Ministry of Education and Science of Ukraine Kharkiv National University of V. N. Karazin Medical faculty «Organization of medical care for rural population and prospects for its development» Prepared by: 3rd year student, group 322 Hamidreza Rahmani Kharkiv – 2021 2 In general, medical care for the rural population is provided on the usual principles of health care, but it is impossible to implement it in the same way as providing medical care to the urban population. This is due to a number of circumstances, among which should be highlighted: 1) a large dispersal of the population, and therefore a low density of population; 2) the specifics of agricultural labor; 3) the condition of roads inside the rural area; 4) peculiarities of the age and sex composition of the inhabitants (a large proportion of the female population, the elderly, etc.); 5) a significant number of settlements with a small number of inhabitants. The staged system of providing medical care to the rural population, its essence, stages Changes in views and economic conditions during the transition to market conditions (relations) of management have necessitated the redistribution of treatment and prophylactic care between medical institutions. The concepts of primary health care (PHC), secondary and tertiary (IHC, TMSA) have been introduced, and their definitions have been given. In particular, PHC is not only the treatment of the most common diseases and injuries with the main methods, but also assistance in organizing rational nutrition, providing for mother and child, immunization against major infectious diseases, prevention and control of epidemic diseases, health education of the population, etc. In this regard, at the level of the rural district center, there was a separation of health care institutions for the provision of primary and secondary health care. Primary health care is provided by the Primary Health Care Centers located in district cities and urban-type settlements. Centers of primary health care for the population have in their structure a network of feldsher-midwife points (FAPs), feldsher points (FP), outpatient clinics general practice (family medicine), as well as temporary medical centers. 3 Secondary medical care is provided at the district level in the Central District hospitals with consultative and diagnostic centers or polyclinics. To bring secondary health care closer to the population, CRHs can locate their departments or offices on the basis of former district hospitals or rent premises in general practice (family medicine) outpatient clinics. Primary health care is based on the principles of family medicine, the essence of which is to monitor a fairly stable contingent of the population, taking into account medical and social problems; providing the family with free, affordable, continuous, permanent primary health care, etc. In fact, numerous medical and preventive institutions of the primary level are involved in providing it. An important requirement remains for the organization of primary health care for the population, which consists in the fact that 70% of the population of each settlement should be located at a distance of no more than 7 km from a medical institution. The organization of medical and preventive care for the rural population can be conditionally subdivided into several stages: - the first stage – an outpatient clinic of general practice (family medicine) that provides medical, qualified primary health care, a paramedicobstetric station (FAP), a paramedic point (FP), medical temporary base; - the second stage ˗ district medical institutions providing primary and secondary health care (VMSP). Primary health care is provided by the Primary Health Care Centers assistance to the population, secondary Central regional hospitals, consultative and diagnostic centers or polyclinics; - the third stage – regional treatment-and-prophylactic institutions (regional hospitals, dispensaries), which provide specialized and highly specialized medical care; - the fourth stage – interregional, republican medical institutions, clinics of research institutes, which also provide specialized and highly specialized care. 4 The first stage of providing health care to the rural population. Family medicine outpatient clinic. In modern conditions, it is most rational to provide the population with primary health care on the principles of family medicine in special institutions – outpatient clinics of general practice (family medicine). A family medicine outpatient clinic can be organized as: - an independent outpatient clinic, - subordinate to the relevant Primary Health Care Center for the population; - subdivision of a communal polyclinic institution; - subdivision of a non-governmental medical institution; - private medical institution (they may employ several doctors). The main principles of the functioning of family medicine are: 1) focus on the implementation of the national health policy to preserve the health of citizens of Ukraine and the doctrine of the WHO "Health for all in the 21st century"; 2) general accessibility for all citizens, regardless of status in society, age, gender, state of physical and mental development; 3) the use of scientifically based and oriented modern technologies of prevention, diagnosis, treatment and rehabilitation, which are based on domestic traditions, advanced experience and achievements of health science; 4) compliance with a comprehensive social, medical, ecological and psychological approach to health protection; 5) preventive focus, health preservation and the formation of a healthy lifestyle; 6) financing from various sources, including insurance funds; 7) the state guarantee of medical and sanitary provision of families, the absence of a monopoly character and the possibility of healthy competition. 5 The tasks of the outpatient clinic of general practice (family medicine) are: - monitoring the health status, factors and conditions that determine the health of the population, the implementation of preventive measures and programs with an assessment of their effectiveness; - teaching the elements of hygiene, adherence to a healthy lifestyle, methods of providing self- and mutual assistance; - involvement of prepared sanitary assets, public organizations, employers, local self-government bodies in solving the problems of public health; - provision of a guaranteed volume of primary health care in the assigned territory. - provision of ambulance and emergency care for conditions, - which threaten the life, injury and poisoning of every person, regardless of place of residence, nationality, religion and economic condition; - implementation of preventive work aimed at elimination of risk factors, identification of latent and early forms of diseases; - dynamic monitoring of the state of health of everyone - a citizen of a fixed territory and members of his family throughout his life, as well as people of other areas at their request; - active participation in the implementation of programs that contribute to the protection of the health of citizens and their families, especially women and children; - organization of the provision of all secondary (except primary) types of medical care (specialized and highly specialized) by various specialists of polyclinics and in stationary conditions; - participation in the provision of medical and social assistance to people with disabilities, the elderly and other socially unprotected groups of the population. In outpatient clinics, where a group of family doctors of at least 5–7 people work, it is possible to form an independent department of family doctors. 6 The tasks of the General Practice / Family Medicine Department are: providing qualified, including emergency medical assistance, attached population in the scope of the specialty «general practice / family medicine» in a polyclinic and at home; referral of patients for consultation to doctors of other specialties of the polyclinic and, by agreement, to other medical and preventive institutions; organization and holding of consultations with the involvement of specialists from the polyclinic and other medical and preventive institutions; in the presence of indications – the organization of referral of patients to the hospital; carrying out medical and social examination of temporary disability; ensuring continuity in work with departments of the polyclinic and other medical and preventive institutions; implementation of a set of measures aimed at prevention of diseases, injuries, poisoning, reduction of disability and mortality of the population; ensuring the conduct of medical examination of the population and monitoring the state of its health; organization and implementation of sanitary and anti-epidemic activities on the site; carrying out sanitary and educational work among the population, promoting a healthy lifestyle; introduction of modern methods of prevention, diagnosis, treatment, rehabilitation for various diseases; maintaining accounting and reporting medical documentation; consultation of the population of the site on medical and social, psychological issues, family planning issues. Organizational forms of family medicine work (models family medicine). The effectiveness of family medicine is highly dependent from the organizational 7 form of the work of family medicine. In international practice, it is customary to distinguish certain models of the work of a general practitioner (family doctor). A general practitioner can work alone (single practice), in partnership (2 general practitioners), in a group of several doctors (group practice). Recently, there has been a trend towards wider spreading group practice. So, if in 1951 in Western Europe 81% of general practitioners worked alone or together and 6% of general practitioners worked in groups of doctors consisting of 4 or more people, then in 1983 this ratio was already – 29% and 49%. The main reason for this trend is that for each doctor there are fewer shifts, the doctor has a greater opportunity to take a vacation, more wide opportunities for diagnostics, treatment (the best equipment, apparatus), expanding opportunities for professional communication, mutual consultations, study. In a number of countries (Turkey, Israel, Finland, Scandinavian countries), general practitioners work in health centers serving at least 10,000 people, with at least 3 general practitioners in each center and an average of 11 support staff. Models of work of general practitioners (family medicine) formed depending on the socio-economic conditions in a particular country and they are classified as follows. 1st model – individual practice (solo version). Individually working family doctors can refer patients to diagnostic and auxiliary treatment units of a medical and prophylactic institution under the conditions specified in the contract. 2nd model – twin version. In the second option (paired), two family doctors or two related doctors work together, one of whom is more specialized in pediatrics, and the other in therapy. 3rd model – group family practice. All doctors are family doctors, each has its own family – territorial area. All family doctors work in the same family medicine room. 4th model – multidisciplinary health centers. In a number of countries (Turkey, Israel, Finland, Scandinavian countries), general practitioners work in health centers serving at least 10,000 population, at least 3 general practitioners in 8 each center and an average of 11 people support staff. The emphasis in health centers is placed on the protection of mothers and children, preserving the health of the elderly population, family planning, promoting a healthy lifestyle, etc. The effective functioning of all models of family medicine is possible with adequate psychological and social support. Family medicine specialists must have an appropriate social and legal status, and a new form of organization and the provision of health care should be actively supported by local governments, parliamentary health commissions and the general public. Feldsher-obstetric station (FAP), formation criteria, tasks. FAPs are formed in villages located at a distance of up to 2 km from the base village if there are 700 residents, at a distance of 6 km or more if there are 300 inhabitants and less. One of the most important tasks of FAPs is the prevention of injuries and the provision of sanitary and epidemiological well-being. In general, the work carried out by medical workers consists of two sections: A. Treatment-and-prophylactic assistance to the population: outpatient reception of patients; home health care; fulfillment of doctors’ appointments; participation in clinical examination of patients with chronic diseases and persons with risk factors; assistance to the doctor at the reception of patients; patronage of pregnant women; medical care for women in labor; dispensary observation of children; organization of examination of temporary disability, etc.; B. Sanitary and anti-epidemic measures: identification infectious patients; organization and conduct of current disinfection; observation of contacts with infectious patients; preventive vaccinations; implementation of deworming measures; conducting current sanitary supervision of economic facilities, schools, kindergartens, the territory of settlements; implementation of sanitary and educational work; preparation of a sanitary asset, control over its activities; implementation of measures for the prevention of agricultural injuries and poisoning with pesticides. 9 The second stage of providing medical care to the rural population At the level of the district center, medical and sanitary services for the population are carried out by the Centers of Primary Health Care for the Population, which organize and provide primary health care to the population and Central District hospitals with consultative and diagnostic centers or polyclinics, dispensaries and other institutions for the provision of secondary health care. In the regional centers, centers for emergency (ambulance) medical assistance to the population have also been created. The main tasks of the PHC center are: 1) the organization of the provision of primary health care to the attached population; 2) ensuring the proper availability and quality of primary medical (medical and sanitary) care for the attached population; 3) organization of interaction with health care institutions providing secondary (specialized) medical care, tertiary (highly specialized) medical care, as well as emergency medical care; 4) organization and provision of emergency medical care the population; 5) planning the development of primary health care for the population; 6) carrying out organizational and methodological work to ensure primary health care; 7) implementation of financial, material and technical and personnel support of primary medical (medical and sanitary) care; 8) ensuring interaction between the units of the primary health care center in the interests of maintaining and strengthening the health of the population; 9) promoting accessibility for the population of rural areas in obtaining emergency dental care; 10) organization and creation of conditions for the implementation of retail trade in medicinal products. 10 The third stage of rendering assistance to the rural population At the third stage, medical and preventive institutions of the regional center or subordinate ones are involved. At the third stage, the rural population is provided with highly specialized medical and preventive care in regional combined clinical hospitals, dispensaries, specialized hospitals (oncological, emergency and emergency care, etc.), but the main institution for the provision of highly specialized medical and preventive care remains the regional combined clinical hospital. Its tasks are: providing the population of the region in full highly specialized inpatient and outpatient care; organization and provision of emergency and advisory medical care on the territory of the region; introduction of modern methods and methods of diagnostics, treatment, work experience of the best health care facilities into the practice of the hospital; advanced training of doctors and paramedical personnel of the regional health care facilities; organization, management and control over statistical accounting and reporting, preparation of general reports, analysis of performance indicators of health care facilities in the region; development of measures aimed at improving the quality of medical care and improving the health of the population. The fourth stage of rendering assistance to the rural population If necessary, the population of rural areas can be sent to provide medical and preventive care at the 4th stage of medical care, which is represented by interregional or state centers, republican hospitals, clinics of research institutes of the Academy of Medical Sciences, clinics of higher educational institutions, etc. provides highly specialized medical care that cannot be provided by other medical institutions. 11 CONCLUSIONS At present, the main directions for further improvement of medical and preventive care for the rural population can be identified, among them: - improving communication between the stages of providing medical and preventive care; - improving the quality of emergency (ambulance) and emergency medical care; - carrying out a set of measures to improve the work of all medical institutions in rural areas, first of all, providing them with effective medicines, improving the material and technical base. - the formation of institutions for the social protection of the elderly and the organization of medical supervision over them. 12 REFERENCES 1. 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