From Big Medical Encyclopedia

RURAL MEDICAL SITE — the complex of treatment and prevention facilities representing first, the link, closest to the population, in system of medical support of villagers in the USSR.

Page of century at. includes integrated with out-patient clinic local (intercollective-farm, interstate-farm, interlearning-stkovuyu)-tsu or out-patient clinic (see), network medical and obstetrical centers (see), collective-farm maternity homes (see. Obstetric aid ), a day nursery (see. Day nursery, day nursery gardens ), medical assistant's health centers of the industrial enterprises and crafts located in the territory of the site (see. Health center ), and also dispensaries at milk and commodity farms and livestock complexes. All medical institutions which are S.'s part of century at., are organizationally integrated and work by a unified plan under the leadership of the chief physician S. of century at. — district chief doctor-tsy or manager of rural medical out-patient clinic. The average number of the inhabitants serviced by S. century at., fluctuates usually ranging from 5 to 7 thousand people at the radius of the site (the distance of the most remote cynthion from the punktovy village, in Krom would be local or out-patient clinic) 8 — 15 km. Wide network of the medical and obstetrical centers which are S.'s part of century at., considerably brings closer pre-medical medical aid to residents of the village.

Page of century at. is to original, our inherent country a form of medical providing country people, edges arose still in the late sixties 19 century. On the first, so-called traveling, a stage territorial medicine (see) district police officers of BC and out-patient clinics was not. The part of the territory of the county was assigned to the district doctor, on a cut it had to drive about and render medical aid to needing systematically. From 80th 19 century the second begins — a stationary stage of development of territorial medicine. The offers developed by the special commission led by one of founders of territorial medicine E. A. Osipov, approved in 1875 were the basis it. Moscow territorial meeting. However the territorial medicine was not able to provide medical aid all needing it. St. 70% of residents of the village were actually out of a zone of medical service. Also the network of infirmaries was extremely insufficient. Situation with the stationary help was even worse — one hospital bed fell on 2 thousand inhabitants. In large part Transcaucasia and Siberia, according to the official report of medical department, doctors in the village was not in general.

Soviet health care (see) fully carried out the idea of the local principle of the organization of medical aid to the population. For years of the Soviet power the network of local medical institutions in the village considerably grew. If in 1913 there were 4367 rural medical sites, then in their 1979 there were 13 730; the number of medical assistant's and obstetric points in 1913 made 4539, and medical and obstetrical centers in 1979 — 89 224.

The local principle (see. Medical site ) provides availability of main types primary medical - a dignity. help (therapeutic, pediatric, obstetric and gynecologic and dental) to country people. According to decisions XXIV, XXV, XXVI of congresses of the CPSU and medico-social aspects Food programme (see), the CPSU accepted by a May (1982) Plenum of the Central Committee, improvement of the organization of medical aid to country people, first of all works of primary link of health care — S. continues century at., to-ry provides the main, most mass types of medical assistance (therapeutic, pediatric, dental) and the pre-medical help. It possesses also important role in the organization and carrying out routine maintenances, dispensary observation (see Medical examination), in early detection of the diseased needing specialized types of medical aid and in ensuring this help by the direction of specialists on the site or patients in corresponding to lay down. institutions. Much attention is paid also to improvement of regional and regional links of medical aid to country people that allows to solve a problem of considerable approach of specialized medical care (see) to toilers of the village. Creation of departments of the emergency and planned and advisory help in structure regional (regional, republican) BC, and also departments of a fast and urgent tsomoshcha at central regional-tsakh and their branches at a number of district police officers of BC made possible rendering emergency medical service (see) country people of the most remote districts. Highly skilled medical aid to country people is rendered by medical institutions of the cities and the specialized centers of regional and republican value (the clinics, clinics special in-you). Advisory ‘and organi-zatsionno-methodical help is given by them to S. century at. systematically according to in advance approved schedule and on the emergency calls of doctors of rural districts.

In resolutions of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) and «About additional measures for improvement of public health care» (1982) the emphasis on every possible strengthening of a local link, including on expansion of network of rural medical out-patient clinics is placed. In all federal republics programs of creation of wide network of rural medical out-patient clinics are developed and approved, to-rykh expansion a wedge, laboratories, diagnostic and physiotherapeutic offices, pharmaceutical points is provided in structure. In each out-patient clinic reception on three specialties — pediatrics, therapy and stomatology is planned.

The steady increase in number of out-patient sites which is the main tendency in X and XI five-years periods brings closer the most mass type of medical assistance to country people that is in full accordance with the growing needs of country people. At the same time district police officers-tsy on 10, 15, 25 beds which played a positive role in the past in a crust, time cannot provide in full need of country people for specialized medical aid. Therefore there is a tendency to their enlargement for fit with a number of the serviced population, existence in the fixed territory of the industrial enterprises and state farms, remoteness from central regional-tsy or their reorganization in medical out-patient clinics or departments of the central regional hospitals. The number of medical personnel of hospitals of local BCs is defined from calculation: one medical position on 25 beds in therapeutic, infectious (for adults) and surgical (for adults and children) departments and on 20 beds — in pediatric, infectious (for children) and obstetric departments; in out-patient clinics one position of the therapist is established on 2500 people of adult population, the pediatrician — on 1250 children, the dentist — on 4000 people of adult population and children.

The pre-medical help is provided on S. by century at. medical and obstetrical centers, the greatest objekhm works to-rykh is the share of prevention.

Fundamental obligations of the district doctor consist in carrying out treatment-and-prophylactic and sanitary and recreational work on the site assigned to it. For the purpose of approach of a medical ambulatory care to all population of the site outpatient appointment is carried out not only in medical out-patient clinic, but also on medical and obstetrical centers, in to-rye doctors systematically leave according to a certain schedule. There is also a schedule of consultations of regional specialists in out-patient clinics approved by the chief physician of the area. Domiciliary care (see) all doctors of the site and paramedical staff render. Urgent and emergency medical service (see) is provided round the clock with department of fast and acute medical aid of the central regional hospital (see), and also department of the emergency and planned and advisory help of regional hospital (see). Within the site also stationary help is given, volume a cut is defined * by the power and a profile of a hospital.

Further development of medical aid to country people consists mainly in every possible strengthening, approach and improvement of the organization of an ambulatory care. The out-patient clinic reveals premorbidal conditions and early forms of diseases, carry out dispensary observation for' the allocated contingents healthy and sick, carry out expertize of working capacity, pay special attention to prevention of diseases, complications and a recurrence, carry out rehabilitation of the broken functions of an organism and recover working ability of patients and disabled people, conduct a dignity. educational and anti-epidemic activity. Outpatient appointment is conducted by doctors; to the medics having the finished secondary medical education, independent reception of patients in medical out-patient clinics is allowed only in exceptional cases when the doctor is sick or is in a business trip. All appeals to out-patient clinic fix in the medical card of an ambulatory. It is entered individual posemeyny the account, according to the Crimea the individual map completed on each patient is stored together with cards of all family members in one cover that gives the chance to generalize data on incidence not only the population of all site and certain settlements, but also each family, tracing communication between individual and family pathology.

Obstetric and gynecologic medical assistance is given by obstetricians-gynecologists of large local BCs, regional and central regional BCs. Dispensary observation for pregnant women, women in childbirth and ginekol. patients midwifes of out-patient clinics or local BCs, medical and obstetrical centers and collective-farm maternity homes, and also patronage sisters conduct. Obstetricians-gynecologists of the central regional BCs provide them the advisory and organizational and methodical help. Women with patholologically the proceeding pregnancy, the adverse obstetric anamnesis, pregnant women with diseases of internals and other complications would be sent for obstetric aid to the central regional.

Lech. - the prof. the help to children are rendered by pediatricians of rural medical out-patient clinics and average medics of medical and obstetrical centers. Paramedic (see) and midwife (see) carry out patronage (see) children of early age, paying special attention to the babies and children carried to risk group. Stationary help to persons in need is given in children's departments of local and central regional BCs. Average medics under the direction of and control of district doctors exercise constant medical control behind a day nursery gardens. For field works, in addition to constant preschool institutions, develop the seasonal day nursery gardens which is financed collective farms. Boards of collective farms provide the respective rooms, the equipment, soft and rigid stock, food stuffs, and also allocate the necessary personnel which had special training on the courses organized at regional or local-tsakh.

Providing country people with medicines carries out network of rural drugstores and pharmaceutical points (see. Drugstore ).

Along with to lay down. - irof. the help district doctors and average medics systematically conduct versatile sanitary and preventive and anti-epidemic activity according to the approved comprehensive plan for a certain period and the current tasks, to-rye are defined by a sanitary condition of the site. Plans tasks separately for each collective farm, state farm, the industrial enterprise are approved by their heads. Along with measures of the general sanitary improvement (see. Improvement of the inhabited places ) plans provide prevention of operational injuries (see) and occupational diseases and poisonings (see), immunization of the population against inf. diseases (see Immunization), fight against smoking and alcoholism (see), every possible development of physical culture and sport and other components of a healthy lifestyle. The variety of forms and methods of sanitary education is widely used (see).

Page of century at. works according to the plan, approved as the chief physician of the district. According to the annual plan of work quarter and monthly tasks are formed. The annual report of local (out-patient clinic) would be submitted to the chief physician of the district together with reports of medical and obstetrical centers. Chief physicians of S. of century at. directly submit to the chief physician of the area. Regional specialists carry out necessary measures for professional development of district doctors and average medics. Specialists of regional BCs carry out these functions on the scale of area.

The main quantitative indices of activity of S. of century at. — number of appeals to out-patient clinics and visits at home, number of the persons who had the prof. examinations and captured by dispensary observation, the average number of visits on one inhabitant and the doctor. Activity of a hospital is defined by usual indicators of use of bed fund (see. Hospital ).

The main quality indicator of activity of S. of century at. level of health of the serviced population is, for assessment to-rogo use, in turn, the following indicators: level of physical development of newborns and children, incidence of the population, including inf. diseases, incidence with temporary disability, disability, povozrastny mortality rates, average duration of the forthcoming life for newborns. At the same time levels of perinatal and child mortality have special value (see. Child mortality , Perinatal mortality ).

See also Health care , Prevention , Prevention primary .

Bibliography: Agayev E. R. and Boldyreva In - Century. Rural medical site, M., 1975; Gavrilov N. I. and Fofanov V. P. Organization of medical care to country people, M., 1982; Shidovich I. A., the Brow in and the p B. X. also Swept A. M. Ways of upgrading of the out-patient and polyclinic help to country people, Owls. zdravookhr., No. 6, page 42, 1983; Lekarev L. G. Rural medical site, M., 1964, bibliogr.; M and - fishing N. I. and Churakov V. I. Development of network of healthcare institutions in rural areas, Owls. zdravookhr., No. 10, page 6, 1983; Romanenko A. E. New boundaries of rural health care, in the same place, No. 12, page 13, 1982; Semashko N. A. Chosen works, page 228, M., 1967; Nightingales 3. P. Chosen works, M., 197 0; T r at - and l and N of H. T. Agrarian policy of party and problem of rural health care, Owls. zdravookhr., No. 9, page 3, 1982; T I - e N about in S. U. Features of the organization of the out-patient and polyclinic help to country people, in the same place, No. 8, page 32, 1983; Frenkel 3. G. Sketches of territorial medical and sanitary business, SPb., 1913; 60 years of the Soviet health care, glavn. edition, B. V. Petrovsky, page 159, M., 1977 *

L. G. Lekarev.