health to the victim in the event of the development of an occupational disease.
According to the State Statistics Committee of Russia, 63.9 million people (30.5 million women) work in the Russian Federation, of which 14.3 million are in industry, 8.7 million in agriculture and forestry, and 5.1 million in construction. , in transport and communications 4.9 mln.
In hazardous working conditions that do not meet sanitary and hygienic standards, 21.3% of the total number of employees in industry (i.e. every fifth), 9.9% in construction, 11.2% in transport, 2.5% due. About half of those working in hazardous working conditions are women.
By sectors of the economy, the indicator of occupational morbidity fluctuates in a wide range. The highest levels of occupational morbidity are recorded in the coal industry (43.5 per 10 thousand employees), in mechanical engineering, including road construction (17.7), energy (14.1), non-ferrous (14.2) and ferrous (10.2) metallurgy.
The analysis of occupational morbidity by administrative territories and federal districts of the Russian Federation deserves the most serious attention.
A high level of occupational morbidity was registered in Kemerovo - 18.4 per 10 thousand workers, Sakhalin regions - 8.4, Komi Republic - 7.9, Perm region - 5.06. A low level of occupational morbidity was noted in the city of Belgorod, Bryansk, Vladimir, Ivanov, Tambov, a number of republics of the Southern Federal District.
The occupational morbidity rate is higher than the average Russian level in the Sverdlovsk and Chelyabinsk regions, lower - in the Kurgan, Tyumen regions, Khanty-Mansiysk and Yamalo-Nenets autonomous districts.
At the same time, it should be noted that low rates of occupational morbidity in individual constituent entities of the Russian Federation may be due to the absence of occupational pathology centers in these administrative territories, inefficient periodic medical examinations, and low detection of occupational diseases.
The death rate due to accidents at work continues to rise. Total 2001 in the Russian Federation, 5957 people died in organizations of all sectors of the economy (in 2000 - 5977), including 466 women (in 2000 - 420) and 29 minors (in 2000 - 35).
The reasons for the growth of occupational and general morbidity and mortality from industrial accidents of the working population in the Russian Federation are a number of factors.
The unstable work of industrial enterprises, the lack of financial resources, the lack of economic interest among employers, led to a sharp reduction in the volume of work and financing of measures to improve the working conditions of workers.
The depreciation of fixed production assets and technological equipment, a noticeable reduction in the volume of capital and preventive repairs of industrial buildings, structures, machinery and equipment also played a significant role, which is also one of the reasons for the deterioration of working conditions for the working population.
The enterprises, as a rule, do not carry out work on reconstruction and technical re-equipment, introduction of new technologies, mechanization and automation of production processes, replacement of worn-out and modernization of obsolete equipment.
Certification of workplaces, staffing and organization of the work of sanitary-industrial laboratories, canteens are carried out at a slow pace, therapeutic and preventive nutrition is not organized.
As before, the mass of gross violations of the requirements of sanitary legislation is revealed at the so-called small enterprises.
The current situation in the Russian Federation with the protection of the health of the working population is primarily due to the imperfection of the legislation of the Russian Federation on labor protection, the lack of legal and economic sanctions for concealing occupational diseases, shortcomings in the organization and quality of preventive examinations of workers.
A significant role in the deterioration of the organization of medical care for the working population was also played by the reform of primary health care, which was accompanied by a reduction in the number of medical units and the transfer of their functions to territorial health facilities, which led to the curtailment of preventive activities at enterprises, incomplete coverage of workers in harmful professions with periodic medical examinations and a significant deterioration their qualities.
The detection rate of persons with suspected occupational disease is more than two orders of magnitude higher if specialists from occupational pathology centers participate in periodic medical examinations compared to doctors from the general medical network.
The Ministry of Health of Russia is carrying out certain work to improve the organization of medical care for the working population.
In 2002 submitted to the Government of the Russian Federation, together with the Ministry of Labor of Russia, the draft law "On Amendments and Additions to the Federal Law of the Russian Federation "On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases" dated July 24, 1998 No. 125-FZ.
In this draft law, the Ministry of Health of Russia insists on conducting "medical rehabilitation for the direct consequences of an accident at work or an occupational disease, in the form of rehabilitation (restorative) treatment of the insured, carried out on the territory of the Russian Federation immediately after accidents at work and occupational diseases until the restoration of working capacity or establishing a permanent disability", which will allow the use of funds from the Social Insurance Fund for the treatment of victims of accidents at work and occupational diseases from the first day of the disease.
A draft decree of the Government of the Russian Federation "On harmful and (or) dangerous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, and on the procedure for conducting these examinations (examinations)," is under preparation, which will increase responsibility employer for the health of the working population.
Under the current conditions, the role of occupational pathology centers is increasing, which, along with medical diagnostic and expert work, carry out joint activities with the relevant authorities and institutions of healthcare and state sanitary and epidemiological supervision, medical and social insurance, medical and social expertise for the prevention of occupational and general diseases among workers, medical social and professional rehabilitation of sick and disabled people.
The Ministry of Health of Russia is preparing an order "On improving the organization of medical care for the working population", which will develop the structure of the occupational pathology service, the regulation on occupational pathology centers, the regulation on the activities of medical units at enterprises, etc.
Within the framework of the sectoral target program "Quality Management in Health Care for 2003-2007" being developed by the Ministry of Health of Russia, a number of normative documents are envisaged to regulate medical activities related to protecting the health of the working population.
Licensing requirements for structural subdivisions that carry out an examination of the connection between a disease and a profession will be brought into line with the legislation of the Russian Federation.
Accreditation of medical institutions, certification of workplaces and medical personnel, certification of medical services received a new development in the management of the quality of medical care.
Accreditation of medical institutions that carry out prevention, treatment and rehabilitation of the working population will make it possible to identify the compliance of the activities of these institutions with the established standards for providing affordable medical care to those working in harmful and dangerous working conditions.
As part of quality management in healthcare, medical technologies with proven effectiveness will be developed, which will increase the effectiveness of preventive medical examinations and increase the detection of occupational diseases in the early stages of their development.
The development of a health care quality management program provides for the development and implementation of standards (protocols) for the management of patients with occupational diseases, which will significantly reduce disagreements in resolving expert issues to establish a relationship between a disease and a profession.
The introduction of standards will significantly improve the rehabilitation of patients with occupational diseases, which will help preserve the professional longevity of various groups of the working population of Russia. At present, methodological recommendations have been prepared and will be submitted for approval on the types and volumes of medical rehabilitation for victims of accidents at work and occupational diseases and tariffs for these types of medical services.
The implementation of the medical care quality management program will ensure interaction between employers, territorial social insurance funds and health authorities of the constituent entities of the Russian Federation in order to create effective economic mechanisms that ensure health protection and social guarantees for people employed in production.
Improving the organization of medical care for the indigenous and alien population living in the northern regions of the Russian Federation. Socio-economic prospects, demographic situation, problems of maintaining and strengthening the health of the indigenous and alien population living in the northern regions of the Russian Federation, whose area is almost 60% of the country's territory, - one of the most serious issues regularly considered at parliamentary hearings in the State Duma and the Federation Council Federal Assembly Russian Federation, meetings of the Government of the Russian Federation, congresses and conferences of interested public associations and organizations.
The active work of the Ministry of Health of Russia, aimed at developing and implementing a set of measures to protect the health of residents of the northern regions, was carried out in several directions.
First of all, within the framework of the activities of the working group of the Presidium of the State Council of the Russian Federation on the problems of the development of the northern territories of the Russian Federation, a report was prepared "On the fundamentals of state policy in the regions of the Far North", a plan and justification for priority measures to solve the problems of the northern territories, sections of the Concept of the Federal Law "On the fundamentals of state policy in the regions of the Far North" and the Plan for the implementation of the main provisions of the Concept concerning the social sphere in general and health problems.
These documents not only stated the presence of climatic, geographical and biogeochemical features of the region, the more severe consequences of the negative anthropogenic impact on the ecology of the North, the deep differences in the socio-economic situation of the constituent entities of the Russian Federation classified as northern regions, but also the lack of adequate regulatory and legal regulation, taking into account special requirements to the protection of the environment and the health of northerners.
The main objectives of the state northern policy are the normalization and improvement of the demographic situation, the reduction of mortality, especially in childhood and working age, by creating a medical care system that can ensure the preservation of health for all population groups based on prenosological diagnostics, preventive methods of correction and prevention of pathological conditions.
The State Council of Russia on the problems of the development of the northern territories supported the proposal of the Russian Ministry of Health on the need to introduce mandatory medical examinations for the population living in the conditions of the North. At the same time, it is advisable to introduce into everyday practice modern remote telecommunication technologies that allow for a complex of advisory, diagnostic and therapeutic measures using scientific potential. clinical centers carrying out high-tech specialized types of medical activities.
The solution of these problems depends not only on the identification of sources of targeted, adequate and sufficient financial and material support. Conducted in September 2002, a comprehensive audit of the state of health of the population and medical care for the indigenous and alien population of the Murmansk region showed the need in the near future to develop and adopt managerial decisions aimed at changing the structure and organization of medical institutions in the northern regions.
On the one hand, today it is extremely difficult to solve the problem of staffing medical personnel not only for low-capacity medical institutions (district, district hospitals, outpatient clinics and FAPs), but even for regional, regional and large city hospitals located in the regions of the Far North and the Far East.
Although, on the whole, in the constituent entities of the Russian Federation classified as northern territories, the availability of doctors and paramedical personnel corresponds to the average Russian indicators (41.9 and 95.5 per 10 thousand population), over the past 10 years there has been a steady decrease in the number of doctors and paramedical workers in these regions, especially in indigenous areas. A particularly unfavorable situation has developed in the staffing of primary health care, since a significant part of the medical staff is in retirement and pre-retirement age.
The level of professional training of medical personnel working in the North is not inferior to the level of specialists in other regions.
To correct the staffing situation in the medical institutions of the Far North, associated with the migration of the population to the European part of the country, the Ministry of Health of Russia has defined a plan for training doctors in the near future through targeted recruitment and training of specialists from among the indigenous peoples of the North.
In 2002 1721 people were admitted to medical universities of the country according to the target recruitment (against 1422 in 2000), including 1224 in the specialties of general medicine and pediatrics, 200 in medical and preventive care, 155 in dentistry, 57 in nursing, but legislative Today, there are no grounds for sending certified doctors after graduation to work in the regions most in need of such specialists.
In order to secure medical workers in the northern regions, it is necessary to make changes and additions to a number of legal acts both at the federal and local levels, including in terms of:
Strengthening the social protection of health workers by increasing wages through the introduction of appropriate progressive coefficients;
Provision of housing, including service housing, or preferential loans for its purchase and construction;
Payment or subsidies for travel, etc.;
Development of a system of targeted lending for vocational education, which provides for subsequent work for 3-5 years in state or municipal health care institutions in accordance with the existing staffing needs;
Establishment of administrative responsibility for non-fulfillment of the agreement (contract) of targeted training of a specialist in cases of refusal to work by distribution.
In addition, the organization of medical care in areas with a low population density, a great distance from centers with a developed network of health care institutions and limited transport accessibility should be based on other principles. Firstly, it is necessary to shift the emphasis in the provision of primary health care from a doctor to an assistant doctor (paramedic) of general practice, who has a broader training in the main sections of medicine, and the training of junior medical workers or paramedics (non-medical specialists) from among the indigenous inhabitants of sparsely populated villages in the Arctic zone, which has already begun in many medical schools in Siberia, the Far East, and the North-West of the country.
Secondly, the organization of work medical specialists in remote sparsely populated areas, it is advisable to carry out on a rotational basis, create mobile medical teams, air ambulance and ambulance services equipped with modern compact medical equipment to provide mobile forms of medical care in remote villages.
This requires a revision of both the regulations on the activities of various structural divisions of regional (regional, district, etc.) hospitals, as well as the standards for the staffing and workload of the personnel of these institutions.
Revision of the staffing standards for health care facilities in the northern regions and, first of all, primary care, requires the obligatory medical examination of the indigenous (aboriginal) and the entire child population of the North.
In addition, a serious concern is caused by the deterioration of the health indicators of citizens traveling to the regions of the Far North to work under labor contracts that require permanent or long-term temporary residence in these territories. In these cases, there is a rapid decrease in the physiological reserves of the body, which leads to chronic tension of functional systems and diseases of adaptation, as well as premature development or rapid progression of diseases of the cardiovascular, respiratory, peripheral nervous systems, depletion of immune mechanisms.
This provision needs to be revised as a list medical contraindications to be sent to work in the northern regions, and to tighten the regulations for monitoring the health status of these contingents.
The preparation of the above normative documents involves not only an in-depth analysis of the state of affairs, but also scientific research on these problems, such work is planned for 2003.
Co-financing of scientific research and practical measures for in-depth medical examination of the aboriginal and alien population will be carried out by the Norilsk Nickel Mining and Metallurgical Plant and the administration of the Taimyr Autonomous Okrug.
The resumption of the practice of conducting research expeditions to study the state of health of the indigenous peoples of the North, assigning supervising research centers and specialized clinics of medical universities to the northern regions today is impossible without financial participation from the administrations of the constituent entities of the Russian Federation assigned to the Far North, and located there large industrial enterprises.
In addition, the development of voluntary medical insurance on a cumulative basis (similar to pension insurance) of citizens will contribute to the solution of the urgent problems of the newcomer population in the North. This will allow people working in the Far North, after moving to a permanent place of residence in the European part of the country or other "non-northern" territory, to receive medical care in any healthcare facility outside the territory of permanent residence, regardless of the financial capacity of the budgets of this subject of the Russian Federation (municipal education) and compulsory health insurance.
The above aspects were reported and discussed at parliamentary hearings in the State Duma and the Federation Council: "Southern Kuriles: problems of economics, politics and security" (03/18/2002), "On the foundations of the state policy of the Russian Federation in the regions of the Far North and equivalent areas" (23.05.2002), "Prospects for ratification by the Russian Federation of ILO Convention No. 169 "On indigenous peoples and peoples leading a tribal way of life in independent countries" (22.11.2002), meeting of the Interdepartmental Commission of the Security Council of the Russian Federation on the constitutional security of the population "On ensuring constitutional rights of indigenous peoples living in the regions of the Far North, Siberia and the Far East" (09/25/2002).
Improving the organization of medical care for war veterans. Every year there is a decrease in the number of disabled people and participants in the Great Patriotic War (mainly due to those who died from natural causes of death, due to their advanced age). The main causes of death among combatants are unnatural: injuries, poisoning, murders and suicides.
One of the primary tasks for improving the socio-economic conditions of war veterans is the creation of their name register, the medical part of which (data bank on injuries, injuries, diseases, treatment and current state of health) should be formed and constantly be only in the medical - preventive institutions, taking into account the confidentiality of this information.
Not the last role in the creation of the Register should be played by public organizations and associations of veterans, since the effectiveness of measures aimed at preserving and improving the health of these contingents.
It is active dispensary observation, regular planned treatment and medical rehabilitation that make it possible to ensure active longevity of this contingent (mortality in general in the age group of 70 years and older ranges from 8–20%).
In accordance with the Program of State Guarantees for Providing Citizens with Free Medical Care, approved by the Government of the Russian Federation, all veterans are provided with emergency, inpatient and outpatient care, including annual medical examinations, at the expense of budgets of all levels and compulsory medical insurance, as well as preferential drug provision and prosthetics (dental, ocular and hearing aids).
Medical assistance to war veterans and invalids in all medical and preventive institutions of the Russian Federation, regardless of departmental affiliation, is provided according to the priority principle: priority admission in polyclinics and extraordinary planned hospitalization for inpatient treatment. There are no significant problems in the implementation of this benefit, established by the Federal Law "On Veterans", since it does not require the allocation of additional financial resources from the budgets.
Hospital institutions focused on the primary provision of planned inpatient care to veterans are 61 war veterans hospitals located in 54 constituent entities of the Russian Federation. They are also provided with dispensary supervision and medical rehabilitation. Only in 2002, 3 hospitals for war veterans were opened in Primorsky Krai, Tambov and Bryansk regions.
There are no refusals in inpatient treatment in medical institutions that do not have departments or wards for war veterans, and hospitalization of veterans is carried out on a priority basis. Out of turn, outpatient care for veterans is also provided.
According to annual examinations, more than a third of the participants and almost half of the war invalids need inpatient treatment.
Taking into account the advanced age of veterans of the Great Patriotic War, geriatric centers were created on the basis of many hospitals, the main function of which is organizational and methodological assistance to all medical and preventive institutions of the subject of the federation in providing geriatric care to the elderly and senile. Some of them (in Yaroslavl, Samara, Ulyanovsk and other cities) have the status of international centers for the elderly.
In many hospitals (Orenburg, Rostov regional and others), medical and social expert commissions constantly operate, some establish or change the disability group for veterans, associate disability with being at the front, determine indications for the provision of vehicles, the need for outside care already during the period of treatment in the hospital .
It is the hospitals of war veterans that most closely cooperate with veterans' organizations on solving a number of medical and medical and social problems of veterans. Representatives of veteran associations are members of the boards of trustees of these medical institutions, actively contribute to attracting extrabudgetary funds to improve the material and technical base of hospitals, supply them with medicines and food.
Thanks to the vigorous activity of public associations of veterans, the issues of medical assistance to these contingents, including drug provision and various types of prosthetics, are regularly considered at the boards of territorial health authorities.
One of the urgent tasks today is the creation of an effective interdepartmental system of medical and medico-social rehabilitation of combatants. The discussion of the organizational and methodological aspects of the creation in the Russian Federation of a unified interdepartmental system of medical and social rehabilitation of participants in hostilities and counter-terrorism operations, family members of dead military personnel and law enforcement officers was devoted to a working meeting of the heads of hospitals for war veterans, military medical institutions of various departmental affiliations, held in Samara, June 27-28, 2002.
Since the diagnosis and treatment of the consequences of a "combat injury" are now carried out both in hospitals for war veterans and in institutions of the general medical network, the main attention at the meeting was paid to the issues of medical rehabilitation of combatants.
In 1989, 3 rehabilitation centers for "warriors-internationalists" with a capacity of about 1000 beds were created in the Russian Federation: "Rus" in the Moscow region, "Baikal" in the Irkutsk region and "Anapa" in Krasnodar Territory financed from the federal budget.
Since 1994, "Baikal" and "Anapa" have ceased to function as centers of rehabilitation. Rehabilitation center "Rus" was transferred to the All-Russian public organization of disabled veterans of the war in Afghanistan. Disabled "Afghans" and members of the families of the dead are undergoing medical rehabilitation at the expense of federal budget funds allocated to the Ministry of Labor and Social Development of the Russian Federation for sanatorium treatment of disabled people.
Serious difficulties have arisen in the medical rehabilitation of "warriors-internationalists" on the ground, since there are only a few specialized medical institutions in the country that provide comprehensive medical and diagnostic, consultative, medical and social assistance, dispensary observation of only this contingent.
However, the problem of limited availability of medical rehabilitation assistance to combatants is not only in a small number of specialized centers, but also in the absence of a clear system of interagency cooperation and continuity in resolving these issues.
As a unified system of phased medical rehabilitation, which includes all organizational links in the provision of medical care (polyclinic, hospital, rehabilitation and sanatorium-resort treatment institutions), the medical and preventive institutions of the cities of St. Petersburg and Moscow, Volgograd, Nizhny Novgorod, Omsk, Rostov, Ryazan and other regions. In many cases, this system works as an interdepartmental one and includes structural units of social protection, employment services, etc.
At the same time, the main link in this system, as a rule, are hospitals for war veterans. The centers or separate units of medical rehabilitation created in their structure need not only to be re-equipped with other medical equipment, taking into account the change in the structure of morbidity and disability among younger contingents, but also to introduce new treatment and rehabilitation methods, and retrain personnel.
Part of the upcoming tasks (primarily in the creation of infrastructure) can be solved through the development and implementation of an appropriate federal targeted program. Another part of the tasks of ensuring the current activities of such an interdepartmental structure can only be solved by determining the target source of current funding.
One of the targeted sources of funding for the medical and medico-psychological rehabilitation of military personnel and law enforcement officers who have received a "combat injury", including post-traumatic stress disorders, may be the funds of "additional" state medical insurance, covering only contingents sent to "hot" spots .
The accumulation of these funds in the state medical insurance fund or the corresponding military insurance medical company (same for all "power" structures or in each of them), providing combatants with such insurance policies will allow them to receive the necessary rehabilitation measures in medical organizations and institutions, regardless from their departmental affiliation and organizational and legal form.
A possible mechanism for optimizing the functioning of the interdepartmental rehabilitation system, its effective management would be the creation of coordinating councils under the local executive authorities, which would include the heads of the territorial health authorities, social protection, compulsory medical and social insurance funds, employment services, education, as well as "power" ministries and departments, public organizations of veterans, etc.
The creation of similar coordinating bodies in the federal districts and at the federal level, to which authorized military insurance medical companies and funds would be accountable on these issues, would make it possible to make the system of state guarantees for the protection and restoration of the health of military personnel and law enforcement officers really effective.
In pursuance of the action plan of the Russian Organizing Committee "Victory", the Russian Ministry of Health in the reporting year conducted selective checks of the state of medical and drug provision of veterans in the Republics of Ingushetia, North Ossetia-Alania, Tatarstan, Arkhangelsk, Kemerovo, Lipetsk, Penza, Smolensk, Yaroslavl regions.
In the course of selective cross-checks of the organization and quality of medical care for elderly citizens, including veterans, it was noted that in recent years hospital-replacing types of medical care have become more widely used. This led to a reduction in the number of unjustified hospitalizations and, accordingly, the financial costs of paying for expensive inpatient care. However, talking about a decrease in the availability and quality of medical care, including high-tech expensive types, is not justified for the elderly, since the main consumers of medical services are still people older than working age.
Priorities in the queue for hospitalization, placement in more comfortable hospital conditions, improvement of nutrition and drug care in hospitals due to higher funding standards for these items, provided for by the regulatory legal acts of the Ministry of Health of Russia, are implemented everywhere.
Inspections also showed a generally satisfactory state of preferential drug coverage for veterans in these constituent entities of the Russian Federation. Despite a significant difference in the amount of funding for drug benefits, no cases of unjustified refusals to issue preferential prescriptions were identified.
Problems with preferential provision of medicines to veterans are related to the discrepancy between the financial capabilities of the consolidated healthcare budgets and the real needs of socially unprotected groups of the population.
This benefit is most fully implemented in those constituent entities of the Russian Federation where there are effectively operating budget-forming enterprises and the bulk of the population is people of working age (for example, the Khanty-Mansiysk, Taimyr Autonomous Okrugs, etc.). In these territories, the number of citizens eligible for drug benefits does not exceed 10%.
At the same time, in the course of the above inspections, it was universally noted that the funds allocated from the federal budget for equalizing the conditions for the implementation of benefits in the regions, including drug provision, are directed without designated purpose by type of subsidized benefits and are spent by decision of the heads of administrations in most cases for the implementation of other benefits established by the Federal Law "On Veterans" (payment for utilities, travel by transport, etc.).
The results of the checks, as well as proposals for improving interaction with veteran organizations on the issues of medical support for veterans, the prospects for the development of medical institutions focused on providing medical care to these contingents, together with representatives of public organizations and veterans' associations, were also discussed at the All-Russian meeting of heads of hospitals (hospitals) war veterans October 10-11, 2002 in Ulyanovsk.
Improving the organization of the blood service in the Russian Federation is a national task, and the quality of medical care in peacetime and in emergency situations depends on its solution.
At the beginning of 2002 In the blood service of the Russian Federation, there were 195 blood transfusion stations, 1101 blood transfusion departments and 319 blood collection hospitals.
In the last 15-17 years, blood donation in the country experienced a significant decline, which was due to the difficult socio-economic situation in the Russian Federation, the lack of effective promotion of the donor movement in the media, and the failure to fulfill the obligations of the state to implement the rights and benefits established for donors by the legislation of the country.
Concerning, total donors in Russia has more than halved in fifteen years. In 1985 the total number of donors was 5.6 million in 1995. - 2.9 million. In 2002 the number of donors amounted to 2,229,659 people, of which 1,865,497 people (83.6%) were gratuitous. The number of donors per 1000 of the population corresponds to the world average of 15.4, but is significantly inferior to the European one (in the countries of the European Union - 40).
Taking into account current trends in global and domestic transfusiology (transition to therapy with components and blood products) and the growth of hemotransmissible infections, it is important to introduce the latest technologies in the organization of the donor movement and the production of blood products (primarily to ensure their infectious and viral safety).
When compared with European indicators, the percentage of satisfaction of the needs of medical institutions for essential blood products is extremely low. Plasma fractionation buildings are experiencing significant difficulties due to a lack of funding, the equipment is worn out and needs to be replaced. At the existing fractionation buildings, new modern production technologies (including plasma virus inactivation) are not being actively introduced. The production of blood products does not comply with GMP rules, as a result of which domestic blood products are inferior in quality to foreign ones. Many valuable blood products, in particular, blood clotting factors for the treatment of hemophilia patients are mainly purchased abroad. It is necessary to increase the release of targeted immunoglobulins.
One of the main reasons that hindered the development of the donor movement and the production of blood products was the imperfection of the regulatory legal framework. Many normative legal documents regulating the work of the blood service in the Russian Federation are outdated. The imperfection of the legislative framework for blood donation led to numerous violations of the rights and benefits of donors.
In 2002 The Ministry of Health of Russia has developed a package of regulatory legal documents to improve the work of the blood service in the Russian Federation.
Considering the need to solve the problem of blood donation and the production of blood products by a program method and in accordance with the Law of the Russian Federation of 09.06.1993. No. 5142-1 "On donation of blood and its components" a draft federal target program "Development of donation of blood and its components, production of blood products in 2004-2009" was prepared.
The drafting of the most important orders for the national health care "On improving the work of the blood service in the Russian Federation", "On improving the work on the prevention of post-transfusion complications", "On the introduction of the method of quarantine of fresh frozen plasma into the practice of the blood service" is nearing completion.
The introduction of the above-mentioned departmental regulations will significantly improve quality management in the blood service in the country. In general, the Ministry of Health of Russia is developing a quality management program in the blood service in the Russian Federation, based on the principles of evidence-based medicine, standardization and licensing, which will ensure the quality of transfusion of blood components and products. Orders of the Ministry of Health of Russia dated September 23, 2002 No. 295 "On approval of the "Instructions for performing donor intermittent plasmapheresis" and dated November 25, 2002 No. 363" On the approval of the "Instructions for the use of blood components" laid the foundation for the development of standard operating procedures (SPO) in healthcare institutions . Standards for blood transfusion media are being developed that meet international requirements. in the Russian Federation in 2002. pharmacopoeial article FS 42-0091-02 "Plasma for fractionation" was put into effect, providing for a single type of raw material for the production of blood products, the mandatory quarantine procedure and virus safety.
In order to improve the efficiency of blood service management in the Russian Federation, by order of the Ministry of Health of Russia dated November 8, 2002 No. 298, the state institution "Blood Center of the Ministry of Health of the Russian Federation" was established.
To streamline the procedure for awarding donors with the badge "Honorary Donor of Russia", an order of the Ministry of Health of Russia dated 08.10.2002 No. 299 "On the procedure for presenting a citizen of the Russian Federation for awarding the badge "Honorary Donor of Russia" and presenting it" was prepared and issued. Work has been carried out to clarify the number of honorary donors in the Russian Federation as a whole (582,565 people) and separately for the constituent entities of the Russian Federation. The deadlines for passing award documents have been reduced. During 2002 62,000 citizens of the Russian Federation have been awarded the Honorary Donor of Russia badge by the Russian Ministry of Health. Work is underway to create national and territorial registers of persons awarded the badge "Honorary Donor of Russia".
One of the main directions for improving the work of the blood service is the creation of a new legislative framework for blood donation and the production of blood products in the Russian Federation. A proposal has been sent to the Government of the Russian Federation to develop required documents to draft a new federal law regulating blood donation in the country (to replace the Law of the Russian Federation "On donation of blood and its components").
Another important direction is the creation of an industry of modern domestic production of blood products that meet international standards.
Sanatorium and resort activities and medical rehabilitation. Together with other federal ministries and departments, interacting with the executive authorities of the constituent entities of the Russian Federation, with the support of the Government of the Russian Federation, the Ministry of Health of Russia is consistently implementing the principles of protecting public health, the initial basis of which is the prevention of diseases, rehabilitation and restorative treatment.
Passed in October 2002. The All-Russian Forum "Zdravnitsa - 2002" clearly showed that, despite the existing organizational and financial problems, the sanatorium and resort complex is actively developing and participating in the system of therapeutic and preventive measures aimed at improving the health of the country's population.
The resort business is one of the achievements of domestic health care.
Since 1992, the network of sanatorium-and-spa institutions in the Russian Federation has been shrinking every year, and the privatization of a number of organizations has led to a change in the profile of their activities. Weakened control over the state of resort resources. The volume of research work in the field of exploration and use of medical resources, the development and implementation of new methods of sanatorium treatment have significantly decreased.
The change in the form of ownership, the decentralization of funding flows have set new requirements for the state system of regulation of the work of the sanatorium and resort industry.
Given the urgent need to improve the health of the population, as well as in order to strengthen the coordination of sanatorium and resort activities, the Government of the Russian Federation in 2002. determined the Ministry of Health of Russia as a federal executive body authorized to implement state policy and coordinate activities in the field of resort business. Indeed, resort institutions in Russia, regardless of their form of ownership and departmental subordination, should act as a single complex that ensures the provision of sanatorium and resort care to the population. First of all, such assistance should be provided to working and socially unprotected categories of the population - children, the disabled, war and labor veterans, citizens affected by industrial injuries and occupational diseases, man-made accidents and military operations.
Health resort care should be an integral part of all medical programs for prevention, treatment and rehabilitation.
Over the past two years, the Ministry of Health of Russia has significantly stepped up its activities in addressing these issues. With the participation of specialists from specialized research institutions, the regulatory framework in the field of sanatorium and resort activities has been significantly updated: medical indications and contraindications for sanatorium treatment of adults, adolescents and children have been developed; order medical selection and referral of patients to sanatorium and outpatient treatment; together with the Social Insurance Fund of the Russian Federation, issues of organizing aftercare (rehabilitation) in sanatoriums for patients immediately after inpatient treatment were worked out; on rehabilitation in the conditions of sanatorium-and-spa institutions of persons injured as a result of accidents at work and occupational diseases. A number of new effective technologies and methods of sanatorium treatment and medical rehabilitation of patients with various, even severe, diseases have been developed, which made it possible to treat patients at resorts who had never been sent there before: ischemic disease hearts of more severe functional classes, who underwent acute myocardial infarction, with heart rhythm disturbances, after reconstructive operations on the vessels, with disorders cerebral circulation, diseases of the musculoskeletal system, bronchopulmonary system and others. A number of regulatory documents have been adopted to improve the work of specialized children's sanatoriums of federal subordination.
In order to improve the regulatory and legal framework in the field of resort business, at the initiative of the Ministry of Health of Russia, the Government of the Russian Federation adopted Decree No. 909 dated December 20, 2002 "On Amendments to Certain Decisions of the Government of the Russian Federation Concerning Determining the Status of Medical and Health-Improving Areas and Resorts of Federal Importance."
The Ministry of Health of Russia, together with the Russian Scientific Center for Restorative Medicine and Balneology, has developed a draft Concept of the State Policy for the Development of Resort Business in the Russian Federation, which provides that the strategic goal of state policy in improving the resort business is to create a modern resort complex based on domestic traditions and scientific achievements, able to solve the problems of disease prevention and public health promotion. The main provisions of the draft Concept were discussed and approved by the participants of the All-Russian Forum "Zdravnitsa-2002". The draft concept was sent to the Committee for Health Protection and Sports of the State Duma of the Russian Federation, the Federation of Independent Trade Unions of Russia, the federal executive authorities, the Compulsory Medical and Social Insurance Funds of the Russian Federation, and the health authorities of the constituent entities of the Russian Federation.
The Ministry of Health of Russia plans to conduct an accounting of the objects of the country's sanatorium and resort complex, regardless of the departmental affiliation and form of ownership of health resorts, which will create an information system for solving state problems for the development of the resort system.
About 250,000 people work in the country's health resorts, including 15,000 doctors and 45,000 nurses. In order to improve their qualifications, a number of attestation commissions have been created at specialized research institutions of the Ministry of Health of Russia, where medical workers of sanatorium and resort institutions can be certified, regardless of departmental affiliation and form of ownership.
Considering the important role of sanatorium-resort and rehabilitation treatment in the complex of measures to protect public health:
it is necessary to study the issue of attracting funds of compulsory medical and voluntary insurance to the sanatorium-resort sphere,
it is necessary to actively involve large investors in the development of the health resort complex,
to continue the development of the organizational and legal foundations of the medical rehabilitation service,
develop standards for the provision of rehabilitation care to patients,
to continue organizing centers for medical rehabilitation of patients with various diseases, including on the basis of sanatorium-resort institutions,
to improve the quality of organization and increase the efficiency of sanatorium-resort and rehabilitation assistance to the population of the country.
Organization of medical care for the population in emergency situations in recent years, the number of natural and man-made disasters, including man-made and occurring in the environment, as well as military conflicts and terrorist attacks in almost all regions of the world, has clearly continued to grow.
In 2002, the disaster medicine service of the Ministry of Health of Russia (CMK), performing the tasks of eliminating medical consequences emergency situations (ES), organization of medical support for the population in case of threat and occurrence of terrorist acts, plannedly participated in the restoration of healthcare in the republics of the North Caucasus.
At the same time, the improvement of the regulatory and legal framework of the disaster medicine service, the organizational and staffing structure and the management system continued to improve the performance of tasks within the framework of the Unified State System for the Prevention and Elimination of Emergencies (RSChS).
Over the past year, 860 emergencies were registered, including 721 man-made, 12 natural, and 7 terrorist attacks.
Solving the tasks of eliminating the medical consequences of emergencies, the Disaster Medicine Service of the Ministry of Health of Russia provided medical assistance to more than 31 thousand people affected, including 2328 road accidents. More than 6,500 people have been hospitalized.
In eliminating the medical consequences of the hostage-taking in Moscow on October 25-26, 2002, the Headquarters of the All-Russian Service for Disaster Medicine, together with the Moscow Center for Emergency Medical Aid and Ambulance, supervised the work of emergency response teams of the VTsMK field multidisciplinary hospital "Protection". Specialists of the VTsMK "Protection" participated in the organization of medical triage and the provision of medical care in medical institutions in Moscow.
In 2002, the Zashchita Center continued to organize medical support for the population of the Chechen Republic. During this period, specialists from the field hospitals of the All-Russian Central Medical Center "Zashita" provided medical assistance to more than 27,000 people. The health care of the Chechen Republic has been greatly assisted in the in-depth medical examination of children living in camps for internally displaced persons. Headquarters specialists took part in the restoration of healthcare facilities in the Chechen Republic.
From April 16, 2001 to July 6, 2002 in the city of Gudermes of the Chechen Republic, a field pediatric hospital of the All-Russian Center for Medical and Microcosmetics "Zashchita" operated with 50 beds. In 2002, more than 9.1 thousand children were treated at the hospital, 914 surgical operations were performed.
From February 5, 2001 to the present, Art. Ordzhonikidzevskaya, the field therapeutic hospital of the VTsMK "Protection" operates. Since January 2002, more than 18.7 thousand people have been treated at the hospital, 430 surgical operations have been performed.
Over the entire period of the anti-terrorist operation (since 1999) on the territory of the Chechen Republic, the disaster medicine service provided medical assistance to more than 170 thousand people, of which more than 64 thousand were children, 3 thousand military personnel. In difficult field conditions more than 4.4 thousand surgical operations were performed.
As a result of heavy continuous rains that took place in the summer of 2002, floods and flooding of settlements located on the banks of rivers (reservoirs) occurred on the territory of 9 subjects of the Southern Federal District, as a result of which more than 305 thousand people suffered. 51.4 thousand people applied for medical help, including 11 thousand children. Of those who applied, more than 4.3 thousand people were hospitalized, including 855 children. The largest number of hospitalized in the Krasnodar Territory - more than 1.8 thousand people in the Stavropol Territory - more than 1.6 thousand. human. The flood killed 169 people, including 11 children.
The Ministry of Health of Russia in the Southern Federal District, in the city of Stavropol, created a headquarters for the elimination of the medical consequences of emergencies.
The headquarters of the All-Russian Service for Disaster Medicine was transferred to the emergency mode and provided round-the-clock management and control over ongoing activities. Representatives of the Ministry of Health of Russia and the headquarters of the VSMK worked in the main areas of emergency situations (the cities of Stavropol, Krasnodar, etc.).
During the liquidation of the consequences of the flood from June 19 to November 6, 2002. more than 106 thousand people were evacuated from flood zones. 98.3 thousand people were returned to their places of permanent residence. In places of temporary accommodation, where 7.6 thousand people lived, round-the-clock work of medical centers was organized by the territorial health authorities (149 medical workers were involved, including 53 doctors, 48 medical and nursing teams worked).
B 2002 In the Southern Federal District, a difficult sanitary and epidemiological situation has developed due to outbreaks of acute intestinal infections. In carrying out sanitary and anti-epidemic measures, the formation of territorial centers for disaster medicine of the Southern Federal District under the leadership of employees of the headquarters of the VSMK took part.
To provide assistance to the affected subjects, the All-Russian Center for Disaster Medicine "Protection" of the Ministry of Health of Russia delivered 12.0 tons of medical equipment worth about 2.7 million rubles to the Southern Federal District. The Federal Compulsory Medical Insurance Fund under territorial programs transferred subventions to support healthcare in the subjects of the Southern Federal District for a total of 125.5 million rubles. rub.
In order to improve the quality of emergency medical care for the population of the Russian Federation affected by emergencies, the Institute for Problems of Disaster Medicine (IPMC) was established at the VTsMK "Zashchita", which performs an important task of continuous postgraduate training of healthcare managers and specialists of medical units of the QMS.
Thus, the issues of medical support for the population affected by natural disasters, accidents and catastrophes are reflected in the constant improvement by the Ministry of Health of Russia of the organizational structure of the disaster medicine service, in the consolidation of the actions of the management bodies, formations and institutions of various departments that are part of the VSMK, the development of organizational foundations creation and operation of the QMS at the local and facility levels. In the reporting period, active work was continued to create centers for disaster medicine (CMC) in the constituent entities of the Russian Federation, improve their organizational and staffing structure and build up the material base. In 2002 Disaster medicine centers were organized and started to work in 7 constituent entities of the Russian Federation - in the Republic of Udmurtia, the Republic of Kabardino-Balkaria and the Republic of Buryatia, the Khanty-Mansiysk and Nenets Autonomous Okrugs, in the Oryol and Ulyanovsk regions. In general, there are 80 full-time territorial centers for disaster medicine in the Russian Federation, 47 of them are accredited as independent healthcare institutions with the status of a legal entity. The public health authorities of the Republic of Tyva, Ryazan and Kirov regions, Komi-Permyatsky, Taimyrsky, Chukotsky, Evenksky, Aginsky-Buryatsky, Ust-Ordynsky Buryat Autonomous Okrugs have practically not started to create a CMC.
The work completed by the Ministry of Health of the Kabardino-Balkarian Republic on the integration of the service of disaster medicine, emergency medical care and air ambulance is positively assessed. Emergency medical care of the Republic of Dagestan, Moscow and the Sverdlovsk region is under the operational subordination of the directors of disaster medicine centers. This best practice is being actively implemented in the republics of Ingushetia, North Ossetia-Alania, Kaliningrad, Volgograd, Murmansk and a number of other regions.
Specialists of the field multidisciplinary hospital of the VTsMK "Protection" as part of the brigade of the Ministry of Emergency Situations of Russia traveled to Afghanistan to provide humanitarian and medical assistance to the population of the republic and the population affected by the earthquake (March-April 2002)
To date, the disaster medicine service at the federal, regional and territorial levels has more than 500 full-time units (hospitals, medical teams, emergency response teams and specialized medical care teams, including constant readiness). In the Republic of Tatarstan, Novgorod, Tula, Perm, Sverdlovsk, Nizhny Novgorod and Novosibirsk regions, extensive experience has been gained in the use of mobile units - medical teams in emergency situations. This experience deserves a positive assessment and can be recommended for all disaster medicine centers in the process of improving their organizational structure.
An analysis of the elimination of the medical and sanitary consequences of the hostage-taking in Moscow on October 25-26, 2002 showed the need to create non-standard mobile medical teams (special purpose) in the constituent entities of the Russian Federation, capable of organizing timely sorting and medical care for victims of various terrorist acts in autonomous working conditions .
The Disaster Medicine Service, while solving new problems in the Southern Federal District, has gained valuable experience in providing medical support to the population in an armed conflict over the course of several years.
Until now, two independent services function in the system of the Ministry of Health of Russia (the service of disaster medicine in peacetime and the medical service of civil defense, intended mainly for wartime), with similar tasks. These services create and use the same base and medical personnel, are guided by practically the same basics of organizing medical support, which leads to duplication of management bodies, makes it difficult to resolve issues of recruitment and training, as well as logistics. This position is not optimal.
Taking into account the decision of the meeting of the Interdepartmental Commission of the Security Council of the Russian Federation (09.12.2002), there is a need to integrate the medical service of civil defense and the service of disaster medicine into a single system of medical support for the population, the federal medical service of civil defense. For this, it is advisable to develop a scientifically based Concept for improving health care in wartime, to take into account the experience of the management bodies and formations of the disaster medicine service at the federal and territorial levels that are successfully functioning in the elimination of the medical and sanitary consequences of emergency situations in peacetime. It is possible to pay special attention to the development of the material and technical base and increase the readiness for response and the functioning of the disaster medicine service at the territorial level, since it is advisable to use the territorial centers of disaster medicine in wartime as the governing bodies of medical units at the pre-hospital stage.
Organization of special health care training. The main efforts in the work on special training in health care were aimed at developing mobilization plans for health care for the new accounting year and taking measures to develop and improve the activities of the Federal Medical Service of Civil Defense.
Guidelines for the development of plans for a special period have been prepared for the health authorities of the constituent entities of the Russian Federation, data on the procurement and processing of donor blood and its components have been summarized, the range and volumes of accumulation of medicines, medical, sanitary and other property, preparations of immunobiological products in a special reserve.
A number of legal acts aimed at increasing the level of mobilization readiness of health care have been prepared, in particular, a decree of the Government of the Russian Federation of March 14, 2002 No. No. 153-12 "On approval of the Regulations on the removal, adaptation and equipment of buildings intended for the deployment of special forces of the Ministry of Health of the Russian Federation during the period of mobilization and in wartime."
The developed Decree of the Government of the Russian Federation provides for the withdrawal of buildings and premises of medical institutions, regardless of their departmental affiliation and form of ownership (hospitals for war veterans, sanatoriums, rest homes, dispensaries, etc.), which greatly simplifies the deployment of special forces, staffing them, reduces the financial costs of carrying out adaptive work, changes approaches to the creation of mobilization stocks of medical and sanitary equipment.
Conducted tactical-special exercise in the Kaliningrad region in November 2002. on the deployment of a special formation on the basis of a local sanatorium, confirmed the reality of the requirements of the above resolution.
On the basis of the health authorities of Moscow and the Moscow Region, the city of St. Petersburg and the Leningrad Region, research exercises were conducted on the "Possibilities of the First Aid Unit of the New Organizational Structure for Providing First Aid to the Wounded and Injured medical care", which were the first step in the development and improvement of the activities of the Federal Medical Service of Civil Defense, for the period 2002 - 2005.
The results of the exercises showed that the first aid team is mobile, can be formed by one medical institution without the involvement of additional forces and means of other institutions, and is able to perform the tasks assigned to it on time.
advanced training
secondary medical
and pharmaceutical workers
towards
"Nursing
in dentistry"
Choose one or more correct answers
1. Outpatient clinics include:
A) medical and obstetric station
B) polyclinic
B) an ambulance station
D) hospital
2. Indicators characterizing the health of the population:
A) demographics
B) morbidity
C) physical development
D) quality and standard of living
^ 3. Compulsory medical insurance of the working population is carried out at the expense of:
A) deductions from the local budget
B) insurance premiums of enterprises and institutions
C) personal funds of citizens
D) all answers are correct
^ 4. Types of health insurance:
A) required
B) voluntary
B) individual
D) collective
5. A document authorizing a medical institution for the type of activity indicated in it:
A) license
B) an order
B) a certificate
D) diploma
^ 6. Preventive work of outpatient clinics is to organize:
A) day hospitals
B) medical examination of the population
C) therapeutic care in the clinic and at home
D) rehabilitation work
^ 7. At present, the healthcare model has been adopted in the Russian Federation:
A) government
B) budget insurance
B) private
D) mixed
^ 8. Guaranteed types of medical care are provided with insurance:
A) compulsory medical
B) voluntary medical
B) return
D) social
^ 9. The purpose of accreditation of a medical institution is:
A) protecting the interests of consumers of medical services
B) determining the scope of medical care
C) establishing compliance with quality standards of medical care
D) assessment of the degree of qualification of medical personnel
^ 10. Improving medical care for the population of the Russian Federation at the present stage is associated with the development of:
A) inpatient care
B) medical science
B) rural healthcare
D) primary health care
^ 11. Preventive medical examinations are the basis for:
A) primary health care
B) medical examination
C) medical rehabilitation
D) examination of working capacity
^ 12. An employment contract is concluded:
A) for an indefinite period
B) for a fixed period of not more than 5 years
C) for the duration of a certain task
D) at least 1 year
^ 13. If the term of its validity is not specified in the employment contract, then it is considered that:
A) the contract is concluded for an indefinite period
B) no contract
c) the employer can terminate it at any time
D) the employee can terminate it at any time
^ 14. If the employment contract is not properly executed, but the employee is actually admitted to work, then the employer is obliged:
A) draw up an employment contract with the employee before the expiration of three days from the date of the actual admission to work
B) draw up an employment contract with the employee before the expiration of a week from the date of the actual admission to work
B) remove an employee from work
D) draw up an employment contract with the employee after the expiration of the probationary period
^ 15. Deadline for applying to the labor dispute committee:
B) 1 month
B) 3 months
D) 10 days
16. Components nursing process:
A) evaluation
B) interpretation of nursing problems
B) planning
D) coordination of efforts
^ 17. Purpose of the nursing process:
A) diagnosis and treatment of diseases
B) ensuring the highest possible quality of life for the patient
C) solving questions about the order of care measures
D) active cooperation with the patient
^ 18. Nursing diagnosis is:
A) identification of existing and potential problems of the patient
B) reflection of the essence of pathological processes in the body
C) clinical judgment of the nurse
D) highlighting the priority problems of the patient
^ 19. The second stage of the nursing process includes:
A) care planning
B) making a nursing diagnosis
C) interdependent nursing interventions
D) assessment of the patient's condition
^ 20. The third stage of the nursing process includes:
A) nursing diagnosis
B) assessment of the patient's condition
B) care planning
D) collection of patient data
^ 21. The fourth stage of the nursing process is:
A) examination of the patient
B) goal setting
B) taking a nursing history
D) nursing interventions
^ 22. Goals of the fifth stage of the nursing process:
A) evaluation of the patient's response to nursing care
B) analysis of the quality of care provided
B) observation and control
D) examination of the patient
^ 23. Independent nursing interventions include:
A) feeding the patient
B) ECG recording
B) IM injections
D) placing a dropper
^ 24. Dependent nursing interventions include:
A) preparing the patient for the study
B) i / m, i / v, s / c injections
C) measures for personal hygiene of seriously ill patients
D) feeding the sick
^ 25. Medical psychology studies:
A) the place and role of mental processes in the occurrence and course of diseases
B) the role of medical workers in the treatment of patients
C) the psychology of communication between medical workers and patients
D) all answers are correct
^ 26. Empathy is:
A) complete similarity of beliefs, opinions, emotional state of partners
B) the ability to manipulate people for their own purposes
C) the ability to inspire others with their thoughts
D) the ability to recognize the emotions of others, to respond to them
^ 27. A way to prevent conflicts in the professional activities of a nurse:
A) consensus
B) group discussion
B) controversy
D) all answers are correct
^ 28. Iatrogenic diseases include:
A) due to harmful factors of production
B) due to careless actions or statements of medical workers
C) with a poor prognosis
D) hereditary genesis
^ 29. The computer system unit includes:
A) central processing unit
B) read-only memory device
B) display
^ 30. The "Enter" key means:
A) end of command input or menu selection
B) canceling any command or exiting the program
C) keyboard alphabet switching (Russian/Latin)
D) deleting a character to the left of the cursor
^ 31. In computers for long-term storage of information are used:
A) diskettes
B) hard drives
B) drives
D) random access memory
^ 32. Functions of the operating system:
A) produces a dialogue with the user
B) manages a computer
C) provides a convenient way to use computer devices
D) make a program
^ 33. A named set of information on a disk or other machine medium is called:
A) working memory
B) a file
B) a program
D) a directory
^ 34. The peripheral part of the computer includes:
A) display
B) central processing unit
B) keyboard
D) printer
35. The information output device includes:
A) printer
B) keyboard
D) monitor
^ 36. In case of HIV infection, the following are primarily affected:
A) macrophages
B) T-lymphocytes
B) erythrocytes
D) platelets
37. Resistance of HIV to environmental factors:
A) it is not stable, at a temperature of 56°C it is inactivated in 30 minutes, at a temperature of 100°C - in a few seconds (up to 1 minute)
B) stable in the environment, dies only when autoclaved
C) not resistant to disinfectants
D) resistant to high temperatures
^ 38. If HIV-infected biological material gets on the skin, it is necessary:
A) wash the skin with water and disinfect with 70% alcohol
B) treat with 70% alcohol, wash with soap and water and wipe again with 70% alcohol
C) wipe with 3% hydrogen peroxide solution
D) wipe with a 3% solution of chloramine
^ 39. Ways of transmission of hepatitis B virus:
A) sexual
B) parenteral
B) fecal-oral
D) aspiration
40. Factors of transmission of hepatitis A virus:
A) food contaminated with the secretions of the patient
B) the hands of the medical staff contaminated with the secretions of the patient
C) syringes, medical instruments
D) all of the above
^ 41. Ways of transmission of nosocomial infection:
A) parenteral, fecal-oral
B) contact, airborne
B) biological
D) chemical
^ 42. Responsible for organizing anti-epidemic measures in the hospital:
A) head nurse
B) chief doctor
C) an epidemiologist of a medical facility
D) procedural and ward nurses
^ 43. Shelf life of the sterility of medical devices when opening the bix:
A) 10 days
44. Sterilization methods:
A) steam, air
B) chemical
B) gas
D) mechanical
^ 45. The air sterilization method is used for products from:
A) metal
B) cotton fabric
B) glass
D) silicone rubber
^ 46. A positive reaction to the presence of occult blood implies:
A) rose color
B) lilac-violet coloration
B) pink-lilac coloring
D) blue color
^ 47. The destruction of the pathogenic principle on various objects of the external environment is:
A) disinfection
B) sterilization
B) asepsis
D) antiseptic
^ 48. Asepsis is a set of measures for:
A) fight infection in the wound
C) disinfection of instruments
D) sterilization of instruments
^ 49. Antiseptics is a set of measures for:
A) fight infection in the wound
B) prevention of infection in the wound
C) disinfection of instruments
D) sterilization of instruments
^ 50. Terms of eruption of the central incisors on the lower jaw (milk teeth):
B) 7-11 months
C) 10-14 months
51. Terms of eruption of the lower canines (permanent teeth):
A) 8-10 years
C) 7-12 years old
D) 9-11 years old
^ 52. Nursing examination of a patient begins with finding out:
B) causes of tooth loss
C) the presence of systemic occupational hazards
D) the presence of systemic diseases
^ 53. Examination of the oral cavity by a nurse should begin with:
A) the oral cavity itself
B) vestibule of the oral cavity
B) examining the tongue
D) examination of the floor of the mouth
^ 54. During the external examination of the patient, the nurse should pay attention to:
A) corners of the mouth
B) the presence of imprints of teeth
B) type of bite
D) the presence of facial asymmetry
^ 55. Be sure to palpate bimanually:
A) vestibule of the oral cavity
B) buccal region
B) floor of the mouth
D) frenulum of the tongue
56. Tooth mobility is determined by:
A) probe
B) tweezers
B) a mirror
D) ironing board
^ 57. For the study of the salivary glands, the following is used:
A) extraoral x-ray
B) pantomography
B) artificial contrast
D) biopsy
^ 58. Before a cytological examination, the nurse recommends to the patient:
a) brush your teeth thoroughly
b) Rinse your mouth with plenty of water
B) sanitize the mouth
D) all of the above
^ 59. Before bacteriological examination, the patient is prohibited from:
A) brush your teeth and apply antibiotics
b) eat and drink
B) do other research
D) rinse your mouth with water
^ 60. Metal dental instruments are sterilized in a dry-heat cabinet at a temperature:
A) 180°C - 45 min
B) 160°C - 60 min
C) 180°C - 60 min
D) 160°C - 90 min
^ 61. Rubber gloves are sterilized in an autoclave at a temperature:
A) 132°C - 2.0 kg/cm - 20 min
B) 120°C - 2.0 kg/cm - 20 min
C) 132°C - 1.1 kg/cm - 45 min
D) 120°C - 1.1 kg/cm - 45 min
^ 62. The sterile table remains sterile for:
A) 6 hours
B) 12 hours
D) whole day
63. Dental mirrors are sterilized at room temperature in:
A) 6% hydrogen peroxide solution, 180 min
B) 6% hydrogen peroxide solution, 360 min
C) 3% hydrogen peroxide solution, 360 min
D) 70% alcohol, 180 min
^ 64. Tools for single use before disposal:
A) sterilized
B) disinfect
B) washed with water
D) wipe with alcohol
^ 65. Materials for temporary filling of teeth:
A) uniface cement, artificial dentin, beladont
B) dentine paste, polycarboxylate cement
C) belokor, silicin, silidont
D) eugedent, unicem
^ 66. Adhesion of cement ensures the presence in the composition of the powder:
A) aluminum oxide
B) phosphoric acid
B) zinc oxide
D) silicon oxide
^ 67. The mixing time of zinc phosphate cements should not exceed:
A) 30-40 sec
B) 50-60 sec
B) 100-120 sec
D) 60-90 sec
68. The main distinguishing features of composite materials from other polymers:
A) the presence of mineral filler more than 30% by weight
B) transparency, color fastness
B) strength, chemical resistance
D) the presence of mineral filler less than 15% by weight
^ 69. For insulating gaskets, cements are used:
A) zinc phosphate, silicate, polycarboxylate
B) bactericidal, silicophosphate, eugenate
C) polycarboxylate, zinc phosphate, glass ionomer
D) zincoxyeugenol, bactericidal, silicate
^ 70. Materials for canal filling have antiseptic properties:
A) iodoform
B) barium oxide
B) white clay
D) zinc oxide
^ 71. The composition of glass ionomer cements includes:
A) polyacrylic acids, glass, silver ions, gold
B) maleic acid, glass, dyes
C) orthophosphate acid, zinc oxide, dyes
D) polyacrylic acid, zinc phosphate cement powder, platinum ions
^ 72. Preparations with wound healing action:
A) ointment and jelly "Solcoseryl"
B) ointment "Iruksol"
C) 1% solution of galascorbin
D) all of the above
^ 73. Concentration of chlorhexidine solution for oral irrigation:
74. To eliminate canal bleeding, use:
A) hydrogen peroxide
B) physiological saline
D) iodinol
^ 75. With the toxic effect of lidocaine, the following are observed:
A) chills, fever, facial flushing, drowsiness
B) pallor, nausea, vomiting, muscle tremors
C) convulsions, hypertension, redness of the face
D) hypertension, nausea, vomiting, headache
^ 76. Lidocaine solutions are used for conduction anesthesia:
77. Application anesthesia is:
A) application of a swab moistened with an anesthetic solution
B) impregnation of tissues of the surgical field with anesthetic
C) injecting an anesthetic into the nerve trunk
D) the introduction of an anesthetic under the periosteum
^ 78. Dependent nursing interventions for syncope include subcutaneous administration of:
A) 0.5 ml of adrenaline
B) 1 ml cordiamine
C) 2 ml diphenhydramine
D) 2 ml of aminophylline
^ 79. To stop bleeding from the canal after pulp extirpation, the nurse should prepare:
A) 21% sulfate iron
B) liquid phosphate cement
B) vagotyl
D) lidocaine
^ 80. General anesthesia can be complicated by:
A) stop breathing
B) exacerbation of chronic hepatitis
C) exacerbation of kidney disease
D) myocardial infarction
^ 81. Primary pathogenetic prevention in dentistry includes:
A) fluoride prophylaxis biologically active substances, isolation of fissures, normalization and improvement of the function of the salivary glands
B) the fight against the microflora of the oral cavity, the fight against plaque
C) removal of dental deposits, determination of oral hygiene indices, oral hygiene training
^ 82. Primary etiotropic prophylaxis in dentistry includes:
A) the fight against the microflora of the oral cavity, the fight against plaque
B) fluoride prophylaxis with biologically active substances, isolation of fissures, normalization and improvement of the function of the salivary glands
C) removal of dental deposits, determination of oral hygiene indices, oral hygiene training
D) all of the above activities
^ 83. Toothpastes containing herbal supplements:
A) "Azulene", "Ira", "Biodent", Blend-a-med complete"
B) Zhemchug, Arbat, Remodent
B) "Propolis"
D) "Prima", "Freedom"
^ 84. Toothpastes containing mineral preparations:
A) Zhemchug, Arbat, Remodent
B) "Propolis"
C) "Azulene", "Ira", "Biodent"
D) "Prima", "Freedom"
^ 85. Toothpastes used for the prevention of dental caries in adults:
A) Fluorodent, Kolinos, Colgate, Blend-a-honey complete, Blend-a-honey fluoristat
B) "Chamomile"
B) Ira
D) "Propolis"
^ 86. Bleeding from canals after pulp extirpation is stopped by:
A) liquid phosphate cement, perhydrol
B) hydrogen peroxide, chlorhexidine
C) caprofer, hydrogen peroxide
D) vagothyl, eugenol
^ 87. The problem of a patient with chronic fibrous periodontitis is:
A) discomfort when biting
B) prolonged pain from cold
C) constant throbbing pain
D) prolonged spontaneous pain
^ 88. In order to prevent periodontal diseases, it is necessary to brush your teeth:
A) 2 times, morning and evening
b) once in the morning
B) 3 times a day
D) 5 times a day
^ 89. Basic Clinical signs periodontal disease:
A) bleeding gums, tooth mobility, discharge of pus from gum pockets
B) exposure of the necks of the teeth and their increased sensitivity, the absence of inflammation of the gums, the absence of tooth mobility
C) tooth mobility, soreness and bleeding gums
D) absence of periodontal pockets, tooth mobility, gum hyperemia
^ 90. Problems of a patient with ulcerative necrotic stomatitis:
A) pain in the gums, putrid breath
B) gum itching, tooth mobility
B) proliferation of gingival papillae
D) the presence of erosion and aft
^ 91. In case of burns of the oral mucosa with acid, rinses are used:
A) a weak acid solution
B) iodine solution
B) soda solution
D) methylene blue solution
^ 92. For application anesthesia in the treatment of ulcerative gingivitis, the following are used:
A) 2% solution of novacaine
B) 15% pyromecaine ointment
C) 10% lidocaine aerosol
D) 0.5% novocaine solution
^ 93. Medicines accelerating the epithelialization of the oral mucosa:
A) oil solutions of vitamins A and E, strong antiseptics
B) corticosteroid ointments, antibiotics
B) decoction medicinal herbs, sea buckthorn oil
D) herbal tinctures, antibiotics
^ 94. Quartzization of the surgical room is carried out during:
A) 15 minutes
B) 30 minutes
B) 60 minutes
D) 120 minutes
95. After surgical intervention, the tool:
A) rinse with running water
B) soak in a disinfectant solution
B) washed with detergent
D) autoclaved
^ 96. Time of disinfection of instruments and gloves in 4% solution of Lysetol AF:
A) 15 minutes
B) 30 minutes
B) 45 minutes
D) 60 minutes
97. In a polyclinic, sterilization methods are used:
A) autoclaving, dry steam, chemical treatment
B) autoclaving, boiling, roasting
C) chemical treatment, dry steam
D) autoclaving, boiling
^ 98. Number of indicators in bix:
99. Sterilization time in SSH at 180С:
A) 20 minutes
B) 45 minutes
B) 60 minutes
D) 10 minutes
100. Test for traces of blood after pre-sterilization treatment:
A) azopyramic
B) amidopyrine
B) phenolphthalein
D) all of the above
101. If there are traces of blood in the azopyram test, staining appears:
B) blue-violet
B) hot pink
D) orange
^ 102. The patient had been ill with viral hepatitis. The nurse needs:
A) make an appropriate mark in the outpatient card
b) inform the doctor
B) report to the infectious diseases department
D) all answers are correct
^ 103. Indication for surgical treatment patient in the outpatient setting:
A) exacerbation of chronic periodontitis
B) multiple fractures of the lower jaw
B) phlegmon of the floor of the mouth
D) periodontal disease
^ 104. Preparing a patient for a planned tooth extraction operation:
A) brush your teeth, rinse your mouth with a solution of potassium permanganate
B) treatment of stomatitis
C) rinsing the mouth with an antibiotic solution
D) not required
^ 105. It is recommended to keep a gauze ball on the hole after tooth extraction for:
A) 3-4 minutes
B) 15-20 minutes
C) 45-60 minutes
D) 30 minutes
106. After tooth extraction, the nurse should advise the patient not to eat for:
B) 5-6 hours
C) 3-4 hours
D) 2 hours
^ 107. Dependent nursing interventions for prolonged bleeding from the hole:
A) the introduction of 10 ml of a 10% solution of calcium chloride, slowly
B) introduction of 1 ml of cordiamine
C) rinsing the mouth with cold water
D) rinsing the mouth with saline
^ 108. To wash a purulent focus, a nurse should prepare:
A) hydrogen peroxide solution, furatsilin, rivanol, dimexide
B) potassium permanganate, hypertonic sodium chloride solution, iodonate
C) iodonate, iodolipol, Lugol's solution
D) potassium permanganate, furatsilin, rivanol
^ 109. Potential problems of patients with jaw fractures:
A) formation of callus
B) the development of periodontitis adjacent teeth
C) delayed consolidation, improper union of fragments
D) osteomyelitis
^ 110. Bleeding from the nose is observed in fractures:
A) zygomatic bone and upper jaw
B) lower jaw
B) condylar process
D) coronoid process
111. The problems of a patient with neuralgia are:
A) pain, autonomic reactions in the zone of innervation
B) mobility of intact teeth
B) anesthesia
D) paresthesia
112. Problems of a patient with neuritis of the facial nerve:
B) vegetative reactions in the zone of innervation
C) anesthesia in the area of the lips and chin
D) lack of facial movements
113. Pain in trigeminal neuritis:
A) acute, constant or intermittent
B) lasts a few seconds, burning
B) spontaneous
D) depends on external stimuli
114. Dependent nursing intervention in the treatment of neuritis of the maxillofacial area is the introduction of vitamins:
B) E, groups B
^ 115. A predisposing factor for the development of a tumor of the maxillofacial region is:
A) chronic injury
B) acute inflammation
B) an infectious disease
D) all of the above
^ 116. Treatment of dentoalveolar anomalies involves
a) preventive measures, multi-gymnastics
b) surgical correction
C) installation of orthodontic and prophylactic orthopedic appliances
d) all of the above
^ 117. Independent nursing interventions for dentoalveolar anomalies in children:
A) conversations with patients and parents on the elimination of bad habits
B) participation in the imposition of orthodontic appliances
C) premedication before medical intervention
D) all of the above
^ 118. Temporary filling materials should have the following properties:
A) be harmless to the pulp, plastic, provide hermetic closure of cavities for several months
B) be radiopaque, resistant to the action of saliva
C) be mechanically and chemically strong, color stable
D) quickly harden, match the color of natural teeth
^ 119. Effectively prevent the development of secondary caries cements:
A) phosphate
B) silicophosphate
B) silicate
D) zincoxyeugenol
120. For gaskets under composite fillings, cements cannot be used:
A) phosphate
B) bactericidal
B) glass ionomers
D) zincoxyeugenol
121. In light-cured composites, shrinkage is directed towards:
A) pulp
B) photopolymerizer
B) the side walls of the cavity
D) the bottom of the cavity
122. The thickness of the light-cured composite layer during layer-by-layer application:
^ 123. The main disadvantages of acrylic plastics:
A) discrepancy between the coefficients of thermal expansion of plastics and tooth tissues, significant shrinkage, residual monomer
B) difficult to model, good adhesion
C) insufficient mechanical strength, residual monomer
D) chemical instability, high water absorption
^ 124. Calcium hydroxide is included in the composition of pastes for canal filling in order to:
A) stimulation of dentinogenesis
B) relieve inflammation
B) stimulation of osteogenesis
D) giving radiopacity
^ 125. Composite filling materials include:
A) dentist
B) acryloxide
B) noracryl
D) all of the above
126. Matrices are used to:
A) reducing the amount of material
B) improve color fastness
C) the formation of the contours of the seal
D) all answers are correct
127. Filling material for a gold crown:
A) aviriol
B) amalgam
B) phosphate cement
D) dentist
128. Material for the treatment of deep caries must have:
A) antimicrobial activity
B) odontotropic action
B) good adhesion
D) good plasticity
^ 129. Basic requirements for materials for filling root canals:
A) good sealing
B) biological tolerance
B) good input
D) radiopacity
^ 130. The following materials are most appropriate for filling root canals:
A) dexamethasone
B) paste with antiseptic and corticoid additives
B) zinc oxide paste
D) phosphate cement
^ 131. In the treatment of deep caries, the following are used:
A) phosphate cement
B) pastes with calcium hydroxide
B) antibiotic paste
D) all of the above
^ 132. The main disadvantages of amalgam:
A) lack of adhesion, thermal conductivity, amalgamation of gold prostheses
B) the formation of microcurrents in the oral cavity, hardness
C) the ability to cause allergic reactions from the oral mucosa
D) lack of mechanical strength and aesthetics
^ 133. The use of calcium hydroxide in deep caries is based on:
A) antibacterial effect
B) desensitizing effect
B) odontotropic action
D) all of the above
134. Medications as an application superimposed on:
B) 6 hours
B) 20 minutes
^ 135. Indications for general anesthesia in therapeutic dentistry:
A) intolerance to local anesthetics
B) mental and organic diseases of the central nervous system
C) carrying out interventions in patients experiencing fear of dental treatment
D) all of the above
^ 136. Contraindications to local anesthesia:
A) severe cardiovascular insufficiency
B) allergic reactions to local anesthetics
B) organic diseases of the central nervous system
D) all of the above
^ 137. Injury of blood vessels during conduction anesthesia leads to:
A) trismus
B) the occurrence of paresthesia
B) the formation of necrosis
D) the formation of a hematoma
^ 138. When removing milk teeth on the alveolar process of the upper jaw, local anesthesia is usually used:
A) infiltration, application
B) infraorbital
B) torus
D) mental
^ 139. The complex of anti-caries measures in adults includes:
A) fluoride tablets inside and topically - fluorine varnish
B) the use of fluoride-containing toothpastes
C) sodium fluoride electrophoresis
D) all of the above
^
140. Hygienic index according to Fedorov-Volodkina should not exceed (in points):
a) 1
141. The daily requirement for phosphorus in an adult is:
142. The daily requirement for calcium in an adult is:
143. The daily requirement for iron in an adult is:
144. UHF-therapy is performed for periodontitis:
A) sharp
B) chronic
B) arsenic
D) all answers are correct
145. Painful percussion is characteristic of pulpitis:
A) acute serous
B) chronic fibrous
B) chronic hypertrophic
D) acute purulent
^ 146. Differences between deep caries and acute pulpitis:
A) the absence of spontaneous pain, sensitivity to chemical and thermal stimuli
B) pain from hot, pain when probing
B) spontaneous pain
D) pain from stimuli
^ 147. Differential diagnosis of acute and exacerbated chronic pulpitis is based on the following data:
A) history of spontaneous pain
B) pain from temperature stimuli
B) the duration of the pain
^ 148. Nosological forms of pulpitis are treated with the biological method:
A) acute traumatic pulpitis
B) acute focal pulpitis
C) chronic fibrous pulpitis
D) acute diffuse pulpitis
^ 149. Symptom characteristic of chronic fibrous pulpitis:
A) communication of the tooth cavity with the carious cavity
B) hot pain
C) the absence of communication between the cavity of the tooth and the carious cavity
D) pain from chemical irritants
^ 150. Rational method of treatment for acute focal pulpitis:
A) vital extirpation
B) biological
B) devital extirpation
D) vital amputation
151. In the biological method of treatment of pulpitis, the inflammatory reaction and pain are removed:
A) eugenol
B) antibiotics
B) corticosteroids
D) sulfonamides
152. Antibiotics and enzymes in the biological method of pulpitis treatment are left in the oral cavity for:
A) 24-48 hours
B) 48-72 hours
B) 24 hours
D) 72 hours
153. Extirpation method of pulpitis treatment involves removal of the pulp:
A) crown
B) root
B) crown and root
D) half of the root
154. The decisive test in differential diagnosis periodontitis and pulpitis is:
A) percussion
B) determination of the nature of pain
B) X-ray diagnostics
D) palpation
^ 155. The patient's problem, defined as the feeling of a "grown" tooth, is typical for acute:
A) purulent pulpitis
B) serous periodontitis
B) serous pulpitis
D) purulent periodontitis
^ 156. Gums in acute purulent periodontitis:
A) hyperemic
B) pale pink
B) cyanotic
D) atrophic
157. The lymph nodes with acute purulent periodontitis:
A) enlarged, painful, mobile
B) not enlarged, painful, motionless
B) enlarged, painless, mobile
D) enlarged, soldered to the skin
^ 158. The presence of a fistulous tract is characteristic of periodontitis:
A) sharp
B) granulating
B) granulomatous
D) fibrous
159. The apical opening of the root canal is opened in the treatment of periodontitis:
A) acute serous
B) chronic fibrous
B) chronic granulomatous
D) acute traumatic
^ 160. An absolute indication for one-session treatment of periodontitis is the presence of:
A) granulomas in periodontitis of a multi-rooted tooth
B) fistulous course with periodontitis of a single-root tooth
C) fistulous course with periodontitis of a multi-rooted tooth
D) exacerbation of periodontitis of a multi-rooted tooth
^ 161. For the treatment of acute herpetic stomatitis, ointments are used:
A) nystatin, levorin
B) hydrocortisone, prednisolone
B) thiobrophenic, bonaftone
D) tetracycline, propolis
^ 162. White curdled rashes are typical for:
A) thrush
B) ulcerative gingivitis
B) herpetic stomatitis
D) contact stomatitis
^ 163. In the treatment of chronic mechanical injury of the oral cavity, first of all, it is necessary:
A) remove the irritant
B) carry out antiseptic treatment
C) treat the mucous membrane with keratoplasty
D) sanitize the oral cavity
^ 164. Afta is a characteristic element of defeat in case of:
A) acute herpetic stomatitis
B) candidal stomatitis
B) HIV infection
D) tuberculosis
^ 165. Allergic reaction immediate type is:
A) erythema multiforme exudative
B) Quincke's angioedema
C) chronic recurrent aphthous stomatitis
D) chronic recurrent herpetic stomatitis
^ 166. General treatment medicinal stomatitis involves:
A) elimination of the allergen, pipolfen, calcium preparations
B) prednisolone, ascorbic acid, prodigiosan
C) elimination of the allergen, dexamethasone, levorin
D) histaglobulin, B vitamins, calcium preparations
^ 167. Manifestations of allergic diseases on the oral mucosa occur when:
A) dysbacteriosis
B) thyrotoxicosis
B) body sensitization
D) the toxic effect of drugs
^ 168. The main signs of clinical death are:
A) thready pulse, dilated pupils, cyanosis
B) loss of consciousness, dilated pupils, cyanosis
C) loss of consciousness, absence of a pulse in the radial artery, dilated pupils
D) loss of consciousness, absence of a pulse on the carotid artery, respiratory arrest, wide pupils without reaction to light
^ 169. Artificial lung ventilation is continued until:
A) 5 breaths per minute
B) respiratory rate 10 per minute
C) respiratory rate 20 per minute
D) restoration of adequate spontaneous breathing
^ 170. Ineffective resuscitation continues:
A) 5 minutes
B) 15 minutes
B) 30 minutes
D) up to 1 hour
171. A drug administered to stimulate cardiac activity in case of sudden cessation of blood circulation:
A) isadrin
B) cordiamine
B) droperidol
D) adrenaline
172. Shock is:
A) acute heart failure
B) acute cardiovascular failure
C) acute violation of peripheral circulation
D) acute cardiopulmonary failure
^ 173. The sequence of actions when rendering assistance to a victim with a syndrome of prolonged compression:
A) application of a tourniquet, anesthesia, release of a squeezed limb, infusion, application of an aseptic dressing, external cooling of the limb
B) release of the compressed limb, anesthesia, infusion, tourniquet, immobilization
C) anesthesia, immobilization, tourniquet, infusion
D) anesthesia, release of the squeezed limb, application of an aseptic bandage
^ 174. Medical care for hemorrhagic shock includes:
A) the introduction of vasoconstrictor drugs
B) transfusion of blood substitutes
C) giving the patient a head-down position
D) oxygen inhalation
^ 175. Algorithm of actions in case of lightning-fast form of anaphylactic shock:
A) the introduction of adrenaline, prednisolone, diphenhydramine, with the appearance of signs of clinical death - mechanical ventilation, chest compressions
B) application of a tourniquet above the injection site, the introduction of diphenhydramine, adrenaline
C) conducting an indirect heart massage, mechanical ventilation, the introduction of cardiac glycosides
D) the introduction of adrenaline, mechanical ventilation, chest compressions
^ 176. First aid patient with acute myocardial infarction:
A) give nitroglycerin
B) ensure complete physical rest
C) immediately hospitalize by passing transport
D) if possible, administer painkillers
^ 177. Emergency measures for pulmonary hemorrhage:
A) complete rest
B) an ice pack on the chest area
C) the introduction of vikasol and calcium chloride
D) oxygen inhalation
^ 178. In the clinic of cardiac asthma in a patient with low blood pressure, a nurse should:
A) apply venous tourniquets to the limbs
B) start oxygen inhalation
C) enter strophanthin in/in
D) inject prednisone i / m
^ 179. The smell of acetone from the mouth is characteristic of coma:
A) hypoglycemic
B) hyperglycemic
B) uremic
D) cerebral
180. An antidote for opiate poisoning is:
A) naloxone
B) activated carbon
B) physiological saline
D) atropine
^ 181. Emergency measures for poisoning with organophosphorus compounds:
A) gastric lavage
B) saline laxative
B) fatty laxative
D) the introduction of an antidote
^ 182. The main task of the disaster medicine service in emergency situations is:
A) carrying out rescue and other urgent work in the seat of disaster
B) search for victims, providing them with first aid, taking them out of the outbreak
C) providing first aid to the victims, maintaining the functions of vital organs in the disaster area and during evacuation to a hospital
D) leadership of the grouping of forces carrying out rescue work in the seat of disaster
^ 183. Medical assistance in emergency situations is primarily provided to:
A) victims with injuries accompanied by increasing disorders of vital functions
B) victims with injuries accompanied by severe functional impairment
C) victims with disabilities incompatible with life
D) agonizing
^ 184. The number of triage groups during triage during emergency response:
185. Terminal states include:
A) preagonal state, agony
B) clinical death
D) biological death
186. Insufflation of air and compression of the chest during resuscitation, carried out by one resuscitator, are performed in the ratio:
187. Insufflation of air and compression of the chest during resuscitation carried out by two resuscitators are performed in the ratio:
188. Effective resuscitation continues:
A) 15 minutes
B) 30 minutes
B) up to 1 hour
D) before the restoration of vital activity
189. In case of electrical injuries, assistance should begin with:
A) chest compressions
B) precordial beat
D) termination of exposure to electric current
190. Pre-reactive period of frostbite is characterized by:
A) pale skin
B) lack of skin sensitivity
B) pain, swelling
D) hyperemia of the skin
191. A bandage is applied to the burnt surface:
A) with furacilin
B) with synthomycin emulsion
B) dry sterile
D) with a solution of soda
192. Contraindications for the use of nitroglycerin are:
A) low blood pressure
B) acute cerebrovascular accident
B) traumatic brain injury
D) hypertensive crisis
193. Cardiogenic shock is characterized by:
A) restless behavior of the patient
B) lethargy, lethargy
B) lowering blood pressure
D) pallor, cyanosis, cold sweat
194. Coma is characterized by:
A) lack of response to external stimuli
B) maximally dilated pupils
B) prolonged loss of consciousness
D) decreased reflexes
^ 195. Stage 1 includes medical evacuation measures carried out by:
A) in the center of emergency
B) on the border of the source of emergency
C) on the way from the outbreak to the health facility
D) in inpatient, outpatient health facilities
^ 196. Stage 2 includes medical evacuation measures carried out by:
A) on the way from the source of emergency to the medical facility
B) on the border of the source of emergency
B) in stationary health facilities
D) in outpatient health facilities
197. Frequency of breaths (per minute) during artificial lung ventilation:
^ 198. Efficiency resuscitation rated as positive if:
A) pallor, cyanosis of the skin and mucous membranes disappear
B) the pupils are constricted, react to light
C) the pulse is determined on large arteries
D) all of the listed features are determined
^ 199. Adsorbent used for poisoning:
A) starch solution
B) a solution of magnesium sulfate
c) activated carbon
d) soda
^
200. Transport immobilization rules:
a) immobility of the joints above and below the injury site
b) physiological position of the limb, cotton-gauze bandage under the bony prominences
c) tight fixation to the tire
d) all of the above
^ Sample responses
| 1 - a, b | 39 - a, b | 77-a | 115 - a |
| 2 - a, b, c | 40 - a, b | 78 - b | 116 - g |
| 3 - b | 41 - a, b | 79 - a | 117 - a |
| 4 - a, b | 42 - b, c | 80 - a | 118 - a |
| 5 - a | 43 - g | 81-a | 119 - in |
| 6 - b | 44 - a, b, c | 82-a | 120 - g |
| 7 - b | 45 - a, c, d | 83 - a | 121 - b |
| 8 - a | 46 - a | 84 - a | 122 - b |
| 9 - in | 47 - a | 85 - a | 123 - a |
| 10 - g | 48 - b | 86 - in | 124 - in |
| 11 - a | 49 - a | 87 - a | 125 - a |
| 12 - a, b, c | 50 - a | 88 - a | 126 - in |
| 13 - a | 51-a | 89 - b | 127 - in |
| 14 - a | 52 - a | 90 - a | 128 - a, b |
| 15 - in | 53 - b | 91 - in | 129 - a, b |
| 16 - a, b, c | 54 - g | 92 - in | 130 - a, b, c |
| 17 - b | 55 - in | 93 - in | 131 - b |
| 18 - a | 56 - b | 94 - in | 132 - a |
| 19 - b | 57 - b | 95 - b | 133 - in |
| 20 - in | 58 - b | 96 - a | 134 - in |
| 21 - g | 59 - a | 97 - a | 135 - g |
| 22 - a, b | 60 - in | 98 - in | 136 - g |
| 23 - a | 61 - g | 99 - in | 137 - g |
| 24 - b | 62 - a | 100 - a | 138 - a |
| 25 - a | 63 - b | 101-a | 139 - b |
| 26 - g | 64 - b | 102 - a | 140 - a |
| 27 - a | 65 - b | 103 - a | 141 - a |
| 28 - b | 66 - in | 104 - a | 142 - a |
| 29 - a, b, d | 67 - g | 105 - b | 143 - a |
| 30 - a | 68 - g | 106 - in | 144 - a |
| 31 - a, b | 69 - in | 107 - a | 145 - g |
| 32 - a, b, c | 70 - a | 108 - a | 146 - a |
| 33 - b | 71-a | 109 - c, d | 147 - a |
| 34 - a, c, d | 72-a | 110 - a | 148 - a, b |
| 35 - a, d | 73 - a | 111-a | 149 - a |
| 36 - a, b | 74 - a | 112 - a, b, d | 150 - b |
| 37 - a | 75 - b | 113 - a | 151 - in |
| 38 - b | 76 - in | 114 - b | 152 - a |
| 153 - in | 165 - b | 177 - a, b, c | 189 - g |
| 154 - a | 166 - a | 178 - b, d | 190 - a, b |
| 155 - g | 167 - in | 179 - b | 191 - in |
| 156 - b | 168 - in | 180 - a | 192 - a, c |
| 157 - a | 169 - g | 181 - a, c, d | 193 - b, c, d |
| 158 - b | 170 - in | 182 - in | 194 - a, c, d |
| 159 - in | 171 - g | 183 - a | 195 - a, b, c |
| 160 - b | 172 - in | 184 - in | 196 - in |
| 161 - in | 173 - a | 185 - a, d | 197 - b |
| 162 - a | 174 - b, c | 186 - a | 198 - g |
| 163 - a | 175 - a | 187 - b | 199 - in |
| 164 - a | 176 - a, b, d | 188 - g | 200 - g |
Chapter 14
Chapter 14
14.1. GENERAL PRINCIPLES OF THE ORGANIZATION OF SPECIALIZED MEDICAL
HELP
Specialized medical care occupies a special place in the healthcare system of the Russian Federation. This is due, first of all, to the fact that it is provided to citizens with diseases that require special methods of diagnosis, treatment, the use of complex medical technologies and, thus, the attraction of a large amount of material and financial resources, highly qualified specialists.
Specialized medical care is organized both in outpatient clinics and in hospitals.
In addition to local doctors, specialist doctors (allergist-immunologist, otolaryngologist, orthopedic traumatologist, endocrinologist, surgeon, ophthalmologist, neuropathologist, urologist, etc.) can work in APU. In order to increase the efficiency of the work of medical specialists for the population of several administrative districts (districts) or the city as a whole, receptions of specialists of the corresponding profile are organized on the basis of one or another polyclinic. Sometimes specialized offices, centers or points are formed on the basis of such polyclinics. For example, a city office for the treatment of strabismus, a 24-hour trauma center, etc.
At present, in large cities for the provision of specialized types of outpatient care, consultative and diagnostic centers(CDC), which are equipped with modern diagnostic equipment for immunological, genetic, cytological, radioisotope, radiation and other unique research methods.
An important role in the provision of specialized inpatient care is played by consultative and diagnostic departments(KDO)
in the structure of powerful multidisciplinary hospitals. The opening of such departments allows expanding the volume of specialized medical care, making unique opportunities individual hospitals more accessible to the population, more efficient use of the expensive medical equipment of the hospital and its highly qualified human resources.
Hospital specialized care is also provided by the relevant departments of multidisciplinary hospitals, specialized hospitals (gynecological, geriatric, infectious diseases, rehabilitation treatment, etc.), clinics of research institutes and higher educational institutions. An important place in the provision of specialized types of medical care to the population belongs to emergency medical care, centers for restorative medicine and rehabilitation, and sanatorium-and-spa institutions.
In the system of organizing specialized medical care for the population, a network plays an important role. dispensaries, which are intended for the development and implementation of a set of preventive measures, as well as for the active detection of patients with certain diseases in the early stages, their treatment and rehabilitation. In accordance with the nomenclature of health care institutions, the following types of dispensaries are distinguished: medical and physical education, cardiological, dermatovenerological, narcological, oncological, anti-tuberculosis, neuropsychiatric, etc. The dispensary provides assistance to both adults and children and, as a rule, includes a polyclinic (dispensary) department and hospital.
Let us dwell in more detail on the activities of individual specialized health care institutions.
14.2. EMERGENCY SERVICE
Emergency(PSC) is a type of primary health care. In 2008, there were 3,029 stations (departments) of the EMS in the Russian Federation, which included 11,969 general medical, 5,434 specialized and 22,043 paramedic teams. As part of the State Guarantee Program, 54.1 billion rubles were allocated to finance the NSR service, the average cost of one call was 1,110 rubles.
Every year, emergency care facilities make about 50 million calls, providing medical care to more than 51 million citizens.
Emergency- this is round-the-clock emergency medical care for sudden illnesses that threaten the life of the patient, injuries, poisoning, deliberate self-harm, childbirth outside medical institutions, as well as in case of catastrophes and natural disasters.
Emergency medical care is provided to citizens of the Russian Federation and other persons located on its territory, in accordance with the State Guarantees Program free of charge.
The structure of the ambulance service includes stations, substations, emergency hospitals, as well as emergency departments in hospitals. Ambulance stations as independent healthcare facilities are being created in cities with a population of over 50,000 people. In cities with a population of more than 100 thousand people, taking into account the length of the settlement and the terrain, ambulance substations are organized as subdivisions of stations (within a twenty-minute transport accessibility zone). In settlements with a population of up to 50 thousand, emergency medical departments are organized as part of central district, city and other hospitals.
Ambulance station (substation, department)- This is a medical facility that operates in the mode of daily operation and emergency situations (ES). The main task of the EMS station (substation, department) in the daily operation mode is to provide EMS to the sick and injured at the scene and during their transportation to hospitals. In emergency mode - carrying out medical and evacuation measures and participating in work to eliminate the medical and sanitary consequences of emergencies. The chief doctor heads the work of the NSR station, and the head of the substation and department.
An approximate organizational structure of an ambulance station (substation, department) is shown in fig. 14.1.
The main tasks of the stations (substations, branches) of the NSR are:
Provision of round-the-clock emergency medical care to sick and injured people who are outside medical facilities, in case of catastrophes and natural disasters;
Rice. 14.1. Approximate organizational structure of an ambulance station (substations, departments) (ACH - administrative part)
Implementation of timely transportation of sick, injured and women in labor to hospitals of hospitals;
Providing medical care to the sick and injured who applied for help directly to the station (substation, department) of the EMS;
Training and retraining of personnel on the provision of emergency medical care.
The effectiveness of solving these problems largely depends on the interaction of stations (substations, departments) of the SMP with health care institutions of the general medical network, the State Traffic Safety Inspectorate (STSI), units of the civil defense and emergency services.
The main functional unit of stations (substations, branches) of the NSR is field team, which can be paramedical or medical. The paramedic team includes 2 paramedics, an orderly and a driver. The medical team includes
a doctor, 2 paramedics (or a paramedic and a nurse anesthetist), an orderly and a driver.
In addition, medical teams are divided into general and specialized. There are the following types of specialized teams: pediatric, anesthesiology and resuscitation, cardiological, psychiatric, traumatology, neuro-resuscitation, pulmonology, hematology, etc. A specialized team includes 1 doctor of the corresponding profile, 2 paramedical workers of the corresponding profile, a nurse and a driver.
Primary Responsibility visiting team doctor ambulance - the provision of emergency medical care to the sick and injured in accordance with the approved standards (protocols) of patient management.
When providing emergency medical care paramedic as part of the medical assistant team, he is the responsible executor, and his duties generally correspond to the official duties of a doctor of a general medical team. In this regard, at present, in order to increase the efficiency of the use of financial and labor resources, work is underway to reduce the number of general medical teams and, accordingly, increase the number of paramedics, and this process should take place without deteriorating the quality of emergency medical care provided. Foreign and domestic experience shows that paramedic teams are able to provide the entire necessary set of "first aid" measures in accordance with the current standards (protocols) for managing patients.
The most important structural subdivision of stations (substations, branches) of the NSR is operational (dispatching) department, which provides round-the-clock centralized reception of appeals (calls) of the population, timely dispatch of mobile teams to the scene, and operational management of their work. Its structure includes a dispatcher's office for receiving, transferring calls and a help desk. Workplaces of department employees should be computerized. The duty personnel of the operational department has the necessary means of communication with all structural divisions of the NSR station, substations, mobile teams, medical institutions, as well as direct communication with the operational services of the city (district).
The operational (dispatching) department performs the following main functions:
Receiving calls with mandatory recording of the dialogue on electronic media to be stored for 6 months;
Sort calls by urgency and timely transfer them to field teams;
Implementation of control over the timely delivery of patients, women in labor, victims to the emergency departments of the respective hospitals;
Collection of operational statistical information, its analysis, preparation of daily reports for the management of the NSR station;
Ensuring interaction with medical facilities, the Department of Internal Affairs (ATC), the traffic police, units of the service for civil defense and emergency situations, other operational services, etc.
Receiving calls and transferring them to mobile teams is carried out duty paramedic (nurse) for receiving and transferring calls operational (dispatching) department of the NSR station.
The on-duty paramedic (nurse) for receiving and transmitting calls is directly subordinate to the senior shift doctor, is required to know the topography of the city (district), the location of substations and health care facilities, the location of potentially dangerous objects, the algorithm for receiving calls.
Sanitary vehicles of ambulance teams should be systematically disinfected in accordance with the requirements of the sanitary and epidemiological service. In cases where an infectious patient is transported by transport of EMS stations, the car is subject to mandatory disinfection, which is carried out by the staff of the hospital that received the patient.
The station (substation, department) of the EMS does not issue documents certifying temporary disability and forensic medical conclusions, does not conduct an examination of alcohol intoxication, however, if necessary, it can issue certificates of any form indicating the date, time of treatment, diagnosis, examinations, medical assistance provided and recommendations for further treatment. The station (substation, department) of the EMS is obliged to issue oral certificates about the location of the sick and injured when citizens apply in person or by phone.
Further improvement of the work of the SMP, increasing the efficiency of the use of its resources provide for a clear distinction between emergency and emergency medical care. Currently, about 30% of all calls received at the EMS station (substation, department) do not require emergency medical care, and their execution can be delayed in time (these are cases of acute diseases and exacerbations of chronic diseases that do not require urgent medical intervention). Such calls are emergency medical care, which should be provided by the departments (rooms) of emergency medical care of the APU of the municipal health system.
The medical activity of stations (substations, departments) of the SMP is characterized by the following indicators:
The indicator of the provision of the population with the SMP;
The indicator of the timeliness of the visits of ambulance teams;
The indicator of discrepancy between the diagnoses of the EMS and hospitals;
Indicator of the proportion of successful resuscitations;
The indicator of the proportion of deaths.
The indicator of the provision of the population with the NSR characterizes the level of accessibility of the population for emergency medical care. The dynamics of this indicator in the Russian Federation is shown in fig. 14.2.
Rice. 14.2. Dynamics of the indicator of provision of the population with emergency medical care in the Russian Federation (1998-2008)
The normative value of the indicator of provision of the population with the EMS is established annually in the Program of State Guarantees for the Provision of Free Medical Care to the Citizens of the Russian Federation and in 2008 amounted to 318 calls per 1000 population.
The indicator of the timeliness of visits of ambulance teams characterizes the efficiency of the stations (substations, branches) of the NSR. Currently, the timeliness of ambulance teams, especially in large cities, mainly depends on two circumstances: first, on the rationality of placing substations in the city; second, from the traffic situation. Under these conditions, GPS and Glonass navigation systems are being introduced to increase the efficiency of managing ambulance crews of NSR dispatching stations.
The indicator of discrepancy between the diagnoses of the EMS and hospitals characterizes the level of diagnostics and continuity in the work of the EMS and hospitals. The most difficult to diagnose at the prehospital stage are pneumonia, traumatic brain injury, acute cerebrovascular accident, and angina pectoris. Regarding these diseases, the rate of discrepancy between the diagnoses of the EMS and hospitals is 13.9, respectively; 5.7; 3.8; 1.2%.
Indicators of the share of successful resuscitations and the share of deaths complement each other, characterize the quality of the work of the EMS teams and their equipment with the necessary material resources. The recommended values of these indicators are, respectively, at least 10% of successful resuscitations performed by the ambulance teams, and not more than 0.05% of deaths in the presence of the ambulance team.
14.3. BLOOD TRANSFUSION SERVICE
One of the most important areas for ensuring the activities of healthcare organizations, improving the quality of medical care is the development of the blood service. In 2007, there were 151 blood transfusion stations and 618 blood transfusion departments in the Russian Federation
as part of state and municipal health care institutions, which in total collected more than 1.8 million liters of blood. Blood transfusion station(SPK) is a medical facility designed to provide healthcare facilities with whole blood and its components. The work of the SPC is headed by the chief physician, who is appointed and dismissed by the head of the relevant health management body.
The main tasks of the SPK:
Carrying out donor plasmapheresis, cytopheresis, conservation of blood components, preparation of preparations for cryopreservation of blood cells;
Provision of healthcare organizations with components and blood products;
Participation in planning and holding special events of the Disaster Medicine Service;
Providing organizational, methodological and advisory assistance to healthcare organizations on the issues of procurement and transfusion of blood components;
Organization and implementation of statistical records of donors, donated blood and blood products;
Carrying out work together with public organizations to promote donation among the population.
Currently, the blood service is experiencing serious difficulties associated, on the one hand, with the low level of material and technical base of stations and blood transfusion departments, and on the other hand, with a decrease in the number of donors due to a decrease in the prestige of the donor movement in society. That is why the main directions for further improvement of the blood service:
Technical and technological modernization of blood service institutions;
Promotion of mass donation of blood and its components. Technical and technological modernization of service institutions
blood provides for equipping blood service institutions at the federal, regional and municipal levels with modern equipment for the procurement, processing, storage and safety of donor blood and its components. In addition, the donor screening process needs to be streamlined to ensure the validity of the donor research results.
blood for bloodborne infections, quarantine blood plasma for at least 6 months, which will provide health care facilities with the safest possible virus-inactivated blood components. It is necessary to carry out everywhere the transition to the procurement of various blood components by a more comfortable, technologically advanced and less traumatic for the donor method of hardware cytoplasmapheresis. The most important direction of technical modernization of blood service institutions is the formation of state information resources in the field of blood donation and its components based on the introduction of modern information and telecommunication technologies.
Promotion of mass donation of blood and its components It involves, first of all, strengthening the public's confidence in government initiatives to develop mass donation based on promoting the safety of the procedure for taking blood and its components, and increasing the prestige of donation in society. It is necessary to take additional measures to provide material and moral incentives to motivate citizens to donate blood. A prerequisite for solving these problems is the formation of joint and several responsibility of regional and local authorities, the professional community, business, and the population for the fate of patients in need of donor blood and its components.
The indicators characterizing the activities of the SEC include:
The indicator of the availability of the population with donors;
Blood collection plan completion rate;
Donor blood processing rate;
An indicator of the average dose of blood donation.
The indicator of the availability of the population with donors characterizes the active participation of the population in the donor movement. In the Russian Federation, the value of this indicator has tended to decrease in recent years and amounted to 12.9 donors per 1,000 population in 2008 (Fig. 14.3).
Blood collection plan completion rate - this is an important characteristic of the production activities of blood transfusion stations (departments), therefore, the heads of the SEC should strive for 100% fulfillment of the blood collection plan.
Donor blood recycling rate characterizes the completeness of the processing of donor blood into components. At least 85% of the collected blood must be processed into components.
Rice. 14.3. Dynamics of the indicator of the provision of the population with donors in the Russian Federation (1998-2008)
Indicator of the average dose of blood donation in the Russian Federation in 2008 amounted to 430 ml of blood per donation. In recent years, there has been a trend towards an increase in this indicator against the background of a decrease in the supply of the population with donors and an increasing need for whole blood, its components and preparations. This is a poor prognostic sign, given that the average dose of blood donation has a certain physiological limit, beyond which the only way to provide healthcare organizations with blood is to increase the number of donors.
14.4. ONCOLOGICAL CARE
The system of providing oncological care to the population includes oncological dispensaries, hospices or departments of palliative care for oncological patients, examination and oncology rooms of APU. In 2008, 107 oncology dispensaries, 2125 oncological departments (offices), in which 7720 oncologists and radiologists worked.
The main tasks of these institutions are to provide specialized medical care to patients with cancer, conduct dispensary observation of patients with cancer, target (screening) medical
Qing examinations, as well as conducting sanitary and educational work on prevention and early detection oncological diseases.
The leading role in the system of specialized oncological care belongs to oncology dispensaries, which, as a rule, are organized at the level of the constituent entity of the Russian Federation (republic, territory, district, region). The work of the dispensary is headed by the chief physician, who is appointed and dismissed by the head of the relevant health management body. The main goal of the dispensary is to develop a strategy and tactics for improving oncological care for the population, providing qualified oncological care to the population of the assigned territory. In accordance with this goal, the dispensary solves the following tasks:
Providing qualified specialized medical care to cancer patients;
Analysis of the state of oncological care for the attached population, the effectiveness and quality of ongoing preventive measures, diagnosis, treatment and dispensary observation of oncological patients;
Maintaining a territorial cancer registry;
Development of territorial targeted programs to combat cancer;
Training and advanced training of oncologists, doctors of main specialties and paramedical workers on the provision of oncological care to the population;
Introduction of new medical technologies for providing medical care to cancer patients and patients with precancerous diseases;
Coordination of the activities of health care institutions of the general medical network on the issues of prevention, early detection of malignant neoplasms, dispensary observation and palliative treatment of cancer patients;
Organization and conduct of sanitary and educational work among the population on the formation of a healthy lifestyle, the prevention of cancer.
In addition to the outpatient and inpatient departments traditional for most dispensaries, the oncology dispensary includes: a department for palliative care, radiation therapy, chemotherapy, a boarding house, etc.
For a comprehensive analysis of the activities of oncological dispensaries, the following statistical indicators are used:
Indicator of the contingent of patients with MN;
Indicator of primary incidence of MN;
Mortality rate from MN;
One-year mortality rate;
The indicator of the proportion of patients with I-II stages of malignant neoplasms identified during targeted medical examinations;
The indicator of neglect of ZNO.
The indicator of the contingent of patients with malignant neoplasms gives a general idea of the prevalence of malignant neoplasms, the organization of statistical records and dispensary observation of cancer patients. For the last 10 years, the growth trend of this indicator has been maintained, the value of which in 2008 in the Russian Federation amounted to 1836.0 per 100 thousand of the population.
The indicator of primary incidence of malignant neoplasms complements the indicator of the contingent of patients with malignant neoplasms and can serve as one of the assessments of the effectiveness of the implementation of federal and regional programs for the prevention of risk factors for malignant neoplasms. Over the past 15 years, this indicator has been steadily growing, and in 2008 it amounted to 345.6 per 100,000 population, which indicates, in particular, an increased level of diagnostics in healthcare institutions (Fig. 14.4).
Rice. 14.4. Dynamics of primary incidence of malignant neoplasms in the Russian Federation (1994-2008)
Mortality rate from cancer can serve as an integral characteristic of the level of specialized medical care for cancer patients. The dynamics of this indicator in the Russian Federation over the past 10 years is shown in Fig. 14.5.
Rice. 14.5. Dynamics of mortality rate from malignant neoplasms of the population of the Russian Federation (1999-2008)
One-year mortality rate serves as one of the characteristics of late detection of malignant neoplasms, the effectiveness of complex therapy and clinical examination of cancer patients. This indicator is calculated as the percentage of deaths in the first year after the diagnosis of malignant neoplasm to the total number of patients with such a diagnosis for the first time in their life. In recent years, a slight decrease in the one-year mortality rate has been observed in the Russian Federation, the value of which in 2008 was 29.9%. The highest values of this indicator are observed in cancer of the esophagus.
(62.3%), lungs (55.4%), stomach (54.0%).
The proportion of patients with stages of cancer, identified
during targeted medical examinations, characterizes the effectiveness of ongoing targeted (screening) medical examinations of the population. According to the results of such examinations carried out in certain territories of the Russian Federation, on average, only 55% of patients with stages I-II of malignant neoplasms are detected. This indicates an insufficient level, on the one hand, of organizing and conducting targeted medical examinations of the population, on the other hand, of oncological alertness of medical workers and patients themselves.
The indicator of neglect of ZNO represents one of the main criteria for the quality of work of all health facilities and diagnostic services (radiological, endoscopic, ultrasound, cytological, etc.). This indicator determines the proportion of patients with stage IV of all and with stage III of visual localization of malignant neoplasms in the total number of oncological patients with a diagnosis established for the first time in their lives. In recent years, it tends to decrease in the Russian Federation, remaining, however, high (30% in 2008).
14.5. PSYCHONEUROLOGICAL HELP
The relevance of improving mental health care is associated with an increase in the prevalence of mental and behavioral disorders. The legal basis for the organization of psychiatric care for the population is the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision." In 2008, there were 402 institutions and 3,016 neuropsychiatric departments and departments in the Russian Federation, employing 16,165 psychiatrists.
The leading institution in the system of providing specialized psychiatric care to the population - psychoneurological dispensary, which is headed by the chief physician, appointed and dismissed by the head of the relevant health management body. The relevance of the problem of mental health of the population determines the following main tasks in the work of the neuropsychiatric dispensary:
Providing outpatient psychiatric and psychotherapeutic care to patients suffering from mental disorders, as well as dispensary observation of them;
Inpatient care for patients suffering from non-psychotic types of mental illness;
Carrying out preventive examinations, examinations, forensic psychiatric, military medical and medico-social examinations;
Social and labor rehabilitation of patients with mental illness;
Emergency psychiatric care, including in emergency situations;
Participation in the decision of issues of guardianship of incompetent patients;
Providing advisory specialized neuropsychiatric care to patients in somatic hospitals and outpatient clinics;
Psychohygienic, sanitary and educational work among the population.
These tasks determine the organizational and functional structure of the dispensary. The typical structure of a dispensary, as a rule, includes the following departments: a treatment and diagnostic department with offices of local psychiatrists, a day hospital for short-term stays of patients suffering from non-psychotic types of mental illness, a department of child and adolescent psychoneurology, a department of psychoprophylaxis and psychohygiene, a department of the Helpline ”, an office of socio-psychological assistance, etc. In addition, a psycho-neurological dispensary may include state medical and production enterprises for occupational therapy, training in new professions and employment of persons suffering from mental disorders, including the disabled.
The dispensary can organize neuropsychiatric departments (offices) at general polyclinics to provide specialized psychoneurological care to the population.
The main indicators characterizing the medical activities of neuropsychiatric dispensaries include:
Indicator of the contingent of patients with mental disorders;
Primary incidence rate of mental disorders;
Rate of re-hospitalization of patients with mental disorders.
Indicator of the population of patients with mental disorders
characterizes the prevalence of mental disorders, the level of organization of statistical accounting and dispensary observation of mental patients. Over the past decade, there has been a tendency towards an increase in this indicator due to an increase in the dispensary group of mental patients (Fig. 14.6).
Primary incidence rate for mental disorders 1 serves as an indirect characteristic of the social stratification of society and violations of the adaptive mechanisms of the psyche of the individual
1 The number of patients with a diagnosis of a mental disorder for the first time in their life who applied for consultative and therapeutic assistance is taken into account.
Rice. 14.6. Dynamics of indicators of the contingent of patients and the primary incidence of mental disorders in the population of the Russian Federation
(1998-2008)
duum. In recent years, this indicator has stabilized and in 2008 amounted to 301.7 per 100,000 population (see Fig. 14.6).
Readmission rate for patients with mental disorders characterizes the effectiveness of dispensary observation and the quality of inpatient treatment of mental patients. For individual subjects of the Russian Federation in 2008, the proportion of patients with mental disorders re-hospitalized in psychiatric hospitals during the year amounted to 20-23%, which indicates the existing reserves for improving the efficiency of dispensary observation and treatment of mental patients.
Further improvement of psychiatric care for the population is impossible without the development of a comprehensive system of prevention, diagnosis, treatment and rehabilitation of patients suffering from mental disorders. This system should include conducting screening forms of medical examinations of the population, improving the quality of forensic psychiatric and medical and social examinations, introducing effective methods of psychosocial therapy and rehabilitation, and training programs for the population on mental health and suicide prevention. A necessary condition for the implementation of this set of measures is the development of modern projects and the construction of specialized medical institutions providing psychiatric care to the population.
14.6. DRUG CARE
The existing problem of alcoholism and drug addiction, which occupies one of the leading places in the ranking of social problems, determines the need for further development and improvement of the narcological service. The legal basis for solving this problem is, in particular, the Federal Law "On Narcotic Drugs and Psychotropic Substances". In 2008, there were 144 narcological dispensaries in the Russian Federation, 12 specialized narcological hospitals, 3 narcological rehabilitation centers, 1891 departments (offices) as part of health care institutions, in which 5764 psychiatrist-narcologists worked. Drug Dispensary serves as the main link in the organization of narcological assistance to the population, which is headed by the chief physician, appointed and dismissed by the head of the relevant health management body.
The main tasks of the narcological dispensary:
Extensive anti-alcohol and anti-drug propaganda among the population and, above all, students of educational institutions;
Early detection, dispensary registration, provision of specialized outpatient and inpatient care for patients with alcoholism, drug addiction, substance abuse;
Study of the incidence of alcoholism, drug addiction and substance abuse in the population, analysis of the effectiveness of preventive and therapeutic and diagnostic assistance provided;
Development of territorial targeted programs to combat drug addiction;
Participation, together with the social protection authorities, in the provision of social assistance to patients with alcoholism, drug addiction and substance abuse under dispensary supervision;
Holding medical examination, alcohol intoxication examinations, other types of examinations;
Methodological guidance in the organization of pre-trip inspections of drivers of vehicles;
Organizational, methodological and advisory assistance to drug treatment rooms that are part of other health care institutions;
Providing advisory specialized narcological assistance to patients in somatic hospitals and APU;
Training and advanced training of doctors and paramedical personnel on the provision of narcological assistance to the population.
The work of the dispensary is based on the district principle. The optimal organizational and functional structure of the narcological dispensary provides for the following divisions: offices of district psychiatrists-narcologists, teenage office, examination of alcohol intoxication, anonymous treatment, anti-alcohol propaganda, specialized offices (neurologist, psychologist, therapist), inpatient departments, day hospital, organizational and methodological department . The dispensary also includes a laboratory, a functional diagnostics room, a hypnotary, a room for reflexology, electrosleep, etc. The dispensary may have specialized vehicles equipped with equipment for conducting alcohol intoxication examinations together with the traffic police. In order to bring narcological assistance closer to employees of industrial enterprises, transport, agriculture and other industries, the dispensary, at the initiative of the heads of these enterprises, can organize narcological departments or offices on their territory.
The medical activities of narcological dispensaries are characterized by the following indicators:
The indicator of the contingent of narcological patients;
Indicator of primary narcological morbidity;
The indicator of the proportion of patients with alcoholism with remission for more than 1 year;
The indicator of the proportion of drug addicts with remission for more than 1 year;
Coverage rate of active observation of patients with alcoholic psychoses;
Recurrence rate of hospitalization of narcological patients.
The indicator of the contingent of narcological patients characterizes the frequency of diseases associated with the use of psychoactive substances, as well as the level of organization of statistical accounting and dispensary observation of persons suffering from these diseases. The
the indicator tends to decrease, which is explained by the increasing mortality of narcological patients among the contingents under dispensary observation. In 2008, its value in the Russian Federation was 2336.3 per 100,000 population.
Primary drug morbidity rate indicates the prevalence of alcoholism, alcoholic psychosis, drug addiction, substance abuse among the population, as well as the availability of alcoholic beverages and narcotic substances. On fig. 14.7 shows the dynamics of indicators of the primary incidence of drug addiction, alcoholic psychosis, substance abuse in the population of the Russian Federation.
Rice. 14.7. Dynamics of indicators of primary incidence of drug addiction, alcoholic psychosis, substance abuse of the population of the Russian Federation
Federation (1999-2008)
Indicators of the proportion of patients with alcoholism (drug addiction) with remission for more than 1 year characterize the effectiveness of treatment and dispensary observation of patients suffering from alcoholism or drug addiction. In 2008, on average in the Russian Federation, the share of patients with alcoholism with a remission duration of more than 1 year was 14.0%, drug addiction - 8.5%. Increasing this indicator
directly related to the development and implementation of new methods of treatment of alcohol and drug addiction.
Active surveillance coverage rate for patients with alcoholic psychoses characterizes the state of medical examination of these patients and is calculated as the proportion of patients with alcoholic psychoses who are examined by a psychiatrist or narcologist at least once a month. Clinical examination of these patients includes, first of all, prevention, which should be based on effective methods psychotherapeutic and drug treatment alcoholism, as well as self-control and control of patients by relatives. The value of this indicator should be close to 100%.
Rate of re-hospitalization of addicted patients characterizes the effectiveness of dispensary observation and the quality of hospital care for these patients. The proportion of re-hospitalized narcological patients during the year in some administrative territories of the Russian Federation is 20-25%. As domestic and foreign experience shows, complex treatment, including medicinal treatment, as well as non-drug methods (plasmapheresis, ozone therapy, acupuncture, electropsychotherapy, etc.), increases the effectiveness of treatment and reduces the recurrence of hospitalizations of narcological patients during the year.
14.7. TB CARE
The basic principles for organizing specialized care for TB patients are defined by the Federal Law “On Preventing the Spread of Tuberculosis in the Russian Federation”. In 2008, the TB service of the Russian Federation included 81 hospitals, 297 dispensaries with a total capacity of 76,989 beds, 1,837 departments (offices) employing 8,749 TB doctors. A specialized healthcare institution providing anti-tuberculosis care to the population in the attached territory, - TB Dispensary, which is entrusted with the following tasks:
Systematic analysis of the epidemic situation on tuberculosis and the effectiveness of anti-tuberculosis measures in the jurisdictional territory, including in the institutions of the penitentiary system;
Planning together with the Centers for Hygiene and Epidemiology, institutions of the general medical network, vaccination, BCG revaccination and organizational and methodological guidance for their implementation;
Hospitalization of bacterial excretors and isolation of newborns from bacterial excretors (for the period of formation of post-vaccination immunity);
Implementation of preventive measures in relation to persons in contact with bacterial excretors (regular dispensary observation of them, current disinfection of foci, revaccination, chemoprophylaxis, etc.);
Carrying out, together with institutions of the general medical network, centers of hygiene and epidemiology, enterprises of medical examinations of the population using fluorographic, immunological, bacteriological and other research methods;
Providing specialized inpatient and outpatient care to patients with tuberculosis, sending them to sanatorium-and-spa institutions;
Carrying out a set of measures for the social and labor rehabilitation of patients with tuberculosis;
Conducting an examination of temporary disability of tuberculosis patients and, if necessary, sending them to the ITU;
Dispensary registration and dynamic monitoring of patients with tuberculosis (timely examination, treatment, chemoprophylaxis).
The anti-tuberculosis dispensary is headed by the chief physician, appointed and dismissed by the head of the relevant health management body. The structure of a tuberculosis dispensary, as a rule, includes the following units: a dispensary department (for adults and children), a hospital, a sanatorium, medical and labor workshops, clinical diagnostic and bacteriological laboratories, X-ray, endoscopic, physiotherapy rooms, a department for the rehabilitation of patients with post-tuberculosis changes and non-specific respiratory diseases, a functional diagnostics room, a day hospital, etc.
Work in anti-tuberculosis dispensaries is based on the district principle. In large cities (with a population of more than 500 thousand people), as well as in municipal districts of a constituent entity of the Russian Federation, if there are two or more dispensaries, one of them is assigned the functions inter-district anti-tuberculosis dispensary.
To analyze the epidemiological situation of tuberculosis, the effectiveness of ongoing preventive and treatment-diagnostic measures, the following statistical indicators are used:
Indicator of the contingent of patients with all forms of active tuberculosis;
Primary incidence rate for all forms of active tuberculosis;
Indicator of the frequency of detection of patients with all forms of active tuberculosis during medical examinations;
Tuberculosis mortality rate.
Indicator of the contingent of patients with all forms of active tuberculosis characterizes the prevalence of active tuberculosis, the level of organization of statistical accounting and dispensary observation of these patients. The value of this indicator in the Russian Federation has tended to decrease in recent years, and in 2008 it amounted to 190.5 per 100,000 population (Fig. 14.8). The highest rate of the contingent of patients with all forms of active tuberculosis is noted in the Republic of Tyva - 670.0; Amur region - 434.7; Jewish Autonomous Region - 402.1; the most - in the Kostroma region - 68.0; the city of Moscow - 77.9; Belgorod region - 85.4 per 100 thousand population.
Primary incidence rate for all forms of active tuberculosis characterizes the operational epidemiological situation of tuberculosis. This indicator has been relatively stable in recent years and in 2008 amounted to 85.1 per 100,000 population (Fig. 14.8).
The indicator of the frequency of detection of patients with all forms of active tuberculosis during medical examinations characterizes the effectiveness of targeted (screening) examinations of the population for tuberculosis by the fluorographic method, which remains the leading method in the early diagnosis of tuberculosis. The value of this indicator in the Russian Federation in 2008 was 0.6 patients with active tuberculosis per 1000 examined persons.
Rice. 14.8. Dynamics of indicators of primary morbidity and the contingent of patients with all forms of active tuberculosis in the population of the Russian Federation
Federation (1999-2008)
TB mortality rate characterizes the effectiveness of ongoing preventive measures, the effectiveness of treatment and the quality of clinical examination of patients with tuberculosis. The value of this indicator in the Russian Federation in 2008 was 17.9 deaths from tuberculosis of all forms per 100,000 population.
Measures to further improve the TB service in the Russian Federation, reduce morbidity, disability, mortality from tuberculosis are provided for by the federal target program "Prevention and fight against social significant diseases(2007-2011)" (subprogram "Tuberculosis"). Within the framework of this subprogram, the construction and reconstruction of healthcare facilities providing anti-tuberculosis care to the population, the development and implementation of accelerated, highly reliable methods and systems for diagnosing tuberculosis, and comprehensive programs to increase the resistance of the child population to tuberculosis are being carried out. In addition, work is underway to introduce comprehensive programs for the medical and social rehabilitation of tuberculosis patients belonging to various risk groups, improve sanitary standards and infection control measures for the spread of tuberculosis, create a system for state monitoring of treatment and drug resistance of the causative agent of tuberculosis on the basis of
personalized records of patients. An important direction is to increase interaction between anti-tuberculosis institutions of the healthcare system and institutions subordinate to the Federal Penitentiary Service, providing them with modern diagnostic tools and the necessary anti-tuberculosis drugs.
14.8. DERMATOVENEROLOGICAL CARE
To provide the population with dermatovenereological care, a wide network of institutions has been deployed in the Russian Federation, including 229 dispensaries (with a total capacity of more than 17 thousand beds), 2944 departments (offices), in which 10,397 dermatovenereologists work. Dermatovenerological dispensary is an independent specialized medical institution designed to provide preventive, therapeutic and diagnostic assistance to the population in case of skin diseases, subcutaneous tissue and infections, predominantly sexually transmitted, as well as a set of anti-epidemic measures to prevent them. The dispensary is headed by the chief physician, appointed and dismissed by the head of the relevant health management body.
The main tasks of the dispensary:
Provision of specialized consultative and medical-diagnostic dermatovenerological assistance to the population in outpatient and inpatient settings;
Development of territorial targeted programs to combat
STD;
Carrying out, together with the centers of hygiene and epidemiology, monitoring of STIs and infectious skin diseases;
Providing organizational, methodological and advisory assistance to institutions of the general medical network on the prevention, diagnosis and treatment of patients suffering from STIs and contagious skin diseases;
Participation in the work of licensing and expert commissions of health authorities, the Compulsory Medical Insurance Fund, HIOs to control the medical activities of commercial structures and private practitioners providing dermatovenerological, gynecological, urological care;
Implementation of modern medical technologies for the prevention, diagnosis and treatment of STIs and dermatosis into the practice of dermatological and venereological institutions;
Propaganda among the population, together with the centers of medical prevention, knowledge on the prevention of infectious skin diseases and STIs, etc.
The dispensary may have the following subdivisions in its structure: outpatient department, inpatient department, organizational and methodological department (office), departments of primary prevention and periodic medical examinations, clinical diagnostic, bacteriological, immunological laboratories, cosmetology department (office), etc.
In order to increase the availability of emergency diagnosis and treatment of STI patients, to overcome social and negative motivations that prevent patients from seeking this type of specialized care, anonymous examination and treatment rooms (CAOL) are organized in dermatovenerological dispensaries or other medical facilities, in which the patient's personal data can be filled in from his words.
The following indicators are used to analyze the medical activities of dermatovenerological dispensaries:
Primary incidence rate for all STIs;
Primary incidence rate of fungal skin diseases;
Primary incidence rate of scabies;
Indicator of the number of examined contacts for STIs, scabies, fungal skin diseases per registered patient.
Primary incidence rate for all STIs characterizes the epidemiological situation of STIs, as well as the organizational work of dermatovenerological dispensaries, institutions of the general medical network for their prevention and timely detection. The value of this indicator in the Russian Federation in 2008 was 430.7 per 100,000 population.
Dynamics of indicators of primary incidence of syphilis and gonorrhea is shown in fig. 14.9.
Most high level the primary incidence of syphilis is noted in the Republic of Tyva - 488.4; Republic of Khakassia - 191.9; Chukotka Autonomous Okrug - 179.1; gonorrhea - in the Republic
Rice. 14.9. Dynamics of indicators of primary incidence of syphilis and gonorrhea in the Russian Federation (1999-2008)
Tyva - 222.4; Chukotka Autonomous Okrug - 210.9; Republic of Buryatia - 169.5 per 100 thousand population. A favorable epidemiological situation is noted for syphilis in the Republic of Ingushetia - 10.4; Republic of Dagestan - 10.5; Chechen Republic - 19.8; for gonorrhea - in the Chechen Republic - 8.9; Kabardino-Balkarian Republic - 11.3; the city of Moscow - 17.3 per 100 thousand population.
Indicators of primary incidence of fungal skin diseases, scabies characterize the epidemiological situation of microsporia, trichophytosis, scabies, the timeliness of detection of these diseases, as well as the interaction of institutions of the general medical network with the services of Rospotrebnadzor. The values of these indicators in the Russian Federation in 2008 were 45.5 and 100.7 per 100,000 population, respectively.
The indicator of the number of examined contacts for STIs, scabies, fungal skin diseases per one registered patient
characterizes the effectiveness of ongoing epidemiological investigations and is calculated as the ratio of the number of examined contacts for STIs, scabies, fungal skin diseases to the total number of registered such patients. The recommended value of this indicator for STIs is 0.1-2.5; fungal skin diseases - 1-10; for scabies - 1-5 examined contacts.
The main directions for the further development of the dermatovenerological service in the Russian Federation are provided for by the federal target program
"Prevention and control of socially significant diseases (2007-2011)" (subprogram "Sexually transmitted infections"). Within the framework of this subprogram, construction and reconstruction of federal and regional medical specialized institutions are being carried out, and information and analytical systems for predicting the emergence and spread of resistant forms of STI pathogens are being gradually introduced. A promising direction here is the study of the molecular mechanisms of the development of resistance of STI pathogens to the antimicrobial drugs used based on nanotechnology. Instead of foreign ones, domestic test systems are being developed for the diagnosis of STIs, taking into account the molecular characteristics of pathogens detected on the territory of the Russian Federation.
14.9. HIV AND AIDS PREVENTION AND CONTROL SERVICE
The Russian Federation has a unified specialized service for the prevention and control of HIV infection and AIDS, which includes 82 federal and regional centers for the prevention and control of AIDS. The general rules governing medical activities to prevent the spread of the disease caused by HIV are formulated in the Federal Law "On the Prevention of the Spread in the Russian Federation of the Disease Caused by the Human Immunodeficiency Virus (HIV)". On the territories of the constituent entities of the Russian Federation there are Centers for AIDS Prevention and Control(hereinafter referred to as the Centers), which have their structural subdivisions in municipalities. The Center is headed by the chief physician appointed and dismissed by the head of the relevant health management body.
The main tasks of the Center are:
Development and implementation of a set of measures for the prevention of HIV infection and AIDS;
Implementation of clinical and laboratory diagnostics of HIV infection, opportunistic infections, viral parenteral hepatitis;
Providing medical, socio-psychological and legal assistance to HIV-infected and AIDS patients;
Development of territorial targeted programs to combat HIV infection and AIDS;
Carrying out, together with the Centers for Hygiene and Epidemiology, monitoring of HIV infection and AIDS;
Organizational and methodological management of the activities of institutions of the general medical network on the issues of prevention and timely diagnosis of HIV infection;
Organization of propaganda of measures to prevent HIV infection and AIDS among the population.
The Center has the following main structural divisions: organizational and methodological, epidemiological departments, prevention department, clinical department (dispensary department and hospital, which in some cases is organized on the basis of an infectious diseases hospital), laboratory diagnostic department, department of medical, social and legal assistance, administrative part, etc.
The main statistical indicators used to analyze the medical activities of the Centers, as well as the epidemiological situation of HIV infection, include:
The indicator of the contingent of patients with HIV;
Primary HIV incidence rate;
The indicator of the proportion of people tested for HIV;
The indicator of the completeness of medical examination coverage of HIV-infected people;
An indicator of the distribution of HIV-infected people according to the main routes of infection.
HIV patient population rate characterizes the prevalence of diseases caused by the human immunodeficiency virus. Over the past 10 years, this indicator in the Russian Federation has increased almost 50 times and in 2008 amounted to 212.2 per 100 thousand people. Given the relatively low mortality among HIV-infected people, this figure will continue to grow.
Primary HIV incidence rate characterizes the epidemiological situation associated with the prevalence of HIV, and in 2008 amounted to 31.0 per 100 thousand of the population.
The indicator of the proportion of people tested for HIV, characterizes the completeness of the survey of the population from risk groups (pregnant women, injecting drug users, commercial sex workers, etc.). The recommended value for this indicator is 100%.
The indicator of completeness of medical examination coverage of HIV-infected people characterizes the level of organization of dynamic monitoring of HIV-infected people and the degree of trust between the patient and the doctor. In 2008, in the Russian Federation, the proportion of HIV-infected people under dispensary observation was 78.5%.
Distribution of HIV-infected people by main routes of infection characterizes the quality of the epidemiological investigation of cases of HIV infection and is calculated as the proportion of people with a certain route of HIV infection in the total number of HIV-infected people. The distribution of HIV-infected people according to the main routes of infection is shown in fig. 14.10.
The main routes of HIV infection are intravenous drug use (63.9%) and sexual contact (34.4%). The dominant route of transmission of HIV infection for women is sexual, for men - parenteral through intravenous drug administration. It is alarming that in 1.1% of cases the route of infection has not been established.
Rice. 14.10. Distribution of HIV-infected people by main routes of infection (2008)
The main directions for the further development of the service for the prevention and control of HIV infection and AIDS in the Russian Federation are provided for by the federal target program "Prevention and control of socially significant diseases (2007-2011)" (subprogram "HIV infection") and the national project "Health" . Within the framework of these programs, it is planned to continue the construction and reconstruction in the constituent entities of the Russian Federation of specialized institutions for the prevention of HIV infection and the treatment of AIDS patients, equipping them with modern medical equipment,
training of qualified personnel. The priority area is to conduct fundamental scientific research on the problem of HIV infection, in particular, the development and clinical trials of diagnostic and medicinal preparations taking into account the molecular characteristics of circulating HIV strains, improving methods for preventing, diagnosing and treating the disease caused by HIV. The most important task remains to study the features of the clinical course of HIV infection and AIDS-associated diseases, develop clinical and laboratory criteria for the progression of HIV infection and the effectiveness of therapy, and develop a set of measures to reduce the risk of HIV transmission when using donated blood and its preparations. To ensure effective management of the service for the prevention and control of HIV infection and AIDS, it is necessary to create a unified system of monitoring and evaluation in the field of combating HIV infection in WHO member countries.
14.10. FORENSIC MEDICAL EXAMINATION SERVICE
Forensic Medicine- this is one of the branches of medicine, which is a set of knowledge, special research methods that are used to solve biomedical issues that arise among law enforcement officers in the process of investigating and litigating criminal and civil cases. In addition, the connection of forensic medicine with other medical disciplines makes it in some cases indispensable in conducting a comprehensive examination of the quality of medical care provided to the population.
The area of practical application of forensic medicine is the production of forensic medical examinations in order to diagnose death, assess the harm caused to health from different types external influence (physical, chemical, biological, mental), establishing the timing and mechanisms of damage to objects of forensic medical examination, identification of a person, an instrument of injury, etc.
In the Russian Federation in 2008, more than 3,210 thousand crimes were registered, including 71,700 murders, attempts
murder, rape, intentional infliction of grievous bodily harm. Specialists of institutions of forensic medical examination (FME) are directly involved in the disclosure of these crimes.
The forensic medical examination service of the Russian Federation includes regional, regional, republican and district bureaus of forensic medical examination (SME bureau), employing more than 5,400 forensic experts.
The head institution of the forensic medical examination service is the Republican Center for Forensic Medical Examination
(RCSME).
The SME Bureau is headed by a chief appointed and dismissed by the head of the relevant health management body.
The main tasks of the Bureau of Forensic Medical Examination:
Production of forensic medical examinations and studies of corpses in order to establish or exclude signs of violent death, determine its causes; the nature, mechanism and timing of the formation of bodily injuries; establishing the prescription of death, as well as resolving other issues raised by the body of inquiry, investigator, prosecutor, court;
Production of forensic medical examinations and forensic medical examinations of victims, accused and other persons to determine the nature and severity of harm to health, the mechanism and prescription of bodily injuries; sexual crimes and to resolve other issues raised by the body of inquiry, investigator, prosecutor, court;
Production of forensic examinations of material evidence by using various laboratory methods for examining objects;
Timely information from the health authorities of the constituent entities of the Russian Federation on all cases of gross defects in diagnosis and treatment; holding forensic and clinical-anatomical conferences on such cases;
Analysis and generalization of forensic materials on sudden death, industrial, street and domestic injuries, poisoning and other causes of death in order to identify factors that are important for the development of preventive measures by health authorities;
Providing a system of continuous professional development of specialists of the forensic medical service.
The typical structure of the regional (territorial, republican, district) SME bureaus includes the following structural units:
Department of Forensic Medical Examination of Living Persons;
Department of forensic medical examination of corpses with a histological department;
Organizational and methodological department (office):
Department for the introduction of new technologies, computer technology and software;
Department of complex examinations;
Department of Forensic Medical Examination of Material Evidence:
Forensic Biological Department;
Forensic Chemical Department;
Forensic Biochemical Department;
Forensic bacteriological (virological) department;
Spectral laboratory;
Laboratory of forensic molecular genetic research.
The following statistical indicators are used to analyze the activities of the SME Bureau:
Prevalence rates of deaths from various types of external influences;
The indicator of the load of the doctor of the forensic medical expert;
Indicators of the quality of forensic medical examinations.
Prevalence rates of deaths from different types of external influences
These indicators are components of the general mortality rate of the population.
Total violent death rate characterizes the criminogenic situation in society and the level of protection of citizens. The value of this indicator in the Russian Federation over the past 6 years tends to decrease and in 2008 amounted to 1.72 deaths from external causes (physical, chemical, biological, mental) per 1000 population (Fig. 14.11).
Child violent death rate serves as one of the components of the indicator of total violent mortality and
characterizes the degree of protection of the child population from the impact of external causes leading to death. The dynamics of this indicator in the Russian Federation is also shown in Fig. 14.11.
Rice. 14.11. Dynamics of indicators of general and child violent mortality in the Russian Federation (1999-2008)
Suicide Rate complements the indicator of general violent mortality and is one of the characteristics of the mental health of the population. The value of this indicator in the Russian Federation in 2008 was 27.1 cases of suicide per 100,000 population.
Rate of death from accidental alcohol poisoning serves as one of the characteristics of the general alcoholization of the population and the prevalence of cases of poisoning by alcohol and its surrogates. The dynamics of this indicator in the Russian Federation is presented in
rice. 14.12.
The decrease in the frequency of deaths from accidental alcohol poisoning over the past three years is primarily due to the tightening of control over the quality of alcoholic products in the retail and wholesale trade network by Rospotrebnadzor institutions.
Forensic doctor workload indicator characterizes the volume of work performed by forensic experts and indirectly - the staffing of positions of forensic doctors
Rice. 14.12. Dynamics of the rate of death from accidental alcohol poisoning among the population of the Russian Federation (1999-2008)
Quality indicators of forensic medical examinations
These indicators make it possible to judge the conduct of the SME on time and the quality of primary conclusions, excluding the need for additional or repeated studies.
The indicator of the share of repeated forensic medical examinations with changes in primary conclusions testifies to the level of qualification of doctors of forensic medical experts and the quality of their primary SMEs. The heads of the SME bureau should strive to ensure that the share of repeated SMEs in the total number of examinations of corpses and victims carried out approaches 0.
The indicator of the timeliness of forensic medical examinations characterizes the level of organization and efficiency of the SME. The recommended duration of the SME is no more than 1 month. In 2008, in the Russian Federation, the share of SMEs completed within 14 days was 37.4%, from 15 to 30 days - 50.7%, over 1 month - 11.9%.
Further ways of developing the SME service: strengthening the material and technical base of the SME institutions, equipping them with modern
medical equipment, increasing the material interest of working specialists, improving interaction with law enforcement agencies and the pathological and anatomical service of healthcare organizations in the general medical network.
14.11. SERVICE OF MEDICAL PREVENTION, THERAPEUTIC PHYSICAL CULTURE AND SPORTS
MEDICINE
The system of medical support for people involved in physical culture and sports, created in the Soviet Union, has been experiencing a period of stagnation for the last 15 years, associated both with financial health problems and with the liquidation or change in the organizational and legal forms of physical culture and specialized medical facilities.
Part of the medical and physical education dispensaries was transformed into centers for medical prevention, while retaining the functions of medical support for people involved in physical culture and sports, as well as the formation of a healthy lifestyle among the population.
In 2007, there were 115 medical and physical education dispensaries in the country, 114 centers for medical prevention, in which 3,479 physiotherapy and sports medicine doctors worked. In most institutions of the general medical network, departments and rooms for physical therapy continue to function. In addition, offices (centers) operate at individual sports societies and organizations. sports medicine.
Sports, as a rule, are accompanied by acute and chronic overstrain of human systems and organs. Depending on the severity of the violation of their activity, four clinical forms of overvoltage are distinguished:
Overstrain syndrome of the central nervous system;
Overstrain syndrome of the cardiovascular system;
Liver overstrain syndrome (hepatic pain);
Overstrain syndrome of the neuromuscular apparatus (muscle-pain).
The emergence and development of these syndromes with a certain lifestyle of athletes determine the state of their health. Conducted studies (Medic V.A., Yuriev V.K., 2001) showed
whether that the proportion of practically healthy athletes involved in sports such as gymnastics, swimming, wrestling and others is 17%. chronic diseases are detected in more than 50% of the examined athletes, which is due to both the high incidence of the population as a whole and the shortcomings of sports selection and sports training methods. In the structure of the detected pathology, diseases of the digestive system, musculoskeletal system and reproductive system in female athletes.
In addition, the reduction of the network of sports and recreation organizations, the commercialization of sports centers have led to a decrease in the physical activity of various groups of the population, especially children and adolescents, an increase in risk factors for the development of diseases and physical defects, and a deterioration in the physical fitness of young people during military service.
As a result of the analysis of the work of children's and youth sports schools, it was found that 30% of students do not undergo in-depth medical examinations, and of those who have passed, only 5% are recognized as healthy, 35% have deviations in health and contraindications to playing sports.
Recently, in most subjects of the Russian Federation, more attention has been paid to the development of physiotherapy exercises and the rehabilitation of people involved in physical culture and sports of the highest achievements. The leading role in this belongs to medical and physical education dispensaries, centers for physical therapy and sports medicine, centers for medical prevention, the most important task of which is medical support for people involved in physical education and sports, as well as the formation of a healthy lifestyle among the population.
Consider the main activities of the service of medical prevention, exercise therapy and sports medicine on the example medical and physical education dispensary, which solves the following tasks:
Providing medical control, dispensary observation, treatment and rehabilitation of people involved in physical education and various sports;
Organization of medical support for training camps, classes and competitions, access to them, examination of sports performance;
Conducting an analysis of deviations in the state of health, morbidity and sports injuries among people involved in sports and physical culture, and developing measures for their prevention and treatment;
Carrying out medical rehabilitation of sick and disabled people using modern methods of rehabilitation therapy;
Carrying out sanitary and educational work on the formation of a healthy lifestyle, the improvement of various groups of the population, primarily children and adolescents, by means of physical culture and sports;
Analysis of the activities of institutions of the general medical network for medical support for people involved in physical culture and sports, promotion of physical activity, coordination and control of this work, etc.
The dispensary is headed by the chief physician, appointed and dismissed from his post by the head of the relevant health management body.
The typical structure of a medical and physical education dispensary includes the following structural units: department of sports medicine; department of physiotherapy exercises; advisory department; diagnostic department; organizational and methodological department; other medical and administrative departments.
The main indicators characterizing the medical activities of medical and physical education dispensaries, centers for physical therapy and sports medicine, centers for medical prevention include:
The indicator of the completeness of coverage by dispensary observation;
The indicator of the effectiveness of clinical examination;
Injury frequency indicator;
Treatment coverage rate.
The indicator of completeness of coverage by dispensary observation allows to assess the level of organization of dispensary observation of people involved in physical culture and sports, as well as the level of interaction between medical and preventive and sports institutions. The value of this indicator should be close to 100%.
Medical examination efficiency indicator characterizes the quality of dispensary observation, the completeness of the restoration
positive treatment of people involved in physical culture and sports. This indicator is calculated as a percentage of the number of people with a positive dynamics of diseases to the total number of people involved in physical culture and sports, registered with dispensaries and in need of treatment. The recommended value of the indicator for the main nosological forms should be at least 70%.
Injury frequency indicator characterizes the levels of training of athletes, the organization of the training process and sports competitions, the qualifications of coaches. An analysis of this indicator in dynamics allows us to evaluate the effectiveness of measures to prevent sports injuries. The value of the injury frequency indicator for various sports ranges from 20 to 55 cases of injuries per 1000 people involved in physical education and sports.
Treatment coverage rate indicates the availability of certain types of medical care for people involved in physical education and sports, and the organization of their dispensary observation. This indicator makes it possible to judge the continuity in the work of medical and physical education dispensaries and specialized medical institutions. Its value should be close to 100%.
Work to improve the service of medical prevention, physical therapy and sports medicine should be aimed primarily at improving the quality of training of specialists in physical therapy, sports medicine, manual therapy, reflexology, as well as the training of scientific and pedagogical personnel in the field of sports medicine and medical physical education. A necessary condition for increasing the effectiveness of the treatment of people involved in physical culture and sports, the disabled, is the strengthening of the material and technical base of rehabilitation treatment institutions, the development and implementation of modern methods of rehabilitation. The most important task remains the formation of a cult of health in society through the promotion of a healthy lifestyle among the population, the development of mass physical culture and sports.
Further improvement of specialized types of medical care for the population of the Russian Federation should go primarily along the path of developing high-tech types of care. This applies, in particular, to increasing the availability of high-quality
Qing technologies in cardiac surgery, oncology, traumatology and, above all, for the treatment of children. The development of a network of inter-regional and inter-district specialized medical centers is especially important for improving medical care for rural residents. A promising direction is the reconstruction and re-equipment of existing centers of high medical technologies, as well as the construction of new centers, primarily in the constituent entities of the Russian Federation in the territories of Siberia and the Far East.
Public health and health care: a textbook / O. P. Shchepin, V. A. Medic. - 2011. - 592 p.: ill. - (Postgraduate education).