From Big Medical Encyclopedia

DOMICILIARY CARE — delivery of health care by the patient at home.

The item of N of is carried out by doctors and average medical workers policlinics (see), out-patient clinics (see), women's and children's consultations (see. Children's policlinic , Clinic for women ), clinics (see. Clinic ), and also stations of ambulance and emergency medical service (see. Ambulance and emergency medical service ). It appears hl. obr. district doctors (therapists and pediatricians) who if necessary involve doctors of other specialties (neuropathologists, surgeons, etc.), and in rural areas also with paramedics.

Before Great October socialist revolution of P. of N of rendered hl. obr. private medical practitioners to generally rich people and only in the nek-ry cities of Russia — the Duma doctors or doctors for the poor.

After Great October socialist revolution P. of N of gained broad development according to the tasks facing health care, and need of the population. In the first years of the Soviet power points P. of N of began to be created. In 1921 in Moscow independent points of acute management were created at home. In 1925 Narkomzdrav RSFSR enacted «The provision on the organization of medical assistance at home», the Crimea it was provided that P. of N of is made by one doctor servicing 4 — 5 thousand zhit. in the territory with a radius of one verst. In 1926 the decision Narkomzdrava of RSFSR P.'s points of N of were a part of out-patient clinics and policlinics; the new provision on the organization P. of N of was approved. By this time only in RSFSR 435 points P. of N of (923 doctors) worked.

In 1938 Narkomzdrav of the USSR in the order «About Development of the Out-patient and Polyclinic Help to the Population» determined structure and norms of local and territorial system of the extra hospital help to the population, including on assistance at home (see. Medical site ). District doctors and nurses began to render the item of N of; also specialized medical aid was provided at home.

The order M3 USSR No. 321 of July 20, 1960. «About a state and measures for further improvement of out-patient and polyclinic service of urban population» the provision on the local therapist of policlinic city-tsy, city policlinic is approved (independent), in Krom it is said that the district doctor is obliged: to provide early detection of diseases and timely rendering qualified to lay down. the help to the population of the site as in policlinic, and at home; to visit patients at home in day of receipt of a call, to provide systematic dynamic observation, active treatment of patients before their recovery or hospitalization. The district doctor has the right to appoint to the patient who is at home, necessary laboratory, electrodiagnostic and X-ray inspections, to lay down. procedures which are performed by medics of policlinic. The order M3 USSR No. 876 of November 11, 1973. «About providing local therapists and pediatricians with a set of medicines for rendering the emergency medical care by the patient at home» the list of the pharmaceuticals which are free of charge given during the rendering medical aid by the patient who is at home is defined.

Several options of the organization P. of N of are known. The option when the local therapist daily conducts outpatient appointment in policlinic is most widespread and renders medical aid by the patient of the site at home. The working schedule of the district doctor in this case is under construction of calculation (approximately) 3 hours on reception in policlinic and 3 hours for visit of patients at home. Also nurses who are allocated from calculation one position for the local therapist and 1,5 — for the local pediatrician take part in rendering medical aid by the patient at home.

From 50th in a number of policlinics of Leningrad, and then in Moscow, Kiev, Riga and other cities the brigade and local method of polyclinic service of the population when join in crew, in addition to local therapists began to extend, doctors of other main specialties are surgeons, neuropathologists, etc. that promotes specialized P.'s improvement N of.

A special form of rendering P. of N of is patronage (see), very widespread at assistance at home mentally sick, suffering from tuberculosis and other diseases.

Development of network of out-patient and polyclinic institutions allowed to expand P.'s volume of N of. In 1970 135,4 million visits of patients at home, in 1975 — 138,8 million, and in 1979 — 164,2 million were made. The number of medical visits averages apprx. 7% of all visits to doctors of out-patient and polyclinic institutions at home. At patients of a therapeutic profile this indicator reaches 28 — 30%.

For rendering the emergency medical aid the service of fast and acute medical aid is created, edges incorporates the linear and specialized medical crews (resuscitation, cardiological, antishock, an intensive care, pediatric, psychiatric, etc.) equipped with the necessary medical equipment that promotes the maximum satisfaction of need of the population for different types of the emergency P. of N of.

A basis of the organization P. of N of in the socialist countries (Bulgaria, Hungary, Poland, Czechoslovakia, etc.) the out-patient and polyclinic service constructed by the principles similar accepted in the USSR is.

In economically developed capitalist countries the extra hospital help, including a domiciliary care, doctors of the general profile who in all countries, except England and a number of the Scandinavian countries where there is a national health service, are private medical practitioners render. The high cost of medical services significantly limits availability of medical aid in system of voluntary insurance due to illness. This type of insurance captured only a part of the population; so, e.g., in the USA, according to the report to the Congress (1968). from 180 million Americans aged up to 65 years it was not insured for a case of the address to the doctor or his call on the house of 102 million people (57%). In the next 12 years calls of the doctor on the house in the USA become more and more unusual occurrence, having decreased from nearly 1 call on each American in a year to 1 call on everyone 12 zhit. in a year.

See also Primary health care .

Bibliography: Goldzilber E. M. Main questions of the organization of polyclinic service of the population, page 96, M., 1963; Gomel G. JT., etc. Sketches of development of the polyclinic help in the cities of the USSR, M., 1971; Petrakov B. D. Organization of work of the local therapist, M., 1979; Serenko A. F., Ermakov V. V. and Petrakov B. D. Bases of the organization of the polyclinic help to the population, page 124, M., 1976.

I. V. Shatkin.