Department (office) of medical prevention. Tasks of the prevention department (office) Certification work for the head of the department of specialized specialists

ORGANIZATION OF THE WORK OF NURSES IN THE PREVENTION DEPARTMENT OF A CITY POLYCLINIC

I. A. ARIBZHANOVA, senior nurse of the department of prevention and medical and social work of polyclinic No. 000 in Moscow;

T. I. VINNIKOVA, chief nurse of clinic No. 000 in Moscow

As part of the implementation of the “Targeted medical examination of the population of Moscow”, a department of prevention and medical and social work (hereinafter referred to as the department) was created in the municipal institution of city polyclinic No. 000 in Moscow in 2005.

The goals of creating this department were: strengthening the health of the population, preventing and reducing morbidity, increasing the duration of active life, ensuring the introduction of universal medical examination of the population.

In the department of prevention and medical and social work of State Enterprise No. 000, 4 nurses are directly involved in the implementation of targeted programs in accordance with the regulations of the department. Previously, before the creation of the department, this function was assigned to nurses in the therapeutic service. When our department opened, the computer program “Department of Prevention and Medical and Social Work” was created, which represents a register of the assigned population with an address breakdown into 32 therapeutic areas and a list of target programs. Each therapeutic area is assigned a specific nurse from the department of prevention and medical and social work. There are 8 therapeutic areas per nurse, and the population of one area is about 3 thousand people.


The work of nurses is organized in accordance with the job description. The main tasks of the department nurses are:

· maintaining a register of patients of certain age groups (studying the database of the assigned population);

· assistance to clinic doctors in organizing preventive medical and social work with the population;

· analysis of the effectiveness of preventive and medical-social work;

· accounting for informing the population on targeted medical examination programs;

· organization and conduct of immunization of the population within the framework of the National Vaccination Calendar;

· formation of individual plans for targeted medical examination programs;

· development and implementation of a progressive targeted system of work with the population;

· generation of reports on the results of the service’s activities for planning preventive work with the population.

Initially, before starting direct work, nurses entered into the program “Department of Prevention and Medical and Social Work” all the data for two years on the relevant target programs from the logbooks of the examination room, treatment room, pre-medical control room, mammography room, file cabinets of the fluorography room. Thus, an information base was prepared for working with the population.

Let's consider what the work of nurses includes when implementing targeted programs.

I. General aspects of working on target programs

1. Targeted work with the register of the attached population, to track the following required for completing targeted programs:

· targeted clinical examination of the population for early detection of cardiovascular diseases (visits to the pre-medical control room by patients from 35 to 55 years old once a year);

· targeted clinical examination of the population for early detection of tuberculosis (visiting the fluorography room once a year);

· targeted clinical examination of the female population for the early detection of breast diseases (visiting a mammography room for women from 40 to 60 years old once every two years);

· targeted clinical examination of the male population to identify prostate diseases (blood tests for men aged 50 to 79 years once every two years);

· targeted clinical examination of the female population to identify diseases of the cervix (annual visit by women from 35 to 69 years of age to the examination room).

2. Calling patients by telephone in order to directly inform them about the targeted programs required for completion.

The invitation letter also includes a list of diseases (with a theoretical basis) for the prevention of which targeted programs are aimed at, indicating the address and telephone number of the department of prevention and medical and social work, where you can get clarification on issues of interest.

4. Processing of outpatient cards.


Every day, before appointments with the therapeutic service and other medical specialists, outpatient cards are sent to the department of prevention and medical and social work for processing. This processing includes pasting a printed insert from a computer program with the necessary set of target programs.

Previously, the transfer of information about the results of completing targeted programs was entered weekly by nurses in the department of prevention and medical and social work manually from the relevant documentation. Currently, to facilitate the work of department nurses, all results are transferred automatically over the local network.

5. Direct work with patients.

The patient visits city clinic No. 000 as a result of receiving an invitation letter or as a result of calling. He is sent to the department of prevention and medical and social work. The department's nurses select the patient's outpatient card at the reception desk and accompany him to an appointment with a specialist out of turn.

II. Differences in operation (depending on the target program):

Targeted medical examination of the population for early detection of cardiovascular diseases.

In the pre-medical control room, the patient undergoes an analysis to determine the level of glucose and cholesterol in the blood. Thanks to the express method, the patient is immediately informed of the result of the study; in case of deviations from the norm (increased glucose or cholesterol levels), the nurse in the pre-medical control room recommends that the patient consult an endocrinologist or cardiologist.

Targeted medical examination of the population for early detection of tuberculosis.

In this office, the patient undergoes a fluorographic examination to identify diseases of the respiratory system, and, mainly, suspicion of tuberculosis. If a pathology in the respiratory system is detected, the x-ray technician informs the patient about this.

Targeted clinical examination of the female population for early detection of breast diseases.

Women over 40 years old undergo a mammography examination once every two years, the result is reported to the patient by the staff of the radiology department, and if a pathology is detected, the patient is sent to see a mammologist.

Targeted clinical examination of the male population to identify prostate diseases.

The nurse in the department of prevention and medical and social work issues a referral for a blood test to determine the PSA level. The result of this study is sent to a urologist; if a pathology is detected, the nurse of the urology department calls the patient for an appointment with a urologist.

Targeted clinical examination of the female population to identify cervical diseases.

Women undergo examination in the examination room. The midwife conducting the examination sends the tests for examination to the cytology laboratory. The results of the examination are sent to the examination room. If a pathology is detected, the midwife invites the woman to see a gynecologist for further examination.

Five years of experience in the functioning of the department of prevention and medical and social work showed the following:

1. After the opening of the department, the turnout of patients to undergo targeted programs increased, therefore, the number of detected pathologies also increased.

2. Coverage of the population with preventive examinations within the framework of targeted programs has increased significantly, primarily due to the work of the department’s nurses.

3. Patients of the department of prevention and medical and social work, doctors of State Hospital No. 000 assign an important role in the implementation of targeted programs to the nurses of this department.

4. Nurses of the department, when performing their activities, rely on the job description.

As an attachment, we present to your attention the job description of a nurse in the prevention department and a sample invitation sent by mail to patients at the site.

JOB DESCRIPTION OF A NURSE

DEPARTMENTS OF PREVENTION AND MEDICAL AND SOCIAL WORK

1. a common part

INVITATION

The state institution City Clinic No. 000 UZ NEAD is working to implement the program “Targeted clinical examination of the population of Moscow.” Targeted medical examination is a real way to improve your health. As part of the “Targeted medical examination of the population of Moscow” program, we offer you to undergo a number of free diagnostic examinations that will allow you to identify the initial forms of various diseases.

In order to further implement the priority National project in the field of healthcare in accordance with the Federal Law of the Russian Federation dated January 1, 2001 “On Immunoprophylaxis of Infectious Diseases,” we offer you free vaccination.

INDIVIDUAL VACCINATION Plan

Vaccination against measles

Measles - one of the most common diseases on Earth. Measles cases are recorded all year round, but the largest number of cases occur in the autumn, winter and spring. Measles affects people of all ages. To prevent the occurrence of this disease, vaccination (children 1 year of age) and revaccination (7-35 years old) are necessary.

Vaccination against diphtheria and tetanus

Diphtheria and tetanus - severe infectious diseases. Risk groups for morbidity include adults who have not been vaccinated or do not have information about vaccinations. In 80% of cases, severe forms of the disease are recorded. Reliable protection against these infections is vaccination. Immunization of the adult population against diphtheria and tetanus is carried out every 10 years with ADS-M toxoid, which has virtually no contraindications to vaccination.

Viral hepatitis B and C - widespread diseases caused by viruses. These infections and their consequences kill more than 1 million people worldwide every year. The danger of hepatitis lies in the significant frequency of transition from the acute form to the chronic form with the development of cirrhosis and primary liver cancer. Vaccination against hepatitis B provides a high level of protection against this infection.

INDIVIDUAL SURVEY PLAN

We invite you to contact the Prevention Department of City Clinic No. 000 at the address:

Moscow, st. Dekabristov, 24, City Clinic No. 000, where you can get detailed advice on the implementation of the program “Targeted clinical examination of the population of Moscow” and immunization of the population.

(4- Hotline of the Prevention Department

(4 ext. 180 - Yulia Vladimirovna Egorova, head of the Prevention Department

(4 ext. 106 - Indira Amirovna Yedikhanova, senior sister of the Prevention Department

Targeted medical examination and vaccination are carried out during the opening hours of City Clinic No. 000

Sincerely, Chief Physician of State Enterprise No. 000

The clinic has opened a medical prevention department, which will become a buffer between patients and doctors.

The main objectives of the department are to improve public awareness about diseases, the possibility of preventing diseases, as well as increasing motivation to lead a healthy lifestyle.

Prevention department specialists

calculate the personal risk of developing a disease;

will create an individual prevention program;

teach self-examination techniques;

will talk about the benefits of early detection of the disease.

Prevention department:

first aid room;

women's examination room;

office for organizing and monitoring the medical examination of the population and maintaining a centralized file index of persons registered with the dispensary;

office for identifying persons with an increased risk of disease - anamnestic;

office of health education and hygienic education of the population;

room for preventive examinations of decreed contingents (maintained at the expense of special funds).

Primary health care and social care, its importance in medical care of the population

This is one of the forms of assistance that is necessary and available for each person individually and for the entire population.

Structure

outpatient clinics

Women's Consultations

emergency care facilities

maternity care facilities

The main goal of this set of measures is to protect the health and provide treatment to the population. Includes the following activities:

health promotion,

prevention,

rehabilitation,

Promote good quality nutrition and an adequate supply of good quality water.

Sanitary and hygienic measures

Protecting the health of mother and child with family planning.

Vaccination

Prevention and control of local epidemic morbidity

Health and Epidemic Education

Treatment of major diseases and injuries

Primary medical and social care for the urban population is provided by outpatient clinics (territorial clinics serving the adult population) and institutions for the protection of motherhood and childhood (children's clinics and antenatal clinics).

The main organizational and methodological principles of the work of polyclinics and territorial medical associations (TMO) are locality (assigning a normative number of residents to a medical position) and the widespread use of the dispensary method (systematic active monitoring of the health status of certain contingents). The main planning and normative indicators regulating the work of polyclinics are: locality standard (1,700 people per 1 position of local therapist); workload norm (5 visits per hour at a clinic appointment and 2 when a therapist serves patients at home); staffing standard for local therapists (5.9 per 10,000 residents over 14 years of age).

The capacity of polyclinics is measured by the number of visits per shift (more than 1200 visits - category I, less than 250 visits - category V). TMOs, to a greater extent than polyclinics and antenatal clinics, meet the new principles of organization and financing of primary health care and social care. They can more effectively organize the work of family doctors (order of the Ministry of Health of the Russian Federation No. 237 of 08.26.92). In a number of TMOs, conditions have been created for family medical care, for example, joint work at the site of a therapist, pediatrician and gynecologist (obstetric-pediatric-therapeutic complex - APTC). In this case, the performance indicator is not the dynamics of attendance, but changes in the health status of the population (decrease in morbidity, disability, infant mortality, number of advanced cancer diseases, health status of patients from dispensary groups, etc.).

The main activities of primary health care institutions are: preventive work, medical examination, hygienic training and education of the population, promotion of a healthy lifestyle; diagnostic and treatment work (including examination of temporary disability); organizational and methodological work (management, planning, statistical recording and reporting, activity analysis, interaction with other health care institutions, advanced training, etc.); organizational and mass work.

The clinic is headed by a chief physician. The structure of the clinic includes: a registry office, a prevention department, treatment and preventive departments and offices, treatment and diagnostic units, an administrative and economic part, rehabilitation treatment departments, etc. The continuity of the work of the clinic and the hospital is assessed by the number of patients prepared for planned hospitalization and the exchange of documentation before and after treatment in the hospital.

  • 1. Public health and healthcare as a science and area of ​​practical activity. Main goals. Object, subject of study. Methods.
  • 2. History of healthcare development. Modern healthcare systems, their characteristics.
  • 3. State policy in the field of protecting public health (Law of the Republic of Belarus “On Health Care”). Organizational principles of the public health care system.
  • 4. Nomenclature of healthcare organizations
  • 6. Insurance and private forms of healthcare.
  • 7. Medical ethics and deontology. Definition of the concept. Modern problems of medical ethics and deontology, characteristics. Hippocratic Oath, Doctor's Oath of the Republic of Belarus, Code of Medical Ethics.
  • 10. Statistics. Definition of the concept. Types of statistics. Statistical data recording system.
  • 11. Groups of indicators for assessing the health status of the population.
  • 15.Unit of observation. Definition, characteristics of accounting characteristics
  • 26. Time series, their types.
  • 27. Time series indicators, calculation, application in medical practice.
  • 28. Variation series, its elements, types, rules of construction.
  • 29. Average values, types, calculation methods. Application in the work of a doctor.
  • 30. Indicators characterizing the diversity of a trait in the population being studied.
  • 31. Representativeness of the feature. Assessing the reliability of differences in relative and average values. The concept of Student's t test.
  • 33. Graphic displays in statistics. Types of diagrams, rules for their construction and design.
  • 34. Demography as a science, definition, content. The importance of demographic data for health care.
  • 35. Population health, factors influencing public health. Health formula. Indicators characterizing public health. Analysis scheme.
  • 36. Leading medical and social problems of population. Problems of population size and composition, mortality, fertility. Take from 37,40,43
  • 37. Population statistics, study methods. Population censuses. Types of age structures of the population. Population size and composition, implications for healthcare
  • 38. Population dynamics, its types.
  • 39. Mechanical movement of the population. Study methodology. Characteristics of migration processes, their impact on population health indicators.
  • 40. Fertility as a medical and social problem. Study methodology, indicators. Fertility levels according to WHO data. Current trends in the Republic of Belarus and in the world.
  • 42. Population reproduction, types of reproduction. Indicators, calculation methods.
  • 43. Mortality as a medical and social problem. Study methodology, indicators. Overall mortality levels according to WHO data. Modern tendencies. Main causes of population mortality.
  • 44. Infant mortality as a medical and social problem. Factors determining its level. Methodology for calculating indicators, WHO assessment criteria.
  • 45. Perinatal mortality. Methodology for calculating indicators. Causes of perinatal mortality.
  • 46. ​​Maternal mortality. Methodology for calculating the indicator. Level and causes of maternal mortality in the Republic of Belarus and the world.
  • 52.Medical and social aspects of the neuropsychic health of the population. Organization of psychoneurological care.
  • 60. Methodology for studying morbidity. 61. Methods for studying population morbidity, their comparative characteristics.
  • Methodology for studying general and primary morbidity
  • Indicators of general and primary morbidity.
  • 63. Study of population morbidity according to special registration data (infectious and major non-epidemic diseases, hospitalized morbidity). Indicators, accounting and reporting documents.
  • Main indicators of “hospitalized” morbidity:
  • Main indicators for the analysis of morbidity with VUT.
  • 65. Study of morbidity according to preventive examinations of the population, types of preventive examinations, procedure. Health groups. The concept of “pathological affection”.
  • 66. Morbidity according to data on causes of death. Study methodology, indicators. Medical death certificate.
  • Main morbidity indicators based on causes of death:
  • 67. Forecasting morbidity rates.
  • 68. Disability as a medical and social problem. Definition of the concept, indicators.
  • Disability trends in the Republic of Belarus.
  • 69. Mortality. Calculation method and analysis of lethality. Implications for the practical activities of doctors and healthcare organizations.
  • 70. Standardization methods, their scientific and practical purpose. Calculation methods and analysis of standardized indicators.
  • 72. Criteria for determining disability. The degree of expression of persistent disorders of body functions. Indicators characterizing disability.
  • 73. Prevention, definition, principles, modern problems. Types, levels, directions of prevention.
  • 76. Primary health care, definition of the concept, role and place in the system of medical care for the population. Main functions.
  • 78.. Organization of medical care provided to the population on an outpatient basis. Main organizations: medical outpatient clinic, city clinic. Structure, tasks, areas of activity.
  • 79. Nomenclature of hospital organizations. Organization of medical care in hospital settings of healthcare organizations. Indicators of provision of inpatient care.
  • 80. Types, forms and conditions of medical care. Organization of specialized medical care, their tasks.
  • 81. Main directions for improving inpatient and specialized care.
  • 82. Protecting the health of women and children. Control. Medical organizations.
  • 83. Modern problems of women's health. Organization of obstetric and gynecological care.
  • 84. Organization of medical and preventive care for children. Leading problems in children's health.
  • 85. Organization of health care for the rural population, basic principles of providing medical care to rural residents. Stages of organization.
  • Stage II – territorial medical association (TMO).
  • Stage III – regional hospital and regional medical institutions.
  • 86.City clinic, structure, tasks, management. Key performance indicators of the clinic.
  • Key performance indicators of the clinic.
  • 87. Precinct-territorial principle of organizing outpatient care for the population. Types of plots.
  • 88. Territorial therapeutic area. Standards. Contents of the work of a local therapist.
  • 89. Office of infectious diseases of the clinic. Sections and methods of work of a doctor in the office of infectious diseases.
  • 90. Preventive work of the clinic. Prevention department of the clinic. Organization of preventive examinations.
  • 91. Dispensary method in the work of the clinic, its elements. Control card of dispensary observation, information reflected in it.
  • 1st stage. Registration, examination of the population and selection of contingents for registration at the dispensary.
  • 2nd stage. Dynamic monitoring of the health status of those being examined and carrying out preventive and therapeutic measures.
  • 3rd stage. Annual analysis of the state of dispensary work in hospitals, assessment of its effectiveness and development of measures to improve it (see Question 51).
  • 96. Department of medical rehabilitation of the clinic. Structure, tasks. The procedure for referral to the medical rehabilitation department.
  • 97. Children's clinic, structure, tasks, sections of work.
  • 98. Features of providing medical care to children on an outpatient basis
  • 99. The main sections of the work of a local pediatrician. Contents of treatment and preventive work. Communication in work with other treatment and prevention organizations. Documentation.
  • 100. Contents of preventive work of a local pediatrician. Organization of nursing care for newborns.
  • 101. Comprehensive assessment of the health status of children. Medical examinations. Health groups. Medical examination of healthy and sick children
  • Section 1. Information about the departments and installations of the treatment and preventive organization.
  • Section 2. Staff of the treatment and prevention organization at the end of the reporting year.
  • Section 3. Work of doctors of the clinic (outpatient clinic), dispensary, consultations.
  • Section 4. Preventive medical examinations and work of dental (dental) and surgical offices of a medical and preventive organization.
  • Section 5. Work of medical and auxiliary departments (offices).
  • Section 6. Operation of diagnostic departments.
  • Section I. Activities of the antenatal clinic.
  • Section II. Obstetrics in a hospital
  • Section III. Maternal mortality
  • Section IV. Information about births
  • 145. Medical and social examination, definition, content, basic concepts.
  • 146. Legislative documents regulating the procedure for conducting medical and social examination.
  • 147. Types of darkness. Composition of regional, district, inter-district, city and specialized MRECs. Organization of work, rights and responsibilities. The procedure for referral to MREK and examination of citizens.

  • Prevention is not a narrow departmental function of health authorities, but is provided by the entire system of socio-economic activities of society, is comprehensive in nature and is aimed at preventing diseases, protecting and strengthening the health of each person and the entire society as a whole.

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

    3 main areas of preventive medicine:

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

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

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

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

    Distinguish3 types of preventive examinations .

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

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

    To contingents subject to mandatory periodic inspections, relate:

    Workers of industrial enterprises with harmful and dangerous working conditions;

    Workers of leading professions in agricultural production;

    Decreed contingents;

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

    Students of vocational schools, technical schools, university students;

    Pregnant women;

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

    Persons affected by the Chernobyl disaster.

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

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

    The main forms of preventive examinations are

    A. individual- are carried out:

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

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

    When doctors visit patients with chronic diseases at home;

    Among persons undergoing treatment in a hospital;

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

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

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

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

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

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

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

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

    c) group “chronic patients” (D3):

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

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

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

    When a disease is detected in the person being examined, the doctor fills out a statistical coupon (form. 025/2-u); makes notes about the state of health in the medical record of an outpatient (f.025/u). Persons classified in the third health group are registered at the dispensary by a local doctor or medical specialist

    "

    early identification of patients and persons at increased risk of disease;

    organization and qualified conduct of preliminary and periodic preventive examinations;

    organization and control of medical examination;

    organizing and conducting preventive vaccinations for adults and adolescents;

    development of an action plan for primary and secondary disease prevention in the clinic’s service area;

    Propaganda among the population of sanitary and hygienic knowledge about a healthy lifestyle.

Structure of the prevention department

    first aid room

    examination room

    preventive examination room

    clinical examination room

    vaccination room

    healthy lifestyle room (HLS)

Indicators of the quality and effectiveness of clinical examination:

    Estimating the extent of the population by dispensary observation

    Assessment of the activity and completeness of the workload of a general practitioner and medical examination

    Evaluation of the effectiveness of clinical examination

    Illustrative material

Scheme of dynamic observation of sick adults and adolescents (15-18 years old) subject to medical examination by a nephrologist, local physician or family doctor/GP

Nosological form, ICD code 10

Timing and frequency of observations

Examinations by doctors of other specialties

Name and frequency of laboratory and other diagnostic tests

Basic therapeutic and recreational activities

Clinical examination effectiveness criteria

Condition after acute glomerulonephritis N00

Therapist, GP - 2 years. In the first half of the year, inspection is done once a month, in the next 1.5 years - once a quarter.

Nephrologist, dentist, otolaryngologist - once a year. According to indications - urologist, obstetrician-gynecologist.

A general urine test at each examination, a general blood test - 4 times a year. Zimnitsky test when the relative density of urine decreases below 1018 in a one-time study. Biochemical blood test (creatinine, urea, total protein and its fractions, cholesterol) 2 times a year.

Mode. Diet. Sanitation of chronic foci of infection.

Recovery after acute glomerulonephritis

Chronic glomerulonephritis N03 - N04

Therapist, GP - lifelong observation. For latent and hematuric forms - 2 times a year, for nephrotic, hypertensive and mixed forms - 4 times a year.

Nephrologist, dentist, otolaryngologist - once a year. Other specialists according to indications.

At each examination, a general urine test, a general blood test, a biochemical blood test (creatinine, urea, total protein and its fractions, cholesterol).

If the relative density of urine decreases below 1018 in a one-time study, the Zimnitsky test is used; if the level of nitrogenous wastes in the blood increases, the GFR is determined. Ultrasound of the kidneys once a year. Daily proteinuria, radioisotope renography, ECG - according to indications

Mode. Diet. Sanitation of chronic foci of infection. Limiting physical activity. Elimination of cooling and insolation. Drug treatment depending on the stage and form of the disease. In case of exacerbation - mandatory hospitalization. Sanatorium-resort treatment during remission

Chronic pyelonephritis N11

Therapist, GP. Lifelong observation. Inspection 2 times a year.

Nephrologist, dentist, urologist, obstetrician-gynecologist once a year. Other specialists according to indications.

General urine test, general blood test 2 times a year. Bacteriological examination of urine according to indications. Biochemical blood test (creatinine, urea) once a year. Ultrasound of the kidneys once a year.

Excretory urography, radioisotope renography, determination of GFR - according to indications

Mode. Diet. Sanitation of chronic foci of infection. Treatment of concomitant diseases. Drug treatment depending on the stage of the disease.

Physiotherapy. Anti-relapse therapy for 2-4 months.

Spa treatment.

Persistent remission after exacerbation. Reduced temporary disability.

No symptoms of renal failure.

Chronic renal failure (CRF) N18

Nephrologist, in his absence, general practitioner, GP - 4 times a year. Lifelong observation.

Inspection once a quarter.

Other specialists according to indications.

General urine test, general blood test, biochemical blood test (creatinine, urea, potassium), determination of glomerular filtration rate (GFR) - 4 times a year. Ultrasound of the kidneys, ECG, fundus once a year. Radioisotope renography, pulmonary radiography, coagulogram, echocardiogram, FGDS - according to indications

Organization of nutrition and care, daily routine. Monitoring daily diuresis, body weight, blood pressure. Symptomatic therapy. When GFR is below 15 ml/min, hemodialysis is performed.

Slowing down the rate of progression of chronic renal failure.

Benign proteinuria N39.2/hematuria N02 in the absence of kidney disease

    Therapist, GP - once a year. Follow-up for 1 year after normalization of clinical test results.

    Nephrologist according to indications.

    General urine test once a year. Ultrasound of the kidneys, excretory urography according to indications.

    Quitting smoking, alcohol/drugs.

    Physical exercise. Hardening.

    Mode.

    Recovery.

    Illustrative material: presentations, slides

    Literature

    How many dynamic observation groups are there?

· organization, coordination and evaluation of the effectiveness of health care facilities in providing preventive services to the population;

· identification of behavioral risk factors for non-communicable diseases among the population and their correction;

· hygienic education of the population;

· organizing and conducting, together with the territorial center for medical prevention, training of medical workers of the institution in methods of providing medical preventive services to the population;

· participation in information provision of specialists and various population groups on issues of disease prevention and health promotion;

· conducting medical and social surveys of medical workers and the attached population on issues of disease prevention, satisfaction and need for preventive care;

· maintaining accounting and reporting documentation.

97 Sanitary and hygienic education of the population: forms and methods

Hygiene - honey. a science that studies the influence of the environment and industrial activities on human health and is developed. optimal, scientifically based requirements for living and working conditions of the population. Gig work The training and education of the population, as a rule, is completely entrusted. to medical centers prevention, which, to the detriment of organizational and methodological and coordination activities, replace the work of specialists and institutions. healthcare, sanitary-epidemiol. services. In medical prof. Institution In rural areas, the positions of doctors and paramedics have been completely or partially abolished. personnel, occupation profile questions zab., hygienic training and education. The existing system of promoting medical hygiene. knowledge does not correspond to modern times. requirements, since it does not provide for the involvement of interested organizations and institutions for these purposes, primarily education, culture, environmental services, society. and religious organizations, media. The country has not resolved the issues of training and higher education. medical qualifications workers on profile issues. zab., hygienic training and education of the population. Research Institutions have practically withdrawn from the development of scientific approaches and hygiene systems. training and education of various groups of the population, criteria for assessing its effectiveness, psychological, pedagogical. and other aspects of promoting a healthy lifestyle. For the purpose of radical restructuring and perfection. hygiene systems. training and education, formation of healthy lifestyle skills among the population.

The most important tasks of healthcare institutions for hygienic training and education of the population:

1) Formation of a healthy lifestyle among the population.

2) Promotion of hygiene and medical care. knowledge

3) Popularization of medical achievements. Sciences

4) Raising a conscious attitude of the population towards the protection and promotion of health.

Work on hygienic training and education and healthy lifestyle is mandatory in every health care facility. This is an integral part of the professional responsibilities of all medical workers, regardless of specialty and position.

The work on hygienic training and education is based on the following: principles:

1. State character - the state finances the activities of institutions for hygienic training and education of the population, ensures the development of the material and technical base, personnel training, and the legal basis for the activities of service institutions.

2. Scientific - compliance of medical and hygienic knowledge with the current state of science and practice.

3. Mass participation - participation of all medical staff. workers, involvement of specialists from other departments and public organizations.

4. Accessibility – when presenting the material, unclear medical terms should be avoided; speech should be easy to understand.

5. Focus - work should be carried out in the chosen direction differentially, taking into account different groups of the population.

6. Optimism - to achieve effect, it is important to emphasize the possibility of successfully combating diseases.

7. Relevance – the choice of direction of work must be relevant at a given time.

99 Dispensaries: functions and organization of work

D - active dynamic. observ. for comp. health is determined. population groups (healthy and sick), registering these population groups for the purpose of early identification. diseases, dynamic observ. and complex. treatment of patients, carried out. health improvement activities conditions of their work and life, warning. development and distribution diseases, recovery difficulty and prolongation of the period of active life.

Currently, there are various dispensaries (medical and physical education, skin and venereology, anti-tuberculosis, drug treatment, cardiology, oncology, psychoneurological). Dispensaries and dispensary departments (offices) carry out mass prevention activities aimed at preventing. diseases, keep records of care and mortality from pathology in their profile, and also carry out therapeutic measures, consultations with patients and organizational and methodological. management of the work of general network doctors to combat compliance. zab. The tasks of dispensaries include: conducting training for general practitioners in relevant specialties; introduction of modern methods of prevention, diagnosis and treatment into the practice of medical institutions; promotion of healthy lifestyles.

Dispensary(English: distribute, care) - this is the main specialized institution that provides medical and preventive care to patients of a certain profile and is an organizational and methodological center for the fight against certain diseases in a specific territory; This is an independent institution of a legal entity that has the rights of a legal entity, a seal, an account, a charter, and internal rules. The dispensary is managed by the chief physician; staffing levels depend on the number of people served, the level of morbidity, and the epidemic situation. The work is based on a territorial principle.

The tasks of the dispensary and their role in improving the quality of specialized care:

Providing qualified, specialized medical, advisory and diagnostic assistance

Carrying out clinical examination of patients and organizing clinical observation of them in medical institutions

Organizational and methodological management of the activities of territorial medical institutions of the general medical network

Registration of patients, analysis of morbidity, disability, mortality, registration of patients, development of preventive and organizational measures

Organization and holding of seminars and conferences in order to increase the level of knowledge on the relevant pathology

Conducting mass preventive medical examinations

Introduction of new methods of diagnosis, treatment and prevention in healthcare facilities

Dissemination of knowledge among the population, hygienic training and education.

The dispensary also provides social assistance to patients (resolving employment issues, guardianship of incapacitated patients, resolving housing issues, etc.)

Dispensary structure:

1. Outpatient department (conducts specialized outpatient care)

2. Diagnostic department (laboratories, radioisotope diagnostics room, radiation diagnostics room, etc.)

3. Hospital

4. Organizational and methodological department

Types of dispensaries by profile (the number in the Republic of Belarus is indicated as of 1997):

Skin and venereal disease clinics – 35

Anti-tuberculosis dispensaries – 30

Psychoneurological dispensaries – 14

Oncology dispensaries – 11

Narcological clinics – 10

Endocrinological dispensaries – 5

Cardiovascular dispensaries – 5

Specialized dispensaries for victims of the Chernobyl nuclear power plant – 2

In total, in 1997 there were 113 dispensaries in the Republic of Belarus.

By localization dispensaries can be republican, regional, city, inter-district.

Interrelation in the work of the dispensary and clinic: the clinic, according to indications, refers patients to dispensaries of the appropriate profile for therapeutic, diagnostic and rehabilitation measures; the dispensary transfers to the clinic documentation about examined and treated patients, provides organizational and methodological management of the work of clinics in its profile, conducts seminars, conferences, etc. to increase the general level of knowledge of doctors on a specific pathology, introduces new methods of diagnosis and treatment, etc.

New technologies

Increasing the availability of high-tech types of medical care
Satisfying the population's needs for high-tech types of medical care, transferring Federal specialized medical institutions to work under state conditions
Creation of new high-tech medical centers capable, taking into account the achievements of medical science, of making a breakthrough in domestic healthcare in the field of high technologies and ensuring the availability of high-tech medical care

Providing the population with high-tech medical care:

· increasing the volume of high-tech medical care;

· construction of new centers of high medical technologies, training of highly qualified doctors and paramedical personnel for these centers.

In 2008, the national project “Health” included new measures aimed at reducing the mortality rate of the population of the Russian Federation from controllable causes and preserving the country’s labor potential:

· Improving the organization of medical care for victims of road accidents, which will help annually reduce deaths from road accidents.

· Improving medical care for patients with cardiovascular diseases will ensure a reduction in mortality from cardiovascular diseases by 1.3 times. As part of this direction, it is planned to create regional vascular centers for minimally invasive surgery in healthcare institutions of the constituent entities of the Russian Federation and municipalities.

· Development of new high medical technologies on the basis of federal medical institutions, as well as medical institutions under the jurisdiction of constituent entities of the Russian Federation and municipalities, which will increase the level of provision of the population with high-tech types of medical care to 70% of the need.

In 2009, the following areas were additionally included in the national project “Health”:

· Formation of a healthy lifestyle among Russians. As part of this area, the Russian Ministry of Health and Social Development plans to conduct a large-scale information campaign aimed both at combating alcoholism and smoking, and at promoting a healthy lifestyle.

· Reducing morbidity and mortality from tuberculosis. The program provides for the introduction of modern methods of diagnosis and prevention of tuberculosis, treatment and rehabilitation of patients.

100 Organization of ambulance and emergency care: defining the principles of organizing the service, main tasks. Stages of emergency medical care.

Emergency(EMS) – a system for organizing round-the-clock emergency medical care for life-threatening conditions and diseases at the address, at the scene of the incident and on the way to medical institutions.

The main feature of emergency medical care that distinguishes it from other types of medical care is its speed of action. A dangerous condition occurs suddenly, and the patient, as a rule, finds himself far from people capable of providing professional medical care, so it is necessary to bring doctors to him as soon as possible. There are two main approaches to providing emergency medical care - the doctor is delivered to the patient (In Russia and the former USSR republics) and the patient is delivered to the doctor (USA, Europe). It is not yet possible to identify the best of these two approaches; each of them has its own advantages and disadvantages.

In accordance with the Federal Law of the Russian Federation of November 21, 2011. No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”, “Article 32. Medical care, paragraph 4:

4.The forms of medical care are:

1) emergency – medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life;

2) emergency – medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases, without obvious signs of a threat to the patient’s life;