Outpatient care to urban population in Russian Federation

CITY POLYCLINIC

OUTPATIENT CARE is the very mass condition of health care rendering.

It is rendered to nearby 80% of patients appealing to health facilities.

Nomenclature of outpatient health facilities in Russian Federation

1. AMBULATORY
2. POLYCLINICS including
- City including Pediatric
- Central rayon
- Stomatological including Pediatric
- Consultative-diagnostic including Pediatric
- Physiotherapeutic
- Physiotherapeutic
- Rehabilitative treatment.

Basic principles of outpatient care in Russian Federation.

1. Preventive orientation;
2. District territorial principle of service;
3. Availability;
4. Stages and continuity of treatment.

СITY POLYCLINIC is a health facility to render outpatient care (primary and specialized)
to urban population at the age 18 and older.
СITY POLYCLINIC Basic tasks:
1. To render medical aid directly in polyclinic and at home;
2. To carry out preventive arrangements among population registered to decrease morbidity,
invalidity and mortality;
3. To carry out prophylactic medical examination (dispensarization) of population first of
all with high risk of cardiovascular, oncological and another social important diseases;
4. To render measures of hygiene education and healthy life style forming.

СITY POLYCLINIC Structure

 Administration
 Administrative-economical section
 Registry
Medical subdivisions
 Before physician control room
 Therapeutic department
 Specialized rooms
 Rehabilitation department
 Day hospital
 Procedure room

Diagnostic and subsidiary subdivisions

  X-ray department
 Clinical and biochemistry laboratory
 Commercial departments

Prophylaxis department

 Doctor rooms
 Diagnostic rooms
 Computer room
 Lecture hall

DISTRICT-TERRITORIAL PRINCIPAL OF SERVICE

Every polyclinic services an appointed territory divided into the districts. The base of division
into districts is standards:
1 district therapeutist serves 1700 persons.

Functions of district therapeutist

1. Timely qualified therapeutic care to the population of the own district in polyclinic and at
home;
2. Timely patients` referral to have inpatient care after obligatory preliminary examination when
planned hospitalization;
3. Use advanced methods of prevention, diagnostics and treatment in practice;
4. Temporary disability examination of patients according to regulation;
5. Carrying out arrangements on the dispensarization of adult population on the district, analysis
of efficiency and quality;
6. Early revealing, diagnostics and treatment of infectious diseases and send notifications to
centers of hygiene and epidemiology;
7. Regular improvement of professional skill;
8. Promotion of healthy lifestyle among population serviced.

Basic medical registration documents

1. “Out-patient medical card’
2. “(Uniform) Coupon of ambulatory patient”
3. “Control card of dispensary observation”
4. “Reference to medical-social examination” (MSE)
5. “Vaccination card”
6. “Sanatorium card”
7. “Reference to hospital, rehabilitation, examination, consultation”
8. “Discharge from outpatient/inpatient card”
9. “Emergency notification of infectious diseases…”
10. “Journal of infectious diseases registration”
11. “Medical death certificate”

DISPENSARIZATION or medical preventive examination (the base of prophylaxis)

 constant dynamic observation the appointed contingent of patients with chronic diseases;
 monitoring of all population with use of preventive examinations.
is a complex of measures including medical examination of some specialists and use of
necessary investigation methods realizing with regard to definite population groups.
 Tasks

 Early detection of chronic non-epidemical diseases, basic risk factors of their

development, drug and psychotropic substances use without medical prescription;
 To determine health state groups, necessary preventive, medical, rehabilitation and
sanitary measures for sick and healthy people;
 To carry out brief preventive consultation for all and individual (group) extend
preventive consultation of people with high and very high sum cardiovascular risk;
 To determine group of dispensary observation.

Groups of health
I HEALTHY
People without chronic non-epidemical diseases and risk factors of their development;
- people with risk factors when low and average sum of cardiovascular risk who needn’t
dispensary observation as regards another diseases and status;
Medical examination – 1 time a year.
II PRACTICALLY HEALTHY
People without chronic non-epidemical diseases with risk factors when high and very high
sum of cardiovascular risk that needn’t dispensary observation as regards another diseases
and status.
Medical examination – 1 time a year and in case of disease.
III PEOPLE WITH CHRONIC DISEASES in different stages of compensation
People with diseases when need dispensary observation and specialized (including high
technology) medical aid;
- people with suspicious of diseases when need extend examination.
Compensated (med.exm. – twice a year and season prophylaxis)
Subcompensated ( 4 times a year);
Decompensated (constant observation not rare than 1 time a month).

 active dynamic observation after health condition of definite population contingents

(healthy and sick);
 their registration with aim of early exposure of diseases;
 dynamic observation and complex treatment of fell sick;
 realization of measures to improve their work and life conditions;
 prevention of diseases development and spreading;
 restoration of work capacity ;
 prolongation of active life period.

Stages of dispensarization:
1. Organizational:
 Personal registration of every inhabitant;
 Definition of medical examinations order;
  Volume of examination and their realization.
2. Estimation of health status and definition of dispensary observation groups.
3. Direct dispensary observation:
 Rational distribution of dispensary contingents between doctors;
 Sanitation of life conditions and elimination of risk factors;
 Treatment in polyclinic and hospital including antirelapse measures, prophylactic
hospitalization, rehabilitation, sanatorium treatment, diet therapy, resettlement.
4. Estimation of dispensary effectiveness, planned diagnostic and sanitary measures, correction
of observe groups.

STATISTICAL INDICES OF OUTPATIENT CARE

1. Staff provision indices

1.1. Provision with doctors _No. of doctors______ x 10 000

Mid-year population

1.2. Completeness with doctor posts

No. of doctor posts occupied x 100
No. of the doctor posts according to staff schedule

1.3. Index of combining job of doctors

No. of doctor posts occupied________________
No. of doctors in fact at the end of the year

1.4. Proportion of doctors with the highest, Ist and 2nd qulified level
No. of doctors with the highest, Ist and 2nd qulified level x 100
No. of doctors in fact at the end of the year
1.5. Proportion of doctors with certificate of specialist
No. of doctors with certificate of specialist x 100
No. of doctors in fact at the end of the year

2. Indices of the volume of outpatient care

2.1. Mid no. of visits per 1 citizen

No. of visits to polyclinic and service at home
Mid-year population

2.2. Proportion of preventive visits of polyclinic

No. of preventive visits of polyclinic at the end of the year x 100
Total no. of patients visits to polyclinic at the end of the year

2.3. Proportion of visits at home

No. of visits at home at the end of the year x 100
Total no. of visits to polyclinic and at home at the end of the year

3. Indices of staff load

3.1. Real mid-hour load of the doctor during reception in polyclinic

No. of visits to polyclinic for day
No. of working hours for day

3.2. Plan function of doctor post during reception for year (week, month, 3 months)
(Plan index of mid-hour load of therapeutist during reception)x(Plan no. of working hours during
reception for year, week, month, 3 months)

3.3. Plan function of doctor post at home

Plan index of mid-hour load of therapeutist at home)x(Plan no. of working hours at home for
year, week, month, 3 months)

3.4. Plan function of doctor post

Plan function of doctor post during reception+Plan function of doctor post at home

3.5. Real function of doctor post during reception

(Real index of mid-hour load of therapeutist during reception)x(Real no. of working hours
during reception for year, week, month, 3 months)

3.6. Real function of doctor post at home

(Real index of mid-hour load of therapeutist at home)x(Real no. of working hours at home for
year, week, month, 3 months)

3.7. Real function of doctor post

Real function of doctor post during reception+Real function of doctor post at home

4. Indices of preventive work

4.1. Population drawing with medical examination

No. of people examined x 100
No. of people who need medical examination

4.2. Population drawing with dispensary observation

No. of people with dispensary observation at the end of the year x 100
Mid-year population

4.3. Drawing of patients with ischemic disease with dispensary observation

No. of patients with ischemic diseases with
dispensary observation at the end of the year____________________ x 100
Total no. of patients with ischemic disease registered at the end of the year

4.4. Registration of ischemic disease patients in time for dispensary observation

No. of ischemic disease patients with dispensary observation in time
(Among people with diagnosis registered first in life) x 100
Total no. of people with first registration of ischemic disease this year

4.5. Efficiency of dispensary work of ischemic disease patients

No. of dispensary patients due to ischemic disease with improvement
(without changes, with worsening)_________________________________ x 100
No. of patients with dispensary observation due to ischemic disease at the end of the year
 SYSTEM OF PRIMARY HEALTH CARE
TO WORKERS OF INDUSTRIAL ENTERPRISES IN RF NOW

 Budget-insurance Healthcare
 Organizational-legal forms of establishments: state and non-state health facilities of
different organizational-legal forms
 Management system:
- giving up of strict centralization;
- destruction of previous normative-legal base;
- developing corporations form their own normative-legal base;
- lack of unification in ways and demands of health protection of workers and
simultaneously more clear adaptation to international standards.
 Health facilities and specialists:
- single preserved Medico-sanitary departments (MSD), first-aid stations and medical
districts of the enterprises sections of previous Healthcare;
- New medical centers are formed by corporations and enterprises, centers of labor
medicine, departmental medical and feldsher first-aid stations.

 Peculiarities of work and functioning of health facilities and services to provide

medical service of the workers:
- business orientation of structural components of non-state facilities rendering
primary care;
- economic orientation of the system, economy of resources expenditures;
- new opportunities of resources and informational providing;
- unique approaches to manage in every company-provider of medical services;
- retention of defects of quality of medical care and duplication like negative
consequences of previous Healthcare system.