Unity of principles for providing treatment and preventive care for urban and rural populations: 1) preventive in nature; 2) locality; 3) mass participation; 4) specialization of medical care 5) general availability.

Features of providing medical and preventive care to the rural population:

1) stages of assistance

2) mobile types of medical care (traveling medical teams).

Features of the organization of rural medical care:

1) low population density - the number of rural population in 2004 was 2,803,600, 2005 2,744,200, 2006 2,691,500. Compared to 2002, the rural population decreased by 118 thousand. In 2005, 90,307 people were born, of which 24,205 (26.8%) were born in rural areas. The birth rate in 2005 was 9.2 in the Republic of Belarus, in rural areas – 8.9. The mortality rate in rural areas is 2.2 times higher than in the city. Infant mortality in general is 6.4, in rural areas – 9.3. Life expectancy in rural areas is 64.52 years, in cities 70.53 years.

Crowding is the number of people in a populated area. The average rural population is 200 people.

2) scattered settlements over a large territory - rural settlements 24 thousand. The average population density in the Republic of Belarus is 48 people per km2, in the village - 10 people per km2. Proximity is the distance between settlements; service radius is the distance from a settlement where there are medical institutions to the most remote settlement whose residents are attached to this institution for medical care. This value is manageable and varies depending on the population size.

3) poor quality of roads

4) specifics of agricultural labor: seasonality, dependence on weather

5) conditions, lifestyle, traditions

6) low supply of specialists

Stages of providing medical and preventive care to the rural population and main organizations:

Stage I – previously – rural medical station (VSU), including a complex of medical institutions:

A) a rural district hospital (SUB, provides both outpatient and inpatient care) or a rural medical outpatient clinic (SVA, provides only outpatient care)

B) first aid station (FAP)

C) health centers (if there is an industrial enterprise in the serviced area).

Currently There are no SVUs, SVA and local hospitals are branches of the Central District Hospital, FAPs are branches of the SVU.

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

FAPs– are created for medical care of 400 people or more at a distance of 2 km or more from the medical institution. When serving more than 400 people. in the staff of the FAP there are: 1 position of a paramedic or midwife or nurse and 0.5 positions of a nurse. Costs for FAPs are 1.5-2.0% of the district budget.

Functions of the FAP:

– provision of pre-medical care and timely implementation of doctor’s prescriptions;

– carrying out preventive work and anti-epidemic work;

– organization of patronage for pregnant women, children,

– carrying out measures to reduce infant and maternal mortality;

– hygienic training and education of the population.

Rural medical station (VU)– served 7-9 thousand people within a radius of 7-9 km.

District hospital- This is the main institution at the VU, consisting of a hospital and an outpatient clinic. Depending on the number of beds, there may be category I - 75-100 beds, category II - 50-75 beds, category III - 35-50, IV - 25-35 beds. At the local hospital All types of qualified medical and preventive care are provided. Medical assistance to the population during field work is of great importance. Significant work is being done to protect the health of women and children, to introduce modern methods of prevention, diagnosis, and treatment.

Provides all types of medical and preventive care to pregnant women, mothers and children Local hospital doctor. If there are several doctors, then one of them is responsible for the health of children and women in a given area.

At Unprofitable activities of local hospitals, they are closed or converted into branches Rehabilitation of district hospitals, and for medical care of the population they open Independent rural medical outpatient clinics(SVA), whose staff should include: a general practitioner, a dentist, an obstetrician-gynecologist, and a pediatrician. Medical care for patients with dental diseases in a local hospital or in a rural outpatient clinic is provided by a dentist (dentist).

From the staffing standards for medical personnel at local hospitals:

1. The positions of doctors for providing outpatient care to the population are established per 10,000 population:

2. The positions of doctors in hospital departments are established at the rate of 1 position:

– general practitioner – for 25 beds;

– pediatrician – for 20 beds;

– surgeon – for 25 beds;

– dentist – for 20 beds.

The bed capacity of the rural district hospital is 27-29 beds.

Organization of work of the SMS:

– provision of medical and preventive care to the population

– introduction into practice of modern methods of prevention, diagnosis and treatment of patients

– development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care

– organization and implementation of a set of preventive measures among the population of the site

– carrying out therapeutic and preventive measures to protect the health of mothers and children

– study of the causes of general morbidity and morbidity with temporary disability and development of measures to reduce it

– organization and implementation of medical examination of the population, especially children and adolescents

– implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.)

– implementation of current sanitary supervision of the condition of industrial and communal premises, water supply sources, children's institutions, public catering establishments;

– carrying out treatment and preventive measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms

– organizing and conducting events for sanitary and hygienic education of the population, promoting a healthy lifestyle, including rational nutrition, and increasing physical activity; combating alcohol consumption, smoking and other bad habits

– widespread public involvement in the development and implementation of measures to protect public health

Stage II – territorial medical association (TMO).

Managed by TMO Chief physician of TMO(he is also the chief physician of the Central District Hospital) and his deputies:

– deputy for medical services to the population (also head of the organizational and methodological office);

– deputy for medical affairs (if the number of beds is 100 or more);

– deputy for medical and social examination and rehabilitation (with a population of at least 30,000 people served);

– deputy for obstetrics and childhood (with a population of at least 70,000 people served);

– Deputy for Economic Affairs;

– Deputy for administrative and economic affairs.

The medical council includes: the chief physician, his deputies, the chief physician of the Center for Hygiene and Epidemiology, the head of the central district pharmacy, leading specialists of the district, the chairman of the district committee of the trade union of medical workers, the chairman of the Red Cross and Red Crescent Society.

The decision to create a TMO is made by a higher health authority. In small towns and rural areas, the TMO usually unites all medical and preventive institutions and replaces the city health department and the central district hospital. In large cities with a population of more than 100,000 people, there may be several TMOs, one of them is the main one.

TMO is a complex of health care facilities that are functionally and organizationally interconnected. TMO may include:

clinics (adults, children, dental);

antenatal clinics, dispensaries, hospitals, maternity hospitals;

ambulance stations;

children's sanatoriums and other institutions.

Merging institutions should be expedient, not mandatory. Institutions that are not included in the TMO act independently. As a rule, these are health centers and hygiene and epidemiology centers, forensic medical examination bureaus, and blood transfusion stations.

Principles of formation of TMO:

1. A certain population size - the optimal size of the TMO - 100-150 thousand people.

2. Organizational and financial separation of outpatient and inpatient facilities.

3. Coincidence of the boundaries of the TMO service area with the administrative boundaries of the district (city).

4. Rational unification of institutions - unification of institutions providing medical care to adults and children.

TMO tasks– providing accessible and qualified treatment and preventive care to the population.

TMO functions:

1. Organization of medical and preventive care for the attached population, as well as for any citizen who seeks medical help.

2. Carrying out preventive measures.

3. Providing emergency care to patients.

4. Timely provision of medical care at the reception, at home.

5. Timely hospitalization.

6. Medical examination of the population.

7. Conducting a medical and social examination.

8. Conducting hygienic training and education.

9. Analysis of the activities of health care facilities.

Main treatment and preventive institutions Stage II includes the central district hospital (CRH) and other district institutions (see question 102).

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

Outpatient dental care at stage II it can be provided in dental clinics and dental departments of the clinic of the Central District Hospital. Inpatient dental care in the dental department of a hospital hospital or on special beds for dental patients in the surgical department.

Stage III – regional hospital and regional medical institutions.

Regional Hospital is a large multidisciplinary medical and preventive institution that provides full, highly qualified, highly specialized care to residents of the region. This is a center for organizational and methodological management of medical institutions located in the region, a base for specialization and advanced training of doctors and nursing staff.

Structure of the regional hospital:

1. Hospital.

2. Advisory clinic.

3. Other departments (kitchen, pharmacy, morgue).

4. Organizational and methodological department with a medical statistics department.

5. Department of emergency and planned advisory care, etc. (see question 104).

The bed capacity of the regional hospital for adults is 1000-1100 beds, for children – 400 beds.

Advisory clinic provides the population with highly qualified, highly specialized medical care, provides on-site consultations, correspondence consultations by telephone, analyzes the activities of medical institutions, discrepancies between the diagnoses of the referring institutions and the clinic, the diagnoses of the clinic and the hospital, and error analysis. Does not have the right to issue sick leave.

The children's and women's population of the region receives all types of qualified specialized medical care at the advisory clinic. Inpatient care for women is provided in regional maternity hospitals, regional dispensaries and other medical institutions in the region.

Outpatient qualified specialized dental care patients receive treatment in regional dental clinics, inpatient care is provided in the dental departments of regional hospitals.

The number of hospital organizations in rural areas in 2005 was 274, of which there were 184 district hospitals, nursing hospitals – 90. The number of outpatient clinics was 3326. There were 253 independent medical outpatient clinics in 2005, and 336 general practitioner outpatient clinics in 2005. FAPs in 2005 – 2524.

IVstage: republican level(RSPC, republican hospitals).

Residents of rural areas - 38 million people, which is about 26% of the total population of the Russian Federation. Does the country's rural population have a high standard of living? – If only in the reports of local officials... Is the social infrastructure developed in the village? – Unfortunately, it’s also more no than yes. Have the working conditions necessary by modern standards been created for rural residents? – Not everywhere (to put it mildly). Rural work itself, which has not actually changed in its principles over many decades, leaves its mark on the health of those who do such work. And the question that has already been raised on the pages of our information and analytical portal - the question of why the Russian village is dying out - is also closely related to the pressing issue of rural healthcare.

This issue is so painful for millions of Russians that any mention of it causes a sharp reaction. Explainable...

So, how to get fast and qualified medical care in rural areas? Officially, everything for this is available. The main option is an equipped paramedic-midwife station with a professional health worker, or better yet, several. He will meet, listen, diagnose, advise, prescribe medication, referral, etc., etc. The FAP is the largest pre-hospital outpatient clinic providing primary health care to the rural population and plays a major role in medical and preventive services, carrying out a set of preventive and health measures, as well as in sanitary and anti-epidemic work. The creation of a FAP was caused by the peculiarities inherent in rural health care, the need to bring medical care closer to the population in conditions of a large service radius of the local hospital (medical outpatient clinic) in relation to all existing settlements.

FAP ensures early detection of infectious patients, carries out primary anti-epidemiological measures in outbreaks, and ongoing sanitary supervision of populated areas. An important place in the activities of the paramedic-midwife station is occupied by the active implementation of sanitary educational work among the population. Paramedics and midwives are directly involved in organizing and conducting medical examinations and annual medical examinations of the rural population.

We can say that the FAP is the face of medicine in rural areas. But the whole difficulty is that with FAPs everything is great only officially, and even then outside of statistics and exclusively in the language of local reporting. Medicine in rural areas may not have a face...

In fact, most of the FAPs have long since become morally obsolete, and in many settlements there are no FAPs at all. The message is often this: “What kind of FAP do they need here, if there are only 30 households left in the village, and there are no young people at all.” The fact that the departure of these very young people may be “somehow” connected, including with the lack of basic medical care, does not particularly concern the compilers of reports and analytical reports for budget variations.

According to information from the independent monitoring fund “Health” with reference to data from the Accounts Chamber, in 2015 there were 31.6 thousand FAPs in Russia - in all regions of the country. However, not everyone is working now. As it turns out, many are listed only on paper. That is, the FAP as a building, it seems, exists, but as a real medical institution - with staff and equipment, it seems, it doesn’t... And this despite the fact that in the overwhelming majority of cases, the FAP is the only place in the village where you can buy basic medicines . Well, pharmacy chains don’t go where the customers, although regular, are extremely few. Do not go.

The issue of accessibility of primary medical care in villages and remote areas was discussed at a meeting between Russian President Vladimir Putin and Russian Health Minister Veronika Skvortsova. This was in August last year.

Veronika Skvortsova cited statistical data from the Russian Ministry of Health characterizing the scale of the problem:

63% of rural residents turn to the city for medical care;
- in the period from 2005 to 2011, the number of paramedic and midwifery stations decreased (or, as we like to say, “optimized”) by more than 5 thousand, then the state program came into play, but it clearly does not cover the needs: from 2013 to In 2015, only 460 FAPs were opened;
- in some villages, FAPs operate once a week; villages with fewer than 100 people found themselves without any medical care at all;
- 17.5 thousand settlements do not have any medical infrastructure, of which 11 thousand are more than 20 km away from the nearest doctor;
- in 35% of settlements where there is no medical care, there is also no public transport;
- in regions with low population density, such as, for example, the Kamchatka Territory, there are no mobile teams;
- the time it takes for an ambulance to arrive in a village can reach several hours. Or maybe this “carriage” will not get to the patient at all for the most banal reason - muddy roads, bad roads.

The Ministry of Health, as it claims, has this situation under control. In 2016, the Minister of Health signed an order on organizing the provision of primary health care to rural residents.

According to the order, settlements with a population of more than 2 thousand people must have an outpatient clinic. With a population of between 301 and up to 2 thousand people, the locality must have a first aid station or a medical outpatient clinic. If the number of residents is 100-300 people, medical care should be provided through FAP or mobile forms of work (choice).

In search of a solution to the problem, regional authorities are looking for different ways.

For example, in the Belgorod region, which in many respects acts as a standard in the Russian Federation, they rely on mobility. For the second year now, a mobile paramedic-midwife station has been running in areas where there are no paramedics at all. The same mobile medical units operate in the Chelyabinsk, Orenburg, Sakhalin regions, Yamal and the Komi Republic.

In medical organizations of the Ivanovo region, 47 medical teams have been formed to travel to rural settlements, and delivery of rural patients to central district hospitals and specialized healthcare institutions has been organized.

In the Voronezh region within the framework of the project “Quality of Life. Health" over the past two years, buildings for 59 medical and obstetric stations and 12 medical outpatient clinics have been built.

And yet, the measures taken to improve the situation with rural medicine are not enough. They exist - that's a fact. But once again, they are not enough for such a huge country. Even despite positive reports from the regions, negative trends in terms of rural residents’ access to medical care continue to persist. In a number of regions it is getting worse.

The majority of rural residents, even in the 21st century, do not have the opportunity to undergo a normal medical examination and cannot afford full-fledged treatment. For many villagers, trips to the district hospital are very expensive and incur debt. In this regard, the mortality rate in rural areas cannot but increase, which is often several times higher than the birth rate. And this raises concerns about the state of demographics in rural areas. Disturbing to say the least...

In conclusion, I would like to note the following thing: a FAP is not just an important part of the infrastructure where you can receive first aid, recommendations for the treatment of diseases, consult, take a referral for a treatment appointment at a district clinic, give an injection or purchase medicine, but also... (and for a villager this is sometimes no less important) - to find understanding from the man in the white coat - the person whom the villages truly pray to as the one who can come to the rescue in the most difficult times. This is moral support, the effect of which is sometimes no less than that of therapy.

I would like this problem, which is directly related to demography, to be dealt with progressively and professionally in government agencies.

Chapter 12. Features of the organization of medical care for residents of rural areas

Chapter 12. Features of the organization of medical care for residents of rural areas

12.1. GENERAL PROVISIONS

In 2008, in the rural healthcare of the Russian Federation there were 1,749 central district hospitals, 481 district hospitals, 39,179 paramedic and obstetric centers, which employed 46.2 thousand doctors and 208 thousand paramedical personnel.

The organization of medical care for rural residents is based on the same principles as for the urban population. However, the special way of life of villagers, the settlement system, low (compared to the city) population density, poor quality and sometimes lack of roads, and the specifics of agricultural work leave their mark on the system of organizing medical care for rural residents. This concerns the type, capacity, location of health care institutions, their provision of qualified medical personnel, and the possibility of receiving specialized medical care. These features also dictate the need to develop and introduce differentiated standards for individual types of resources. For example, for rural areas located in large areas with low population density (the Far North, Siberia, the Far East), the population standard for organizing a first aid station or a general medical (family) practice center should be significantly lower than that in the south of the country, where population density is higher, settlements are located close to each other and there are good transport links.

12.2. COMPLEX THERAPEUTIC AREA

The main feature of providing medical care to the rural population is its staged nature. Conventionally, there are three stages in organizing medical care for the rural population

(Fig. 12.1).

Rice. 12.1. Stages of providing medical care to the rural population

First stage- rural health care institutions that are part of a complex therapeutic area. At this stage, rural residents receive pre-medical, as well as basic types of medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).

The first medical institution that a rural resident usually turns to is first aid station(FAP). It functions as a structural unit of a local or central district hospital. It is advisable to organize FAPs in settlements with a population of 700 or more, with a distance to the nearest medical facility of more than 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.

The paramedic-midwife station is entrusted with solving a large complex of medical and sanitary tasks:

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

Reducing mortality, primarily infant, maternal, and working age;

Providing pre-medical care to the population;

Participation in ongoing sanitary supervision of children's preschool and school educational institutions, communal, food, industrial and other facilities, water supply and cleaning of populated areas;

Conducting door-to-door surveys according to epidemiological indications in order to identify infectious patients, persons in contact with them and persons suspected of infectious diseases;

Improving the sanitary and hygienic culture of the population.

Thus, the FAP is a healthcare institution with a more preventive focus. It may be entrusted with the functions of a pharmacy selling ready-made dosage forms and other pharmaceutical products to the public.

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

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

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

Outpatient care to the population is the most important section of the work of a local hospital. She may be outpatient clinic both part of the hospital structure and independent. The main task of the outpatient clinic is to carry out preventive measures to prevent and reduce morbidity, disability, mortality among the population, early detection of diseases, and medical examination of patients. Doctors at the outpatient clinic see adults and children, make house calls and provide emergency care. Paramedics can also take part in the reception of patients, but medical care in an outpatient clinic should primarily be provided by doctors. In the local hospital, an examination of temporary disability is carried out and, if necessary, patients are sent to medical examination.

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

12.3. CENTRAL DISTRICT HOSPITAL

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

The capacity of the central district hospital and the profile of specialized departments within it depend on the population size, structure and level of care.

leftism, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, central district hospitals have a capacity of from 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatric, infectious diseases and obstetric-gynecological (if there is no maternity hospital in the area).

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

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

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas and paramedics of FAPs is provided by specialists from central regional hospitals. Each of them, according to the approved schedule, goes to the complex therapeutic area to conduct medical examinations, analyze dispensary work, and select patients for hospitalization.

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

The structure of the Central District Hospital has clinic, which provides primary health care to the rural population through the referrals of paramedics from FAPs, outpatient doctors, and general medical (family) practice centers.

The provision of out-of-hospital and inpatient treatment and preventive care to children in the municipal area is entrusted to children's consultations(clinics) and children's departments of central district hospitals. Preventive and therapeutic work in children's clinics and children's departments of district hospitals is carried out on the same principles as in city children's clinics.

The provision of obstetric and gynecological care to women in the municipal region is entrusted to antenatal clinics, maternity and gynecological departments of central district hospitals.

The functional responsibilities of medical personnel, accounting and reporting documentation, and the calculation of statistical indicators of the activities of the Central District Hospital are not fundamentally different from those in city hospitals and administrative offices.

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

12.4. REGIONAL (TERIORAL, DISTRICT, REPUBLICAN) HOSPITAL

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

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

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

The functional responsibilities of medical personnel, the methodology for calculating statistical indicators, and accounting and reporting documentation of a regional (regional, district, republican) hospital are not fundamentally different from those in city or central district hospitals. At the same time, the organization of the work of a regional (regional, district, republican) hospital has its own characteristics. One of these features is the presence in the hospital advisory clinic, where residents of all municipal districts (city districts) of a constituent entity of the Russian Federation come for help. To accommodate them, the hospital organizes a boarding house or hotel for patients.

Patients are usually referred to the advisory clinic after preliminary consultation and examination by district (city) medical specialists. Patients are hospitalized in inpatient departments of the hospital, as a rule, on the referral of specialists from district, city, central district hospitals, emergency medical teams and emergency and planned advisory care departments.

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

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

The department of emergency and planned advisory care works in close connection with regional center for disaster medicine. In cases of emergencies, practical work to carry out sanitary tasks is carried out by teams of specialized medical care on constant readiness.

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

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

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

Further ways to improve the organization of medical care for rural residents include developing a network of general medical (family) practice centers, strengthening the material and technical base and equipping inter-district centers based on large central district hospitals with modern medical equipment, providing ambulance stations (departments) with sanitary transport and communications equipment. , development

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

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

Dear Vladimir Volfovich! Medical care in rural areas is of particular importance. Every year, villages and the people living in them are aging more and more. And with age, sadly, comes health problems. Where to go? Who to contact?

You can get quick and qualified help on the spot - at a rural paramedic and obstetric station (FAP). It’s easier to get to it, and a well-known paramedic will meet you here, and there is enough medicine. FAP is a very important part of rural infrastructure. This is the place where you can not only get first aid, recommendations for the treatment of colds and viral diseases, get advice, get a referral for a medical appointment at the Central District Hospital, get an injection, prescribe or buy medications, but also meet and chat with friends. Indeed, in some places, even bread is delivered to the first aid station, so that people can receive here not only medical care, but also moral and spiritual support... Now in some settlements, all socially significant objects for villagers are located in one place: saving budget funds forced them to combine under one roof there is a first aid station, a library, a post office, a village club, and a school.

And this is very important for an elderly person who finds it difficult to walk far. The economic crisis continues; in connection with this, is the question of closing FAPs being raised in our area?

“Neither the administration of the municipal district, nor the administration of the Central District Hospital, and especially the administration of rural settlements raise this issue. On the contrary, everyone understands that FAP is necessary in rural areas. There is no one to replace him. Despite economic difficulties, the district administration allocates funds for the maintenance of first aid stations, and this is a rather large expense item: heating, lighting, medicines, equipment, etc. Reading these lines, tears involuntarily well up.

This all applies to the Kirov region. We are residents of the Kursk region, Sovetsky district. Our situation with FAPs is completely opposite. FAPs are closed even when local residents still need them. Our administration does not want to pay for light and heating, calling these costs not the intended use of budget funds. Paramedics are licensed in neighboring villages and forced to go there to work, but the assigned areas remain the same.

But which of our elders is able to travel vast distances when there is no regular transport service? It seems that local officials do not understand the essence of the work of a paramedic. Come to the office in the morning, get the necessary injections and vaccinations and go to the site to see those who are completely unable to walk, provide patronage for children, and gather people for a routine examination. It turns out that people are forced to go to the paramedic’s house and wait for him there. But there is no equipped office or quartz lamp for disinfection. The paramedic will not agree to give injections at home, and has every right to do so.

Where to store the vaccine for vaccinations, in the refrigerator with food or something? This is how our administration makes healers out of paramedics, and this is a gross violation of all laws and rules. We, residents of the village of Mikhailoannenka, Sovetsky district, Kursk region, ask you to take all measures to return the FAP to the people. It was closed in 2009, but the local administration found funds for lighting and partial heating, which made it possible to continue to receive the necessary medical care. Instead of the FAP there was an office for a paramedic. After some time, the library and village council were moved to the same building, which is what they do in those regions where they are trying to save on heating and lighting.

But the head of the village council changed and decided to move closer to her home and returned the village council to its original place. She was asked to at least leave the light on, but she said that this was not a targeted use of budget funds. She did not turn any of her convolutions towards people. Pursuing her interests, she found funds to repair the old village council. Maybe our entire administration lives in a completely different country? After all, the president himself spoke about priorities in healthcare and the availability of medical care.

The former building of the FAP is a building from the late sixties, made of brick and has a service life of 150 years - in excellent condition. Repairs were made there when the village council was transferred, and now it is facing gradual destruction. There's nowhere to even vote. They always find money for themselves, but don’t want to think about people. We have many other problems. There is no road to the first aid station, and during snowfalls people leave their cars on the highway, or at home for the whole winter, with no chance of leaving.

For several years now, the entire village has been adorned with a new water tower, which was never put into operation, the water pumps do not work, and the water from the old water tower is not suitable for cooking. And all these difficulties accompany the villagers throughout their lives. With every elected official, people hope for changes for the better, but it only gets worse, and the administration is not even going to solve these problems, and those who should take care of people are killing with their indifference. Maybe you can make the authorities work? 22.08.

2016 Residents of the village of Mikhailoannenka.

The territory of Russia exceeds 17 million km2. Rural territories - 23.4% of the entire territory - have powerful natural, demographic, economic, historical and cultural potential, which, if used rationally and effectively, can provide sustainable diversified development, employment, and a high standard of living for the rural population.

The demographic resource of rural areas is 38 million people (27% of the total population), including the labor force - 23.6 million people. The population density is low - 2.3 people per 1 km2. The settlement potential includes 155.3 thousand rural settlements, of which 142.2 thousand have permanent residents. 72% of rural settlements have a population of less than 200 people; villages with a population of over 2 thousand people make up only 2%.

Over the past 10 years, positive trends in the demographic situation in rural areas have been outlined. Natural population decline decreased from 281 thousand people in 2000 (-7.3 per 1000 people) to 82 thousand people at the beginning of 2010 (-2.1). The birth rate of the rural population is higher than the Russian average - 14 per 1000 people (compared to 12.6). This has a positive effect on the overall fertility rate.

However, the high birth rate in rural areas is accompanied by high mortality. In 2010, with infant mortality in Russia 7.5 babies per 1000 births

alive in rural areas and in the city, the indicators were respectively LOS and 6.9 infants per 1000 live births. The overall mortality rate per 1000 rural residents is 16.1, which is 6% lower than in 2000, but 19% higher than the mortality rate of the urban population. All this negatively affects the health indicators of the country's population as a whole.

The life expectancy of citizens in rural areas at the beginning of 2010 increased by 2.7 years compared to 2000 and amounted to 66.7 years versus 69.4 in the city.

Rural areas are characterized by low population density and large distances between small settlements from each other. As a result, the average radius of the service area is 60 km, and often the distance of settlements from the regional center exceeds 100 km. The service range of a local therapist can reach 10 km or more.

The seasonality of work in rural areas creates tension in the spring-summer and autumn periods, when workers are mainly outdoors, which leads to overheating or hypothermia of the body. The diet and quality of nutrition are often not respected. The incidence of injuries, joint diseases, and vibration disease is high. Contact with animals creates a risk of specific diseases.

As a result, rural residents are characterized by a large number of chronic diseases, for which patients practically do not seek medical help, and specific diseases associated with the characteristics of agricultural production (injuries, diseases of the peripheral nervous system, eye damage, vibration disease).

Medical care for rural residents based on the principles of protecting the health of the country's population. One of the important organizational principles of public health is maintaining the unity and continuity of medical care for the population in urban and rural areas.

However, the factors that determine the differences between urban and rural areas influence the organizational forms and methods of operation of rural health care institutions.

The main factors contributing to differences in health care between urban and rural populations are:

Features of the settlement of residents in comparison with the city are low density, scattered and remote settlements;

Features of agricultural labor - seasonality, high proportion of manual labor, often a significant distance from the place of residence to the place of work;

The outflow of young people and people of working age to the city;

Aging rural population;

Lower living standards in villages;

Poor condition of roads and transport:

Insufficiency or inaccessibility of new information technologies;

Low availability of medical personnel;

Socio-economic and everyday difficulties.

In general, the rural health care system is characterized by limited availability of medical care and low effectiveness of medical, social and preventive measures. The task of bringing together the levels of medical care for urban and rural populations remains relevant.

The frequency of rural residents seeking medical care is significantly lower than that of urban residents. Moreover, the farther a settlement is from a medical institution, the less often residents turn to medical workers. The bulk of medical care is provided by paramedical personnel. A rural resident spends on visiting a medical facility

much more time than city. The equipment of rural medical institutions is much worse than that of urban ones, and the qualifications of personnel are lower than the average in healthcare.

Features of the organization of medical care for rural residents are significant decentralization of outpatient care and pronounced centralization of inpatient care. The main human resource in rural areas is paramedical workers. Medical personnel are largely concentrated in regional hospitals. by receiving the population at the place of their main work and on trips to remote rural settlements as part of special teams according to a specific plan.

In accordance with the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” dated November 21, 2011 N-323-FZ (Article 5, paragraph 2). The state provides citizens with health protection regardless of place of residence and any other circumstances. For residents of rural areas, it is also necessary to adhere to the principles of health protection:

Ensuring the rights of citizens to health care and related state guarantees:

Priority of the patient’s interests in the provision of medical care;

Priority of children's health;

Social security in case of loss of ability to work;

Responsibility of state authorities and local governments, officials for ensuring the rights of citizens to health protection;

Availability and high ILC;

Inadmissibility of refusal to provide medical care;

Priority of prevention and maintaining medical confidentiality.

Organizational basis for providing medical care to rural areaspopulation laid down in the 19th century. zemstvo doctors. The zemstvo medicine system was formed in Russia during the period of zemstvo self-government and operated in 1864-1917. It had new and progressive methods of providing medical care to the population, which have not lost their relevance to this day:

Focus not on the paramedic station, but on the medical level of primary health care;

Local service for the rural population with the organization of several paramedic stations and a pharmacy on the site, in the center of each site there is a hospital with an outpatient clinic;

Maintaining “card” records during outpatient visits to patients, which allows you to collect valuable material for statistical analysis of morbidity;

Combination of medical and sanitary-preventive work;

Active promotion of a healthy lifestyle;

Free medical care.

These principles were also implemented in the organization of primary health care for the population in the Soviet health care system (1918-1991). By the beginning of the first Soviet five-year plan in Russia (1929-1932), the rural population was served by 4,677 medical stations and 3,413 paramedic stations. There were 18,200 residents per medical area. Over the five-year period, the network of medical stations grew to 7962, i.e. more than 70%; the number of rural hospital beds increased from 43,600 to 82,000. Healthcare expenditures in the USSR during the first five-year plan increased almost 4 times compared to the Russian Empire (1913). As a consequence of the efforts made. The life expectancy of Soviet people from 1926 to 1972 increased by an average of 26 years. Health care in general in the RSFSR can be judged from the data of the 3rd edition of the Great Soviet Encyclopedia (1969-1978; Table 5.20).

A typical rural medical institution - FAP - is a primary pre-medical structural unit that provides preventive, curative, and health-improving services. sanitary and anti-epidemic, sanitary and educational, hygienic medical and sanitary care.

In subsequent years, the main feature of the organization of medical care to the rural population was the staged nature of its provision. Conventionally, there are 3 stages of providing treatment and preventive care to the population.

The first stage is a rural medical station - a local hospital, a paramedic station and a first aid station, health centers, medical centers of educational institutions. At the first stage, rural residents receive pre-medical, primary and qualified medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).

The second stage - healthcare institutions of the municipal district: district and central district hospitals (CRH). which provide basic types of specialized medical care.

The third stage - healthcare institutions of the constituent entity of the Russian Federation. among which the leading place is occupied by regional (regional, republican, district) hospitals. At this stage, specialized, including high-tech, medical care is provided in all major specialties.

In modern conditions, this approach is being revised. During the implementation of the healthcare modernization program, a unified system of providing medical care to both urban and rural populations is being built.

Primary health care for the rural population will consist of three levels. At the 3rd level, all outpatient medical institutions are concentrated: at the 2nd level - intermunicipal centers providing qualified specialized outpatient and inpatient medical care in the most popular profiles in accordance with the procedures for providing specialized medical care: at the 1st level - consultative and diagnostic specialized assistance in regional CDCs.

In rural areas of the Russian Federation there are 1,349 hospital medical institutions, including 727 central district ones. 79 district and 382 district hospitals, with a total number of beds of 153.4 thousand. The provision of hospital beds per 10 thousand rural residents is 40.9, which is 2.7 times less than the provision of hospital beds for the urban population (Table 5.21).

In 2010, in the Russian Federation, 40,650 doctors (7.6% of the total number of doctors) and 207,497 paramedical workers (15.7% of the total number of paramedical personnel) worked in rural medical institutions. The provision of doctors in rural areas in 2010 was 12.2 per 10 thousand population, paramedical personnel - 54.3 per 10 thousand population. In all subjects of the Russian Federation in rural areas, there was a shortage of doctors and paramedical personnel.

The emerging trend of reducing the number of district and rural district hospitals and increasing the number of central district hospitals is due to the proven economic inexpediency of the existence of hospital medical institutions with low bed capacity. In large medical institutions (central district, regional, regional, republican, district hospitals) they spend less money per bed on economic and technical needs, heating, maintenance of staff, food. engineering and technical services. In addition, they effectively use diagnostic equipment, qualified medical personnel, introduce modern medical technologies and thereby provide the population with higher quality qualified medical care. In this regard, rural district hospitals in a number of regions of the Russian Federation are being repurposed into medical outpatient clinics, medical clinics.

Often, regions, in order to develop central district hospitals, curtail primary care facilities, leaving the rural population without medical care and drug supply.

District hospitals need to be rebuilt taking into account local conditions: population density, transport accessibility, availability of hospital beds in general, etc.

PHC- the basis of the system of providing medical care to the rural population - includes prevention, diagnosis, treatment of diseases and conditions. medical rehabilitation, monitoring the course of pregnancy, promoting a healthy lifestyle and sanitary and hygienic education of the population.

To get closer to the territory of residence, primary health care is organized according to the territorial-area principle, which provides for the formation of groups of the population served at the place of residence. Primary pre-hospital health care is provided by paramedics, midwives and other paramedics in the FAP.

FAPs are organized in rural areas with a population of 700 people or more and the distance to the nearest medical facility is more than 2 km. If this

the distance exceeds 7 km, then the FAP is organized in a populated area with a population of up to 700 people. Functions of the FAP according to the current regulatory framework:

Providing first aid:

Providing the population with medicines (according to the approved nomenclature);

Timely and full implementation of doctor’s prescriptions;

Patronage of children and pregnant women, dynamic monitoring of the health of certain categories of citizens;

Implementation of measures to reduce child and maternal mortality;

Teaching the population a healthy lifestyle,

FAP also plays a significant role in carrying out preventive vaccinations according to the National Vaccination Calendar, which is compiled taking into account the age and sex composition of the population.

The main task of the FAP in working with children is timely and high-quality patronage. providing a full range of preventive measures. The procedure for prenatal care and medical examination of children is the same for cities and rural areas.

In addition, the duties of a paramedic include systematic monitoring of the work of children's educational institutions, their sanitary condition, and the conduct of physical education in them; organization of preventive examinations. instilling hygiene skills in children, conducting extensive educational work among parents, children, educators and teachers.

There are 37.8 thousand FAPs in the Russian Federation with a steady trend of network reduction. Compared to 2000, their number was reduced by 12.8%, while a number of GP offices were organized in rural areas. When closing a FAP, it is necessary to first comprehensively assess the availability of medical care, especially in sparsely populated areas where the FAP is the only accessible healthcare unit. This is especially important when the FAP provides the population with medicines, monitors the intake of anti-tuberculosis drugs, carries out a set of preventive measures to promote a healthy lifestyle, and patronizes the elderly. Accordingly, the attitude towards a paramedic in rural areas needs to be changed and his working conditions reviewed.

The leading link in the provision of primary health care should be a general (family) practitioner. Its goal is to provide primary health care to the population in a volume that partially replaces the narrow specialists of the clinic, and under the condition of being as close as possible to the place of residence of the assigned citizens.

GPs can work individually or in a group. In individual practice, a doctor works independently, independently of other doctors and specialists, using the assistance of nursing staff working with him. Individual practice is mainly used in rural areas, where

There are only a small number of people living there and the involvement of other doctors is unjustified in terms of the volume of care provided and financial support.

Group practice involves combining the efforts of several doctors to ensure interchangeability, mutual assistance in the provision of medical services to the population and to increase the economic efficiency of the organization of GP offices.

Group practice has a number of advantages:

Possibility of interchangeability during the day and during illness. vacation, training of one of the doctors:

Better equipment of offices, including diagnostic and treatment equipment, creation of a day hospital;

Opportunity for professional communication and consultations;

The possibility of a certain specialization in narrow specialties for each of the doctors (ophthalmology, endocrinology, cardiology);

Reduction of administrative costs;

More efficient use of nursing staff.

The location of the GP's office is determined by the size of the locality;!, the ability of the health care facility to provide premises, the CAPABILITIES of the settlement administration to provide premises for the office as close as possible to the place of residence of the attached population (usually on the ground floor of a multi-storey residential building or in a specially constructed building). The location of the GP office in new microdistricts of settlements, where there is usually no developed social infrastructure, is especially convenient. The number of citizens served per GP is established based on the norm of 1,500 people. It has been established in practice; A smaller number of attached residents will not ensure the economic feasibility of the work, and a larger number will not allow the doctor to provide them with a full range of services in a high-quality manner and on time. The specific number of residents is determined for each doctor by the chief physician of the clinic to which the GP belongs, based on the size of the living population and the staffing level of the institution. The service radius can reach 1.5 km in the city, up to 12 km in the countryside,

Attachment to a GP is carried out in the presence of a compulsory medical insurance policy and a document. identification of a citizen. Every citizen has the right to choose a treating physician, including a GP. However, in most cases, a GP serves the population living in close proximity to his site: for example, in a multi-storey multi-entrance building - the residents of this one house. This approach allows for assistance to be provided at home and at night.

The GP’s work schedule is determined by the location of the office, the size and composition of the assigned population, service radius and availability of vehicles. GP tasks:

Outpatient reception of the population, including simple studies (electrocardiography, clinical examination of blood and urine, determination of blood sugar levels, visual acuity, etc.);

Providing emergency assistance;

Providing assistance in a day hospital setting;

Visiting patients at home;

Visiting your patients in hospital:

Consultations of patients with specialists:

Interaction with social protection authorities.

The doctor's workload is 4-5 thousand visits per year. Subspecialists in the clinic only accept referrals from a GP.

Despite the important place of the FAP in the primary health care system for the rural population, the leading health care facility at the first stage of rural healthcare is the rural district hospital (RPH) or the corresponding unit of the central district hospital. which and

They include a hospital and a medical outpatient clinic. Primary medical care is provided here by general practitioners, local general practitioners, pediatricians, local pediatricians and GPs (family doctors).

The nature and volume of medical care in a rural district hospital are determined by the capacity, equipment, and availability of specialist doctors. Regardless of the capacity of the SUB, it provides outpatient care to therapeutic and infectious diseases patients, assistance during childbirth, and pediatric and preventive care for children. emergency surgical and trauma care. The staff of the SUB includes doctors in the main specialties: therapy, pediatrics, dentistry, obstetrics and gynecology, surgery. Tasks of the SMS:

Providing the population of the assigned territory with qualified medical care (outpatient and inpatient):

Planning and implementation of activities to prevent and reduce morbidity and injury among various groups of the rural population;

Treatment and preventive health care for mothers and children:

Introduction of modern methods of prevention, diagnosis and treatment, advanced forms and methods of organizing medical care;

Organizational and methodological management and control of the work of the FAP and other medical institutions that are part of the rural medical district.

The organization of outpatient care for the population is the most important section of the work of rural district hospitals. In rural areas there are 2,979 outpatient clinics with 436 thousand visits per shift. These include rural medical outpatient clinics(polyclinics), both included in the structure of other medical organizations and independent. Their main tasks are: carrying out broad preventive measures to prevent and reduce morbidity, early identification of patients, medical examination. provision of qualified medical care to the population, Doctors see adults and children, make house calls and provide emergency medical care. Paramedics can also take part in the reception of patients, but outpatient care in a rural medical outpatient clinic must be provided by doctors.

In addition, the functions of the rural outpatient clinic include:

Bringing outpatient medical care closer to rural residents;

Carrying out a set of sanitary and anti-epidemic measures (preventive vaccinations, ongoing sanitary supervision of institutions and facilities, water supply and cleaning of populated areas);

Scheduled visits of doctors to subordinate FAPs and children's educational institutions to provide practical assistance and monitor their work.

Maternal and child health care plays an important role in the work of a rural medical hospital. Medical care for children at a rural medical site provided by doctors and paramedics under the guidance of the chief physician of the local hospital. If there is a pediatrician at a rural medical site, he is responsible for organizing medical care for children (as a rule, the chief physician). In the absence of a pediatrician, the chief physician of a rural district hospital has the right to assign responsibility for medical care to children to one of the general practitioners, allocating him a certain time to work with children.

The main responsibilities of a doctor responsible for medical care for children at a rural medical site:

Constant preventive monitoring of children in villages assigned to the local hospital;

Periodic medical examination of all children in the area, especially in the 1st year of life;

Active identification of sick and weakened children, taking them to the dispensary for regular observation and recovery:

Timely and complete coverage of children with preventive vaccinations;

Regular supervision of children in organized groups, monitoring the correct neuropsychic and physical development of children. carrying out necessary health measures;

Active identification of sick children, timely provision of qualified medical care and provision of hospitalization if necessary;

Constant study of the conditions and lifestyle of children in the family, identification and assistance in eliminating unfavorable environmental factors;

Monitoring the work of the FAP by regular (according to schedule) field visits, providing them with the necessary organizational and methodological assistance;

Extensive educational work among parents, children, teachers, educators on child health issues.

Doctors from rural outpatient clinics travel according to a certain schedule to the FAN of their site for a consultation. At the same time, they should strive to improve the qualifications of their assistants, passing on knowledge and experience to them. The population is notified of the departure schedule.

Pediatricians from central district hospitals must travel to rural district hospitals on schedule to improve medical care for children in rural areas. The population is notified in advance of the pediatrician’s arrival.

Materials from inspections of the work of rural district hospitals and first-aid posts on medical care for children are summarized by district pediatricians and organizational and methodological offices of the Central District Hospital. are periodically heard at district conferences and medical councils. Based on the results of the discussion, appropriate organizational measures are taken.

In accordance with these tasks, the main responsibilities of the doctor (doctors) of the rural medical district are determined;

Outpatient reception of the population;

Inpatient treatment of patients in a rural district hospital:

Providing assistance at home;

Providing medical care in case of acute diseases and accidents;

Referring patients to other health care facilities for medical reasons;

Examination of temporary disability and issuance of certificates of incapacity for work:

Organization and conduct of preventive examinations;

Timely registration of patients for dispensary registration:

Carrying out a complex of medical and health measures, ensuring control of clinical examination;

Active patronage of children and pregnant women;

Carrying out a set of sanitary and anti-epidemic measures;

Sanitary educational work, promotion of a healthy lifestyle;

Scheduled visits to the first aid station.

The structure of a rural medical district is formed depending on the size of the population served, the service radius, the distance to the central district hospital and the condition of the roads. The number of people served in a rural medical district can reach 2.5 thousand people.

Primary specialized health care is provided by medical specialists, including medical specialists from medical institutions providing specialized, including high-tech, medical care. Primary health care is provided on an outpatient basis and in a day hospital setting.

To provide primary health care to citizens in case of acute diseases, conditions, exacerbation of chronic diseases that are not accompanied by a threat to the patient’s life and do not require emergency medical care, medical care units are created within the structure of medical institutions that provide it in an emergency form.

The organization of medical care for residents of rural areas, its volume and quality depend on the distance of medical institutions from the place of residence of patients, the availability of qualified personnel, equipment, the possibility of receiving specialized medical care, and the implementation of medical and social security standards at the regional and federal levels.

Central District Hospital(CRH) is the main medical institution for providing qualified medical care to the rural population. At the same time, the Central District Hospital is a center for organizational and methodological management of healthcare in a municipal district, responsible for organizing medical care for the population, increasing the efficiency, quality and accessibility of this care.

In different regions of the country, there are central district hospitals of different capacities, which depend on the population size, the provision of hospital facilities and other factors. The optimal capacity of the central district hospital is at least 250 beds. The structure of the Central District Hospital includes:

Hospital with departments for main specialties;

Clinic with treatment and diagnostic rooms and laboratory:

Emergency departments:

Pathology Department:

Organizational and methodological office;

Auxiliary structural units (pharmacy, kitchen, medical archive, etc.).

The profile and number of specialized departments of the central district hospital depend on its capacity, but their optimal number should be at least 5: therapeutic, surgical with traumatology, pediatric, infectious diseases, obstetrics and gynecology (if there is no maternity hospital in the area).

The main tasks of the Central District Hospital:

Providing the population of the district and regional center with qualified specialized inpatient and outpatient medical care;

Operational, organizational and methodological assistance to medical organizations in the region;

Organization of material and technical support for the departments of the Central District Hospital:

Development and implementation of measures aimed at increasing the IMP of the population, reducing morbidity, infant and general mortality, improving health;

Arrangement, rational use, advanced training of medical personnel;

Implementation of activities to promote a healthy lifestyle.

The chief physician of the Central District Hospital has deputies in the main areas of activity: medical department, outpatient work, organizational and methodological work (head of the organizational and methodological department), administrative and economic work, security, and in areas with a population of 70 thousand or more - on childhood and obstetrics.

To provide methodological, organizational and advisory assistance to doctors of rural medical districts, the Central District Hospital allocates district specialists who, within the framework of their specialty, organizationally and methodologically manage all medical institutions in the region - often heads of departments of the Central District Hospital or the most experienced doctors. Each of them heads medical work in the region in his specialty, travels for consultations, conducts demonstration operations, examinations and treatment of patients, sends teams of medical specialists to medical institutions of rural medical districts, listens to reports from doctors of local hospitals, heads of first aid stations, analyzes their work, statistical reports, conducts scientific conferences, seminars, advanced training in the workplace.

To bring specialized medical care closer to the rural population, regional centers are creating interdistrict specialized departments(centers, medical districts) equipped with modern equipment. The functions of inter-district centers are performed by health care facilities. capable of providing the population with specialized, highly qualified inpatient or outpatient care if the central district hospitals of neighboring areas do not have the ability to provide specialized care or its volume in each health care facility is minimal, and the necessary specialists are not available. Along with performing the functions of a structural unit of health care facilities, interdistrict specialized centers (departments) carry out:

Consultative appointments in the clinic for patients referred by doctors from medical institutions of the attached areas;

Hospitalization of patients from assigned areas:

Organizational, methodological and advisory assistance (including examination of work capacity) to doctors of health care facilities in the assigned areas, including scheduled visits:

Introduction into the work of healthcare institutions of modern means and methods of prevention, diagnosis and treatment of patients in the relevant specialty;

Analyzing the results of providing medical care to residents of the assigned districts, providing information on the work of the interdistrict medical center;

Conducting joint thematic conferences and seminars. Medical institutions in the attached areas transport patients

and pregnant women to the interdistrict center (by agreement), refer patients for consultation only subject to a complete examination in accordance with the standards of medical care, inform the population about the work hours of the center’s specialists. To coordinate the work of interdistrict medical centers and assigned areas, interdistrict medical councils are created.

Polyclinic Central District Hospital provides qualified medical care to the rural population in 8-10 medical specialties. The tasks of the clinic include:

Providing qualified outpatient care to the assigned population of the district and regional center;

Organizational and methodological management of outpatient departments of the district;

Planning and implementation of activities aimed at preventing and reducing morbidity and disability;

Introduction into the work of all outpatient clinics in the region of modern methods and means of prevention and treatment of diseases, best practices in providing outpatient care;

Implementation of measures to promote a healthy lifestyle.

Rural residents come to the district clinic following referrals from medical institutions of rural medical districts to receive specialized medical care, functional examination, and consultations with medical specialists.

To bring specialized medical care closer to the place of residence, mobile medical care teams are created from among full-time doctors and nurses at the Central District Hospital.

The organizational and methodological office of the Central District Hospital plays an important role in organizing medical care for the population of rural areas. which is staffed by the most experienced doctors. He has data on the economy and sanitary condition of the region, the network and staffing of medical institutions, the provision of the population with various types of medical and social security, etc. The organizational and methodological office is headed by the head, who can simultaneously be the deputy chief physician of the Central District Hospital.

Outpatient and inpatient medical care for children in rural areas they are assigned to children's clinics, children's hospitals and children's departments of the central district hospital.

Children's health care in the district is carried out according to a unified plan approved by the chief physician, who is responsible for the quality of medical care for children. However, he places direct responsibility on his deputy for pediatrics and obstetrics or (in the absence of one) on the district pediatrician who manages medical care for children in the rural area.

The position of a district pediatrician is established on the staff of each district hospital, which includes a children's consultation clinic, in addition to the medical positions provided for by the standard staff of a children's clinic.

The main health care facility providing medical care to children at the subject level RF.- Children's regional (regional, district, republican) hospital. and in its absence - a regional (regional, republican, district) hospital with a children's department and a consultative clinic for children.

In the area, except for the central district hospital. organize specialized dispensaries (anti-tuberculosis, skin and venereology, drug treatment), which operate as inter-district medical institutions, serving the population of nearby areas.

Highly qualified specialized medical care for the rural population in all main specialties is provided by regional (territorial, republican district) medical institutions. The main one is regional (regional, republican, district) hospital, which provides full medical care not only to rural residents, but also to all residents of the constituent entity of the Russian Federation. It is the center of organizational and methodological management of medical institutions located in the region (region, republic, district), a clinical base for specialization and advanced training of doctors and nursing staff.

The capacity and staffing of the hospital are determined by the population of the administrative territory. The optimal capacity of a regional (regional, republican, district) hospital is 700-1000 beds.

Objectives of the regional hospital:

Highly qualified specialized consultative, diagnostic and therapeutic assistance to the population of the administrative territory in outpatient and inpatient settings using highly effective medical technologies,

Advisory and organizational and methodological assistance to specialists from other medical institutions of the administrative territory;

Qualified emergency and planned advisory medical care using air ambulance and ground transport;

Development and implementation of targeted programs for improving medical care:

Introduction into the practice of medical institutions of the administrative territory of modern medical technologies, effective management methods and the principles of health insurance:

Participation in training, professional retraining and advanced training of medical workers;

Formation of a healthy lifestyle.

Organizational and methodological department;

Consultative and diagnostic clinic:

Hospital with emergency department;

Department of expert and planned advisory assistance;

Medical Library;

Other structural units necessary for the operation of the hospital (catering department, accounting, medical archive, garage, etc.).

The work of a regional hospital is in many ways similar to the work of a city hospital. but it also has its own characteristics. One of them is the presence within the hospital of a regional consultative and diagnostic clinic.

The main tasks of the consultative and diagnostic clinic: providing patients referred from medical institutions at the local or district level with specialized qualified advisory assistance in diagnosing diseases, recommending the volume and methods of treatment, and, if necessary, inpatient care in the departments of the regional hospital. Consultative and diagnostic clinics not only perform a consultative and therapeutic function, but also evaluate the quality of work of rural doctors, district, city and local hospitals.

Patients are referred to the regional advisory clinic, as a rule, after preliminary consultation and examination by district medical specialists. To evenly distribute the flow of patients, specialists of the consultative and diagnostic clinic regularly report the availability of free places in hospital departments or registration for examinations, coordinate the timing of admission of patients from medical institutions in rural areas, organize and conduct on-site consultations with medical specialists, provide a medical report for each patient, which indicates the diagnosis. treatment performed and further recommendations. The clinic systematically conducts quality assessments: significant discrepancies in diagnoses, errors made by doctors in district medical institutions when examining and treating patients locally, etc. are examined.

A special feature of the regional hospital is the presence in its composition departments of emergency and planned advisory assistance, which provides emergency and advisory assistance with travel to a remote locality. The department transports the patient to a medical organization, sends specialists on calls from areas and maintains contact with teams sent to provide medical care. The emergency department organizes the delivery of patients, accompanied by medical personnel, to specialized institutions outside the region, urgent delivery of medications and supplies necessary to save the lives of patients.

This department, as a rule, has a fleet of cars for traveling to rural areas. In addition to the manager, its staff includes doctors, specialists

those involved in providing emergency medical care, paramedics, nurses. All specialists from the regional hospital and other medical institutions can be involved in the work of the department. The department of emergency and planned advisory care in some regions is the basic medical unit of the regional center for disaster medicine. In this case, specialized medical care teams work in almost constant readiness.

To bring medical care closer to village residents, specialists from regional institutions practice scheduled visits by integrated teams to consult with pre-selected patients who need clarification of the diagnosis. correction of prescribed treatment, determination of the need for hospitalization in regional medical institutions. This work is also carried out by specialists from central regional hospitals.

Research work- one of the areas of activity of the regional (regional, republican, district) hospital: conducting scientific research, introducing the results of new developments and methods into the practice of medical institutions, organizing scientific conferences and seminars, the work of scientific societies of doctors.

In a regional hospital, unlike a city hospital, the functions organizational and methodological department much wider. In fact, it serves as a scientific and medical basis for the state health management body of the region for introducing into practice advanced organizational forms and methods of medical care to the population. Its main functions:

Analysis of the activities of medical institutions in the region:

Organizational, methodological and advisory assistance:

Study and analysis of population health indicators:

Organization of staff training;

Work planning.

The organizational and methodological work of medical institutions in the region involves the main staff (chief surgeon, therapist, pediatrician, obstetrician-gynecologist) and freelance (often heads of specialized and highly specialized departments) specialists.

Emergency medical care in rural areas at the level of FAP, SUB. Family medical outpatient clinics are provided by the medical staff of these institutions at any time of the day.

The most important issues in organizing emergency medical care for the rural population:

Schedule and procedure for providing emergency medical care in all rural medical organizations;

Availability of styling, bags and their necessary equipment;

Emergency medical care standards;

Registration of calls received and measures taken;

Continuity (based on the feedback principle) between the EMS service, outpatient clinic service, dispatch services of farms and enterprises:

Preparing the population to provide self- and mutual assistance, increasing sanitary literacy of the population;

Development and availability of incentives for participation in this type of care for all health workers, including nursing staff, including their training, equipment and financial incentives;

Training of medical personnel to provide ambulance and emergency medical care;

Priority of medicinal and logistical support.

To improve medical care for the rural population, a lot of work is being done as part of the implementation of the healthcare modernization program. which provides organization of households, further strengthening of the material and technical base of medical institutions in rural areas, advanced training, training and retraining of personnel.

The modernization program provides for the opening of more than 3,800 households in settlements with a population of less than 100 people.

The concept of housekeeping implies a local resident who has agreed to provide first aid to sick or injured residents of the settlement. To do this, specialists in the field of disaster medicine will teach such a resident the basic skills and techniques of first aid, and local authorities will equip him with a telephone connection for promptly calling a paramedic, a doctor, an emergency medical team and a first aid kit. Such work is already being actively carried out in some regions of the Russian Federation.

It is planned to open 1,093 first aid stations and paramedic stations in rural areas. 226 medical outpatient clinics, 1,381 GP offices.

The situation with medical personnel, working in rural areas has been deteriorating in recent years. In 2005-2010 the number of doctors in rural areas decreased by 1,653 people (from 42.2 thousand to 40.6 thousand doctors), the coefficient of part-time doctors increased by 6.7%.

From January 1, 2012, by Decree of the Government of the Russian Federation of October 17, 2011 No. 39, medical and pharmaceutical workers living and working under an employment contract in rural settlements, workers' settlements (urban-type settlements), who are on staff at their main place of work in federal government institutions subordinate to federal executive authorities, as a measure of social support, a monthly cash payment has been established to compensate for the costs of paying for living quarters, heating and lighting in the amount of 1,200 rubles.

To reduce the shortage of medical personnel in rural areas, it was proposed to create additional incentives for doctors who transfer to work in rural areas, in the form of one-time payments in the amount of 1 million rubles for arrangement, solution of housing and other everyday problems.

It is planned to make one-time compensation payments to medical workers under the age of 35. arrived in 2011-2012. after graduating from a higher educational institution, to work in a rural locality or by moving from another locality.

The condition for receiving these payments is the conclusion between the doctor and the authorized executive body of the constituent entity of the Russian Federation of an agreement on moving to work in a rural locality for a period of at least 5 years.

The executive authorities of a constituent entity of the Russian Federation have the right to provide for payments to paramedical personnel at the expense of the constituent entities of the Russian Federation.

Federal target program “Social development of rural areas until 2013” (as amended by Decrees of the Government of the Russian Federation dated April 29, 2005 No. 271 and April 28, 2011 No. 336) provides for the implementation of additional measures for the development of a network of primary health care institutions:

Strengthening the material and technical base of healthcare facilities in rural areas, taking into account the creation of mobile units, centers, and departments of general medical (family) practice;

Improving primary health care for the rural population by introducing general medical (family) practice;

Providing the rural population with emergency medical care by improving regulatory, logistical and personnel support;

Improving consultative, diagnostic and therapeutic assistance by introducing on-site forms of medical care;

Staffing healthcare institutions primarily with specialists from general medical (family) practice:

Development of the Institute of GP (family doctor).

As a result of the implementation of measures, the rural population's access to the services of medical institutions and their departments will be expanded.

To increase the effectiveness of the implementation of the Concept of Demographic Policy of the Russian Federation for the period up to 2025, approved by Decree of the President of the Russian Federation of October 9, 2007 No. 1351, in relation to rural areas, additional measures are necessary in order to:

Reducing the mortality rate, especially in working age:

Reducing infant mortality rates;

Preserving and strengthening the health of the rural population: increasing life expectancy;

Creating conditions for a healthy lifestyle;

Reducing the incidence of socially significant diseases,

Reducing the migration flow of the rural population. In this regard, in the regions it is necessary to provide:

Strengthening primary health care in rural areas:

Increasing the availability of medicines for rural residents;

Forming motivation for a healthy lifestyle, including programs to reduce the consumption of alcohol and tobacco products, non-medical use of narcotic drugs and psychotropic substances, prevention of alcoholism, drug addiction, cardiovascular and other diseases;

Ensuring the operation of health centers in rural areas.

In the field of medical care, it is planned to expand the access of the rural population to qualified primary health care. emergency and specialized medical care based on strengthening the FAP network. district hospitals, the creation of general medical practice outpatient clinics, taking into account territorial characteristics. strengthening the material and technical base of district, central district hospitals and inter-district centers using telemedicine, ensuring transport accessibility for the rural population of inter-district centers, regional, republican and federal medical institutions. It is planned to expand the emergency medical services service, the pharmacy network, on-site forms of specialized medical care and the use of remote forms of diagnostics in rural areas. The entire rural population should be covered by dispensary observation.

To popularize a healthy lifestyle and attract rural residents to physical education and sports, it is planned to expand the network of sports facilities and playgrounds.

All activities proposed and carried out by the Government and local health authorities should really change the existing rural health care system and bring it to a new, higher quality level that meets modern medical requirements.