POLICLINIC (Greek poly is a lot of + clinic) — the treatment and prevention facility intended for rendering medical medical care by the coming patient and for treatment of patients at home. Policlinic from out-patient clinics (see) differs in a large number of doctors and consequently, and great opportunities in rendering specialized medical aid.
Items in the USSR are divided by the contingents of the serviced population, tasks and functions on city (for adults and teenagers), city nurseries, central regional, on the water transport, on. - transport, student's, resort, garrison (for service of the military personnel). At regional, regional and republican-tsakh, clinics of medical institutes and scientific research institute consulting and diagnostic P. Besides, are created specialized P. function: dental, dental nurseries, physiotherapeutic, etc.
On the volume of work (number of visits per shift) P. are divided into five categories, and by the principle of financing — on budget and self-supporting.
Policlinic — the leading link in the organization primary medical and sanitary help (see), the major achievement in the organization of medical care in the USSR, in system of socialist health care.
The item is a form of the most mass to lay down. - the prof. of the help to the population of the USSR. Here it is inspected and treated apprx. 80% of the diseased. Items really provide availability of extra hospital specialized medical aid to the population on many specialties thanks to wide network of these institutions and their maximum approach to the population.
The item at the present stage of development of the Soviet health care is not only large medical diag-nosticheskim, but also the major preventive center. This establishment carries out the general line of development of the Soviet health care — the preventive direction.
- 1 History
- 2 Power and structure of policlinics
- 3 Design of premises of policlinics
- 4 Main divisions of policlinic
- 5 Work of district doctors
- 6 Medical examination of working capacity
- 7 Work on the organization of medical examination
- 8 Interrelation of policlinic with hospital
- 9 Specialized policlinics
- 10 The leadership in activity of policlinic
- 11 Tables
P. in their modern understanding as institutions extra hospital to lay down. - prof. of the specialized help arose in system of socialist health care though to lay down. institutions for the coming patients like out-patient clinics were organized abroad and in Russia before Great October socialist revolution. 5,7 thousand medical institutions which were available in 1913, in to-rykh there was an extra hospital medical aid, were placed generally in rural areas; in each of them one general practitioner worked, as a rule. Already at the 1st meeting of managers to lay down. sections of zdravotdel, the carried-out Narkomzdravy by RSFSR in December, 1920, developed the plan of measures on development of network of extra medical medical medical institutions, and at the V All-Russian congress of zdravotdel which took place in 1924 ways of further development and improvement of the out-patient and polyclinic help to the population were defined. Special attention at the same time was paid to closer combination in work of out-patient and polyclinic institutions of medical and preventive functions.
Implementation in practice of the Lenin principles of health care, in particular the principle of general availability of medical aid for a general population, promoted bystry and broad development of network of out-patient and polyclinic institutions in the USSR. By 1928 in comparison with 1913 the number of out-patient and polyclinic institutions increased almost by 5 times.
For development of measures for further improvement of activity ambula - even and polyclinic institutions, to studying, generalization and distribution of the best practices at Narkomzdrava RSFSR in 1935 created polyclinic council. He played a positive role in development of network of out-patientpoly-clinical institutions, in improvement of their work. As a result preventive functions P. gained further development, use of a dispensary method significantly extended, the level of medical and diagnostic work in extra hospital conditions increased.
New important stage in development of the out-patient and polyclinic help in our country was the reform which is carried out in 1947 — 1949 on association P. with-tsami in uniform to lay down. - professional, institutions (see. Health care ). This action was aimed at providing the maximum succession in inspection and treatment of patients, upgrading and systematic improvement of professional qualification of doctors of policlinics by their intermittent operation in a hospital. As a result of association P. with more specialized medical aid in high gear would begin to develop in P., quicker and more widely to be implemented modern methods of inspection and treatment of patients, including and such which were carried out only in the conditions of a hospital before (see. Hospital ).
Rapid development and change of the principles of housing construction (construction of skyscrapers) led to the fact that in the cities the radius of service of the population by out-patient and polyclinic institutions was considerably reduced. Construction independent began to be provided in a result in inhabited districts P. Vopros about ways of further development of network of polyclinic institutions was a subject of discussion at the all-Union meetings on out-patient polyclinic service of the population which took place in 1960 and 1974. Found reflection of a tendency on development of network of independent P. V of 1960 by the order of m in recommendations of meetings 3 The USSR «About a state and measures for further improvement of out-patient and polyclinic service of urban population» provided actions and ways of improvement of work of P., regulations on policlinic and officials are drafted, the approximate structure of P. and its categorization, temporary (settlement) norms of load of doctors on one hour of work in P., etc. are approved.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR of July 5, 1968. «About measures for further improvement of health care and development of medical science in the country» ways of further improvement of the out-patient and polyclinic help were planned. Since January 1, 1971 the indicator reflecting P.'s construction, expressed in visits per shift was entered into the plan of economic development in the industry of health care (on construction of medical institutions). The development plan for the national economy for 1971 — 1975 provided to construct policlinics on 404 thousand visits. The plan was successfully implemented. In 1971 — 1975 new ambulatornopoliklinichesky institutions with a general power at 566 thousand visits are put into operation.
According to the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) among measures for development out-patient poliklini-cheskoy the help is provided to apply this indicator since 1981 to planning of development of all network to lay down. - professional, the institutions giving to the population out-patient and polyclinic help. In
only 1971 — 1980 it was constructed St. 1500 large P. (polyclinic departments of BC) with a general power at 1263 thousand visits per shift. It allowed bodies of health care to bring closer significantly out-patient polikli-nicheskuyu the help to the population and to increase its level. In 1980 the number of out-patient and polyclinic institutions reached 36,1 thousand. Development of network of out-patient and polyclinic institutions of system of m 3 The USSR in the cities from 1913 to 1980 is given in table 1.
The tasks of further improvement of primary link of medical aid are set by the XXVI congress of the CPSU.
In the report of the Central Committee of the CPSU to the XXVI congress companion L. I. Brezhnev spoke: «Work of policlinics, clinics, out-patient clinics where 80 percent of all patients are treated shall be significantly improved. Unfortunately, in a number of places they lagged behind opportunities of medicine, there are not enough shots, especially average and junior staff, the equipment became outdated, there are no modern drugs» (Materials of the XXVI congress of the CPSU, M., 1981, page 61).
On taken place in December, 1981. An all-Union meeting of an asset of workers of health care actions for further improvement of work of P., opening in city P. of departments of prevention are planned.
Power and structure of policlinics
P.'s Power is characterized by number of its visits per shift, make an exception stomatol. The item, power to-rykh is defined by the number of dentists. Depending on power establish category P. (tab. 2).
Category P. on the water transport (central basin, basin, port, linear), on. - transport (central, road, otdelenchesky, nodal, linear), central regional, etc. ustanavlrshatsya in relation to city P. depending on the number of the serviced population.
P.'s structure, the organization of offices and departments depend on its power and objectives. The approximate organizational structure city P., city P. of the consulting and diagnostic help, etc. is defined by the order of m 3 The USSR No. 1000 of 23.IX.1981. In all P. the following specialists doctors shall conduct reception: therapist, surgeon, obstetrician-gynecologist, otorhinolaryngologist, ophthalmologist, neuropathologist, cardiologist. In large P., except receptions of the specified main specialists, medical receptions on narrower profiles will be organized: urology, endocrinology, hematology, gastroenterology, pulmonology, a psychoneurology, reflexotherapy, allergology (see. Office allergological ), etc. As a rule, in P. medical and diagnostic and auxiliary offices (departments) will be organized: teenage, inf. diseases (see. Office of infectious diseases ), routine maintenances, radiological (see. X-ray department ), physiotherapeutic (see. Physiotherapeutic office ), physiotherapy exercises, functional diagnosis, electrocardiographic, procedural, endoscopic, etc., and also laboratories — clinicodiagnostic, biochemical, bacteriological, cytologic etc. (see. Laboratory ). Data on development of specialized departments (offices) and laboratories in independent out-patient and polyclinic institutions of the USSR in 1960 — 1980 are provided in tables 3 and 4.
At absence around P.'s service specialized clinics (see. Clinic ), clinic for women (see) and children's policlinic (see) in structure city P. (for adults) the relevant departments are created: tubercular, children's, obstetric and gynecologic, etc. The specified and other specialized departments will be organized in the presence in staff of department not less than 4 medical positions (including a position of the manager of department). Except the specified offices and departments of medical and diagnostic and preventive appointment, in P.'s structure are provided: registry, an administrative part and accounts department (in independent P.).
Planning of development of network P., determination of their power and structure are carried out on the basis of studying of need of the population for the out-patient and polyclinic help taking into account the number of the serviced population, system of resettlement and number of visits to doctors of P. falling on each inhabitant in a year (see. Planning of health care ). As the standard of need of the population for the out-patient and polyclinic help 12,9 visits on one city dweller and 8,2 visits on one villager a year are accepted that makes 250 visits per shift on 10 thousand city dwellers and 160 visits per shift on 10 thousand villagers.
During the calculation of necessary number of specialists doctors also norms of load of doctors on 1 hour of work in out-patient and polyclinic institutions are considered. Settlement norms of service for doctors of out-patient and polyclinic institutions (divisions) are approved by the order of m 3 The USSR No. 1000 of 23.IX.1981.
The most important link of P. is the therapeutic medical site (see. Medical site ), which will be organized at the rate of service by one local therapist of 2000 persons. According to the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) population on the therapeutic medical site shall be finished by 1985 till 1700 persons. As a part of P. shop therapeutic departments will be organized (see. Shop medical site ) for rendering medical aid by the worker of the industrial enterprises and construction organizations placed in the territory of activity of the Item. Expansion of network of shop medical sites is carried out depending on the industry of production at the rate of 1 site on 1500 — 2000 workers.
Development of network of therapeutic medical sites (territorial and shop) in the USSR in 1960 — 1980 is given in table 5.
Development of network of out-patient and polyclinic institutions, expansion and integration of divisions of P., systematic process of specialization of the polyclinic help, and also P.'s equipping by the modern equipment for diagnosis and treatment of patients considerably changed the nature of its activity and increased the volume of work (tab. 6 and 7).
Design of premises of policlinics
the Volume and the nature of activity of P., their task and function define a design of rooms and their set. Standard projects P. provide a possibility of their construction as in the form of separate buildings, and integrated under the same roof with a hospital. At complex construction of P. and a hospital between them the block connecting them is arranged, in Krom medical and diagnostic departments — X-ray department (department), laboratories, physiotherapeutic departments (offices), departments (offices) of functional diagnosis, etc. are placed uniform for P. and-tsy that allows to use more effectively the expensive equipment for inspection and treatment both polyclinic, and inpatients.
Standard projects P. are periodically reconsidered, processed or developed again.
At rather high technical equipment the most economic are P. on 1000 and more visits per shift.
Feature of the standard projects P. developed in 1975 — 1980 is more perfect structure which is fullestly answering to tasks and functions of these institutions at the present stage of development of health care and medicine. New structural divisions of P. are provided in them: department of recovery treatment (medical rehabilitation), dictation and recorder center, department of remote diagnosis, etc. In the drawing the plan of the 8th floor of city policlinic for 1600 visits per shift (the standard project of 1980) is shown.
Main divisions of policlinic
Registry. The main objective of registry is hypodispersion of visits by patients of doctors - spetsia - sheets during the working day and week. For this purpose employees of registry will organize record of patients to the doctor and establish priority. In registry on each patient the medical card of an ambulatory (form No. 025/at) — the main medical and legal document where data on the patient are entered (results of inspection, appointment of doctors, councils concerning the mode) is started. They are stored in registry (or in special storage) within 25 years; take place, as a rule, by the principle of an uchastkovost.
The registry consists of information bureau, department of preliminary record, department of the next record, department of paperwork, department of a domiciliary care and archive for storage of medical cards of ambulatories. Placement of registry depending on category P. requires from 80 to 123 m 2 .
Department of prevention will be organized in city P., 500 and more visits per shift also include, as a rule, an office of pre-medical reception, a sick female inspection room, an office of the organization and control of medical examination of the population and maintaining a card file of the persons staying on the dispensary registry, an anamnestic office for identification of persons with the increased risk of a disease and an office a dignity. educations and gigabyte. education of the population.
The office of pre-medical reception is created for the purpose of release of doctors from performance of functions unusual for them and reduction of time spent by patients for P. V visit it work 1 — 2 paramedic, 1 — 3 nurse. Workers of an office shall have length of service not less than 5 years, work in close interrelation with registry and doctors-spetsialis-tami. The state of an office is formed at the expense of the total number of paramedical staff of the Item. The duty of an office is defined with power P. Tak, in P. servicing up to 30 thousand population it is recommended to organize work of an office in one change, and in P. servicing St. 30 thousand — in two changes.
In an office reception of the patients who are repeatedly visiting P., but not having the coupon to the doctor in day of the address is conducted; besides, in it take temperature and the ABP, accept the visitors who addressed in P. for execution of various medical documentation. Workers of an office process a passport part of the document with a vykopirovka of necessary data from medical cards of an ambulatory, give the directions on laboratornodiagnostichesky inspections, make out requests in other medical institutions, etc. All documents issued to patients shall be signed by the attending physician and if necessary — the manager of department.
When the patient needs medical assistance, the paramedic or the nurse of an office of pre-medical reception are obliged to provide it reception at the doctor. The office of pre-medical reception shall have a desktop, chairs, a couch for patients, medical scales, the height meter, the first-aid kit for rendering acute medical aid, pallets, thermometers, stetofonendoskop, a tonometer for measurement of the ABP, various forms. For the accounting of addresses to an office «The magazine of registration of ambulatories», in Krom, except passport data is used, it has to be noted in what occasion the visitor addressed (in the column «diagnosis») what to it is made and it is recommended (in the column «the appointed treatment»). Besides, the worker of an office of pre-medical reception keeps the diary of work of paramedical staff of P. (out-patient clinic), a clinic, consultation. Placement of an office of pre-medical reception depending on category P. requires from 15 to 21 m 2 .
Specialized offices of doctors. Work of these offices will be organized taking into account the fullest satisfaction of need of the population, especially busy on production. In the presence of two and more doctors - spetsia - sheets of one profile reception of patients on this profile shall be carried out to P. during all operating time of P. to provide in time off reception working both in the first, and in a back shift, and employees — after completion of work.
Work of district doctors
the Important link in P.'s activity is the organization of work of local therapists (see. district doctor ) and organization of medical aid by the patient at home. In P.'s most there are two types of local therapists: the doctor on the territorial site (district doctor) and the doctor on the shop site (the shop doctor). Territorial medical sites are created for service of the population around P.'s activity; shop medical sites will be organized at the industrial enterprises and buildings, on to-rykh there is no medical and sanitary part (see), and workers and employees receive medical aid in corresponding territorial the Item. From 6V2 of hour of operating time of the local therapist 3V2 he uses for reception of patients in P.'s office and 3 hours — for assistance to patients at home, at the rate of expense of time for each patient 30 — 40 min. at home. Record to the doctor is made for visit of patients depending on a duty of P. at home, and their visit by the local therapist, as a rule, till 19 — 21 o'clock. After this time acute medical aid is rendered (at home) by institutions of emergency medical service. Till 1977 in P. for this purpose there were departments on rendering acute medical aid to the population. Then these departments were merged into institutions of emergency medical service (see. Domiciliary care , Ambulance and emergency medical service ).
For service of the population at home special transport is allocated to district doctors (at a zn + chitelny distances). The local therapist shall have a phonendoscope, a tonometer, the portable «Salute» electrocardiograph, «Kid», the first-aid kit. For performance of appointments of the local therapist to it in the help it is allocated nurse (see).
The shop therapist, as a rule, carries out scheduled maintenance directly at the enterprise where for this purpose the room is allocated to it. He carries more often out reception of patients in P. Tsekhova's office the therapist directs work of the paramedic (paramedics) of a health center of the relevant enterprise (see. Health center ).
Lechebno - diagnostic offices (departments) are intended for ensuring diagnosis of diseases with use of laboratory, radiological and functional methods of a research.
X-ray department (see) or department is one of the leading medical and diagnostic offices (departments). Large P. have X-ray apparatus (see) of different function: for radiodiagnosis of diseases of internals and a musculoskeletal system, the main and peripheral vessels, dental researches, mammographies, and also photofluorographs, tomographs, mobile X-ray apparatus, etc. Number of X-ray apparatus define proceeding from settlement norm of 600 — 700 visits of policlinic on one device a day. From Total number of visits of P. 3,8 — 4,2% of visits, from them more than a half for production of x-ray films are the share of X-ray department (department). X-ray department of large P. has from 8 to 11 rooms, with a total area from 220 to 340 m 2 .
Laboratory. In P. all laboratory researches are conducted, in essence, (see Laboratory, Laboratory business). In the large cities a number of difficult laboratory researches, napr, biochemical, immunological, is conducted on a centralized basis for what uniform biochemical, serological, cytologic laboratories for several will be organized P. Eto reduces costs of one research and increases quality of laboratory diagnosis. The total area of laboratory rooms depending on category P. makes from 450 to 700 m 2 . During the calculation of power of laboratories use number of laboratory researches in relation to total number of visits (on average one laboratory research on 10 visits to specialists doctors).
Department (office) of recovery treatment provides complex use of various methods of treatment: physical therapy, mechanotherapy, work therapy to lay down. physical cultures, massage, etc. Recovery treatment is widely appointed by the patient having cardiovascular diseases, dysfunctions of a musculoskeletal system owing to injuries, orthopedic, neurologic and other diseases. As a result of recovery treatment terms of temporary disability of patients are significantly reduced, the number of the patients who came back to work increases, the percent of the faces transferred to disability decreases (see. Rehabilitation ).
At the organization of department it is necessary to be guided by the regulations on department and on an office of recovery treatment of city policlinic approved by the order of m 3 The USSR No. 1000 of September 23, 1981.
Offices of physical methods of treatment are widely presented in the standard projects P. developed in 1978 — 1980. Napr, in the standard project P. on 1600 visits per shift (it is approved in 1980) is available 19 rooms intended for the specified offices with a total area of 568,9 m 2 , including an office of UVCh and microwave therapy — 51,85 2 , an office of electrotreatment — 58,2 m 2 , an office of phototherapy — 88 m 2 , an office of mechanotherapy — 30,98 m 2 , an office of training in walking — 29,74 m 2 , the hall to lay down. physical cultures — 47,35 m 2 , an office of LFK for individual occupations — 30,26 m 2 , massage — 39,36 m 2 , and also offices of labor therapy for recovery of the lost functions and an art, recovery of household skills on self-service, etc.
Medical examination of working capacity
In P. addresses considerable number working, and the specialist doctor along with treatment of patients needs to resolve issues by definition of working capacity (apprx. 40% of patients of total number of visits needs release from work in connection with temporary disability). Besides, a certain number of patients requires the solution of a question of permanent disability (see. Disability ). P. specialists doctors systematically have training on these questions. Their duty includes establishment of temporary disability (see), forecasting of duration of a course of a disease and in this regard the solution of a question of the choice of a type of treatment (it is out-patient or in the conditions of a hospital), delivery leaf of disability (see), its extension and closing. In case of permanent disability medical documents, including the messenger sheet are prepared and processed to VTEK. For the leadership in the specified work in P. having in the state of 15 and more positions of doctors on outpatient appointment of patients the position of the deputy of hl is established. the doctor P. on examination of temporary disability VKK is also created (see. Medical and consulting commission ).
Work on the organization of medical examination
One of the most important parties of work of P. is medical examination (see). Order of m 3 The USSR No. 1129 of November 2, 1979. «About enforcement of the instruction for further improvement of medical examination of patients in out-patient and polyclinic institutions for adults» the contingents, the subject medical examinations (dispensary observation), an order of selection of patients on the dispensary account are defined, documentation is approved, forms and methods of active improvement of patients are established, criteria for evaluation of efficiency of medical examination are defined, norms of load of specialists doctors on medical examination are given. E.g., on the local and shop therapist loading on dispensary service not less than 150 — 170 people (in process of disaggregation of therapeutic medical sites the number being on the dispensary account will gradually increase by one local therapist), on the surgeon, the obstetrician-gynecologist and the neuropathologist — 100 — 120 people, on the ophthalmologist — 160 — 180 people, the otorhinolaryngologist — 120 — 150 people and on the dermatologist — 80 — 120 persons is provided.
It is necessary to plan for 1 patient consisting under dispensary observation on average within a year not less than 3 — 4 active visits, including not less than two visits of the doctor, at to-rogo the patient directly consists under dispensary observation.
All dispanserizuyemy patients shall receive active against about - recurrent out-patient and if necessary hospitalization. For their improvement physiotherapeutic methods of treatment, LFK, dietary food, a dignity are widely used. - hens. treatment and improvement in sanatoria dispensaries (see).
As shows experience, from each 1000 dispanseriziruyemy patients not less than 820 people, in dietary food — 315, in a dignity need antirecurrent treatment. - hens. treatment and improvement in sanatoria dispensaries — 430, in hospitalization — 400, in employment — the 150th persons. The organization and control of medical examination of the population are exercised by department of prevention. Here the centralized card file of the persons staying on the dispensary registry is conducted.
Interrelation of policlinic with hospital
P. specialists Doctors send patients to a hospital according to the emergency indications and in a planned order. For these purposes the centralized system of hospitalization — through tsentropunkt the city which will, as a rule, be organized in system of emergency medical service functions, or decentralized — patients would be hospitalized in certain, to the Crimea P. is attached or with to-rymi it it is integrated (see Hospitalization).
For the purpose of reduction of terms of stay of patients in a hospital due to reduction of time necessary for their inspection, special attention is paid on completeness and quality of inspection of patients in P. at the direction them in a hospital.
P. doctors at the same time shall process accurately and fully medical documents with the appendix of these special researches. In turn, at an extract of the patient from a hospital documentation with recommendations of further treatment and observation in the conditions of P.
Kabinet of sanitary education and hygienic education of the population shall be transferred to it to P. is a part of department of prevention. The most important form of its work is the individual conversation of the doctor with the patient, especially local therapist who actually is a family doctor and is well familiar with life and life of the population of the site. Effective form of promotion dignity. - a gigabyte. knowledge short collective conversations of doctors with the population, and also use in P. of means of mass and evident promotion — posters, instructions, slides, wall newspapers, bulletins, etc. are (see. Sanitary education ). During the scheduling a dignity. - the gleam, works are considered the age characteristic of the population, level and structure of incidence, season and other factors. This work is carried out under the methodical management of city (regional) Houses of sanitary education (see).
The office of the account and medical statistics carries out the statistical account and the reporting, using for this purpose the approved m 3 The USSR registration forms and the approved m 3 The USSR and TsSU USSR forms of account (see. Documentation medical ). Such important indicators as number of visits of the doctor, volume and quality of the performed routine maintenances, volume and efficiency of medical examination, quantity of the given leaves of disability and certificates of temporary disability (are subject to especially strict account), the accounting of the issued recipes on narcotic and some other means, and also for free (or preferential) receiving pharmaceuticals are subject to the account. The number directed to hospitalization and other indicators is considered (see. Reporting medical , Account medical ). All in P. 99 registration and 5 forms of account are applied. The list of forms of the account is enacted by the order of m 3 The USSR No. 1030 of 1980.
P.'s activity is estimated on two groups of indicators. (Quantitative) treat indicators of the first group: number of visits to doctors on one patient a year, frequency rate (frequency) of visits, activity of visits of patients at home, an indicator of an uchastkovost (service of patients of the specific therapeutic site by one doctor); it is necessary to carry to indicators of the second group: efficiency of medical examination (by the established criteria), incidence with temporary disability, inf. incidences, results of recovery treatment of disabled people, etc.
The office of pharmaceutical information will be organized at large P. by a drugstore for the purpose of establishment of daily communication of doctors and druggists. It allows to inform timely doctors on availability of medicines in drugstores, their analogs, it is more rational to use the available resources of medicines.
specialized P.' Work is based on the general principles of the organization of the out-patient and polyclinic help, however the nature of incidence and the serviced groups of the population brings certain specifics in their work.
Dental policlinic it is intended for rendering specialized stomatol. help to the population. This type of the help to the population, besides, appears in stomatol, the offices and departments organized as a part of P.'s most of all types, MSCh, sanatoria and also at schools, average special and higher educational institutions.
Stomatol, help to children before achievement of 15-year age by them is given in children's dental P. or children's departments by P. Odna from the main objectives of all stomatol. institutions carrying out planned scheduled maintenance (sanitation of an oral cavity, especially at children), the organization of complex system of prevention and treatment stomatol, diseases is.
Dental P. works by the local principle. The number P. and volume of their activity, especially in the cities, annually increase (tab. 8) that is caused by further specialization stomatol, the help with therapy, surgery, orthopedics and orthodontics, growth of hardware P., improvement of technology to lay down. - professional, process (an opportunity to apply the general anesthesia for what the doctors-ostomy-tologov are allocated for 10 established posts 1 anesthesiologist; implementation of all-metal casting, production of porcelain crowns, etc.).
Dental P. are divided into five categories (tab. 2).
Are most widespread stomatol. the policlinics of the IV category (on 20 dentists) functioning in towns and the rural regional centers. According to the standard project approved in 1979 they include 5 to lay down. offices (for sanitation and dental care) with a total area of 142,7 m 2 (including on 1 chair — 2 offices; on 2 chairs — 1 office, on 3 chairs — 1 office and on 4 chairs — 1 office); 3 surgical stomatol, office with a total area of 80,2 m 2 (including the room for performing anesthesia); 1 orthopedic office; 1 orthodontic office; 1 office for x-ray films; 1 office of a hydrotherapy; 1 office of physical therapy, etc.
Dental to the Item I of category (on 40 dentists) it is intended for the average and large cities (100 thousand zhit. and more). 15 medical offices for reception and treatment of patients with a total area of 357,3 m are provided in the standard project (1979) of this P. 2 , including 6 offices for sanitation of an oral cavity on 205,4 m 2 ; 4 offices for surgical manipulations — 52,7 m 2 ; 5 offices for prosthetic dentistry — 99,2 m 2 ; 3 offices for anesthesiologists — 32,9 m 2 both other medical and diagnostic and auxiliary offices.
Are included in the package of the equipment of a workplace of the dentist: 1 stomatol, installation, 1 electric microdrill, 1 turbine drill, 1 stomatol, the hydroblock, 1 stomatol, a chair, 1 table of the stomatologist, 1 special chair of the stomatologist, 1 stomatol, the lamp, 1 compressor, etc.
Besides, dental P. are equipped: cryosurgical autonomous stomatol, installations, vacuum devices for treatment of periodontosis, amalgamosme-sitel and another stomatol, the equipment and tools (see. About tomatologichesky tools, About a tomatologichesky chair, Dental installation).
City children's policlinic — the structural division of the nursery-tsy or independent to lay down. - professional, the establishment intended for rendering medical aid to children before achievement of 15-year age as is out-patient, and at home; works by territorial local principle (see. Children's policlinic ).
Resort policlinic it will be organized in large resorts p it is intended for rendering polyclinic medical aid and maintaining the patients who arrived to the resort area not according to resort permits in sanatorium, and according to vouchers. The patients who arrived according to vouchers accommodate on private apartments (on the basis of the agreements signed by territorial resort administration), and all types of treatment (bathtubs, massage, to lay down. physical culture, etc.) and medical observation are carried out in resort P., and sometimes in basic sanatoria. Besides, resort P. provide with advisory medical aid of the patients who are on treatment in sanatoria in the direction of their attending physicians on profiles — urology, ophthalmology, endocrinology, otorhinolaryngology, neurology, a dermatovenereology, surgery, traumatology and orthopedics, etc.
Resort P. will be organized by hl. obr. on balneol. resorts, sometimes on climatic. The first resort P. in the USSR was organized in 1925 in Kislovodsk. In 1980 in the country there were 32 resort P., from them 5 — in Sochi, 4 — on Caucasus Mineralnye Vody region (in Kislovodsk, Pyatigorsk, Zheleznovodsk and Yessentuki). The structure and resort P.' standards are standard, but insignificant amendments depending on volume and the nature of activity of P., and also the tasks set for them are introduced in them.
City policlinic of the consulting and diagnostic help it will be organized as a part of regional (regional, republican)-tsy or clinics medical in-that, scientific research institute in the cities with the population of St. 400 thousand people for rendering advisory medical assistance by the patient directed from others to lay down. - professional, institutions of area (edge, the republic), or the patient who addressed independently (see. Regional hospital). In P. hl are created. obr. специа^-лизированные departments (offices). The ophthalmologic advisory policlinic can be organized with the permission of min.-va health care of the federal republic as a part of regional, regional and republican-tsy.
Self-supporting policlinic it is created in the large cities for rendering specialized advisory medical aid by that patient which wish to receive for a low payment medical aid at the doctor chosen by them. Self-supporting city P. can be attracted for performing routine medical examinations of the persons going to work, and also working at food and utility objects in child care and other facilities which according to the current legislation are subject to obligatory medical examinations (from 2 to 4 and more times a year) using laboratory, hardware and other methods of a research (see. Medical examination). In these cases payment of medical examinations is carried out by the relevant enterprise.
The physiotherapeutic policlinic is intended for implementation of recovery treatment with use of methods of physical therapy, to lay down. physical cultures, work therapies, etc., directed to further decrease in temporary and resistant disability, preservation of a manpower. Such P. are created in the large cities.
The central district clinic would will be organized in the rural administrative district in the absence of the central regional and performs functions of a rayzdravotdel.
The geriatric policlinic is intended for rendering medical aid to persons of advanced and senile age. However the organization of geriatric departments in city Items is more preferable.
Shop policlinic. In a number of the cities where the large industrial enterprises are concentrated, as an experiment the shop P. intended for service working at one enterprise begin to be created. These P., as a rule, accommodate in close proximity to the enterprise. Doctors of the main specialties (therapists, the surgeon, the traumatologist, the otorhinolaryngologist, the ophthalmologist, the neuropathologist, the dermatovenerologist) are presented to shop P., necessary diagnostic will be organized and to lay down. offices. All doctors of this P., and not just shop therapists, study working conditions of workers and actively influence their improvement. Shop P. would be a part city and, therefore, uses all advantage of large multi-profile establishment.
Garrison policlinic — military to lay down. - professional, the establishment intended for rendering medical aid to ambulatories. Garrison P. is independent to lay down. - professional, establishment. In a number of garrison hospitals there are polyclinic departments performing functions of garrison Items. The following duties are assigned to garrison P.: rendering medical aid to the ambulatories consisting on service and also to the persons sent to P. for consultation from parts and institutions of garrison; medical examination of the serviced contingents; rendering medical aid at home; rendering the methodical and practical help to army (ship) doctors in the organization of scheduled and medical and diagnostic maintenance in parts (by the ships).
Have the right for medical providing in garrison P.: military personnel of military units (ships) and institutions of garrison; the military personnel who is in a business trip or issue in this garrison; the generals, admirals and the senior officers retired or reserved according to the situation approved by the resolution of Council of ministers of the USSR of February 17, 1981 No. 193, living in the territory of garrison, and also members of their families.
In garrison P. members of families of the military personnel, and also workers and employees of the Soviet Army and the Navy can also receive medical aid if rendering medical aid in civil to lay down. - professional, institutions it is impossible or complicated. It in each case is defined by the order of the top military commander of the military district (fleet).
One of the leading principles of activity of garrison P. is ensuring succession of out-patient and polyclinic and stationary medical aid. In P. prepare patients for planned hospitalization and carry out timely recovery therapy of patients after their extract from a hospital. The most important section of work of garrison P. is medical examination (see) military personnel.
The following main functional divisions are garrison P.'s part: registry; diagnostic departments (offices) — laboratory, radiological, functional diagnosis; medical departments (offices) — therapeutic, surgical, neurologic, ophthalmologic, otorhinolaryngological, dental, dermatological, physiotherapeutic, physiotherapy exercises; department of a domiciliary care and drugstore. Pediatric and obstetric and gynecologic departments are provided in necessary cases as a part of P. At each garrison P. there are garrison military-medical and sanatorium and selection commissions. In connection with specialization of medical aid in large garrison P. specialized departments and offices regular and emergency more narrowly are created (cardiological, endoscopic, allergological, reflexotherapies, etc.). In army and on the fleet events for further improvement of the out-patient and polyclinic help are constantly held.
The organization of reception of patients, rendering medical aid, account, work of functional divisions of garrison P. are based on the same principles, as in all to lay down. - professional, institutions of the country.
The leadership in activity of policlinic
Independent P. directs hl. doctor (chief P.); it is a manager of the credits and presents P. as establishment in bodies of health care (tso to subordination), and also in other institutions and the organizations. In P. combined with-tsey the general management is performed by hl. the doctor-tsy (the chief of hospital), and managing (chief) has polyclinic department the same rights and has the same duties, as well as another managing (chiefs) structural divisions-tsy (hospital). The manager of the credits in P. combined with-tsey is the hl. doctor-tsy (chief of hospital). The means provided for ensuring activity of P., allocated under the budget counting on one visit and also for free or on the preferential bases of issue of pharmaceuticals an ambulatory, etc.) are strictly fixed. Funds for overhauling, acquisition of the medical equipment and stock, working costs, etc. would be distributed within the general budget.
At P. the public council consisting of representatives of the Soviet, trade-union and public organizations is created and works (see. Public councils ). P.'s guide in the work relies also on activists about-in Red the Cross and Red Crescent, especially in holding preventive actions, medical examination, patient care at home.
The organization of work of ambulatornopoliklinichesky institutions abroad is considered in articles about health care of the certain countries (see. Bulgaria , Great Britain , Hungary , German Democratic Republic etc.), and also in article Treatment and prevention facilities (see) abroad.
Table 1. DEVELOPMENT of AMBULATORNOPOLIKLINICHESKY NETWORK of INSTITUTIONS, the INDEPENDENT AND being a PART HOSPITALS as POLYCLINIC DEPARTMENTS, In the CITIES FROM 1913 for 1980 (USSR M3 systems)
Table 2. POWER AND CATEGORIZATION of POLYCLINIC INSTITUTIONS of the USSR
Table 3. DEVELOPMENT of SPECIALIZED DEPARTMENTS (OFFICES) In INDEPENDENT OUT-PATIENT and POLYCLINIC INSTITUTIONS in 1960 — 1980 (in institutions of the USSR M3 system)
Table 4. DEVELOPMENT of LABORATORIES IN OUT-PATIENT and POLYCLINIC INSTITUTIONS in 1960 — 1980 (USSR M3 system)
Table 5. GROWTH of NETWORK of THERAPEUTIC MEDICAL SITES as a part of POLICLINICS of the USSR for 1960 — 1980
Table 6. DYNAMICS of VISITS of OUT-PATIENT and POLYCLINIC INSTITUTIONS for 1960 — 1980 (USSR M3 systems)
Table 7. The VOLUME AND the NATURE of SCHEDULED AND DIAGNOSTIC MAINTENANCE of OUT-PATIENT and POLYCLINIC INSTITUTIONS of the USSR for 1975 — 1980.
Table 8. DEVELOPMENT of DENTAL INSTITUTIONS To the USSR, VOLUME AND the NATURE of the DENTAL HELP GIVEN by DENTAL INSTITUTIONS in 1950 — 1980.
Bibliography: Goldzilber E. M. Main questions of the organization of polyclinic service of the population, M., 1963; Gomel G. L. and d river. Sketches of development of the polyclinic help in the cities of the USSR, M., 1971; I Will pour P. I. Modern problems of management of health care, M., 1975; Minyaev V. A., Polyakov I. V. and Shestakova N. A. Forms and methods of work of large city policlinic, M., 1980; Sketches of development of the polyclinic help in the cities of the USSR, under the editorship of A. F. Serenko, M., 1971; Seren-k about A. F., Ermakov V. V. and Petrakov B. D. Bases of the organization of the polyclinic help to the population, M., 1976; Frey of lengths of Page. I, City policlinic, L., 1961; 60 years of the Soviet health care, glavn. edition B. V. Petrovsky, M., 1977; Encyclopaedic dictionary of military medicine, t. 4, Art. 723, M., 1948.
A. G. Safonov; Yu. P. Bagayev (soldier.).