Lecture on a theme: «Concept about the general medical practice. Principles of the organisation of the primary medicosanitary help (PMSH)»

The lecturer д.м.н. G.M.MuldaevaDiscipline «The general medical practice»Speciality 051301 «the General medicine»

Course V

The lecture purpose: To generate representation about the organisation of the primary medicosanitary help and a role of the doctor of out-patient-polyclinic service in the organisation PMSH

The lecture plan: The international conference on the primary

medicosanitary help, Alma-Ata, the USSR, on September, 6-12th, 1978,

Characteristics of the general medical practice Structure of development PMSH and

characteristic GP Development PMSH in Republic Kazakhstan

Almaty conference of 1978

Almaty conference has generated «movement in support of the primary medicosanitary help», united medical workers and establishments, the governments and the organisations of a civil society, scientific and mass public organisations which have incurred the obligation to struggle with «Politically, socially and economically unacceptable» * Inequality in level of health of people in all countries.The primary medicosanitary help: the Report on the international conference on the primary medicosanitary help, Alma-Ata, the USSR, on September, 6-12th, 1978, it is spent in common by World Health Organization and Children's fund of the United Nations Organization. Geneva, The worldThe organisationPublic health services, 1978 г. (A series «HealthForAll» № 1).

Almaty conference of 1978

The international conference on the primary medicosanitary help on September, 12th, 1978, specifying in necessity of immediate measures from all governments, all workers in public health services and development sphere and all world community with a view of protection and strengthening of health of all nations of the world, accepts the Declaration

Almaty conference of 1978

Conference the CART, 1978, Alma-Ata,The declaration «Health for all by 2000»: Health and public health services is

one of inalienable laws of the person The primary medicosanitary help is

the mechanism by means of which the granted right can be realised

The Almaty declaration

In the Almaty declaration the purposes to which achievement it is necessary to aspire are accurately designated: Social justice and the right to higher level of health for everything, participation and Solidarity *The primary medicosanitary help: the Report on the international conference on the primary medicosanitary help, Alma-Ata, the USSR, on September, 6-12th, 1978, it is spent in common by World Health Organization and Children's fund of the United Nations Organization. Geneva, The worldThe organisationPublic health services, 1978 г. (A series «HealthForAll» № 1).

The Almaty Declaration

The primary medicosanitary help Is the basic function and centre of system of public health services of any country and is «the first level of contact of the person, a family and a society with national system of the public health services, providing the greatest approach of public health services to the places of residence and works of people.

The Almaty Declaration

ПМСП makes an important part of medicosanitary maintenance and is based on practical scientifically well-founded both socially comprehensible methods and technology which should be everywhere accessible both to separate persons, and families in a community at their all-round participation in this work and at such expenses which the community and the country as a whole presume at each stage of the development in the spirit of independence and self-determination.

The primary medicosanitary help

1. Reflects and develops according to economic conditions both characteristic welfare and political lines of the country and its communities, develops and based on application of corresponding results of social, medical and biologic and organizational scientific researches of medicosanitary services, and also experience of public public health services;

2. It is aimed at the decision of the basic medicosanitary problems in a community and provides accordingly services of improvement, preventive maintenance, treatment and rehabilitation;

The primary medicosanitary help

3. Includes, at least: Education on the most important problems

of public health services and methods of their prevention and the permission,

Assistance to maintenance of a balanced diet, good-quality water supply and to carrying out of the basic sanitary measures;

Health protection of mother and the child, including family planning;

Immunization against the basic infectious diseases;

Preventive maintenance эндемических in the given area of illnesses and struggle against them; corresponding treatment of widespread diseases and traumas;

And maintenance with the basic medical products;

The primary medicosanitary help

4. Covers besides public health services all others adjacent секторы and aspects of development on national and oбщиннoм level and, in particular, agriculture, animal industries maintenance with the foodstuffs, the industry, formation, housing construction, public works and communication facilities; also demands coordination of activity of all these sectors;

The primary medicosanitary help

5.Demands self-sufficiency of a community and separate persons, promotes it, providing their participation in planning, the organisations, realisation and control over the medicosanitary help at the fullest use of local, national and other available resources for this purpose develops by corresponding education skills of participation of the population in this work;

The primary medicosanitary help

6. It should be supported by the integrated, functional and interconnected systems of the advisory help directed on progressive improvement of universal medicosanitary maintenance of all people with paying of prime attention to the most needing groups of the population;

The primary medicosanitary help

7. Leans on local and higher levels against workers of public health services, including, where it is possible, doctors, nurses, midwifes, support personnel and public workers, and also if necessary on the traditional doctors accordingly prepared from the social and professional points of view for work as a part of a brigade of public health services and for satisfaction of medicosanitary needs of the population.

Medicine institute, the USA, 1994

The primary medicosanitary help Is a granting of the complex, accessible medical services rendered by clinical physicians which are responsible for the decision of the majority of individual problems with health, development of steady partnership with patients and realisation of medical practice within the limits of a family and inhabitants of the occupied point/area of residing.

Advantages ПМСП

предотвращает госпитализацию

предотвращает госпитализацию

обеспечивает более высокую

эффективность медицинской помощи при меньших затратах

обеспечивает более высокую

эффективность медицинской помощи при меньших затратах

сокращает необходимость использования

высокотехнологичных методов диагностики

сокращает необходимость использования

высокотехнологичных методов диагностики

сокращает необходимость использования специалистов

сокращает необходимость использования специалистов

Квалифицированная ПМСП

Квалифицированная ПМСП

World Health OrganizationThe European Regional Bureau1998 EUR/HFA Problem 28

STRUCTURE OF PROFESSIONAL AND ADMINISTRATIVE DEVELOPMENT OF THE GENERAL MEDICAL PRACTICE /

FAMILY MEDICINE IN EUROPE In the given document special characteristics of

the general medical practice as are presented a speciality, and also conditions for its development. The information for professionals and the persons responsible for decision-making at all levels of system of public health services is given.

The general medical practice possesses potential for:

Rendering of accessible and satisfactory services for patients;

Fair distribution of resources of public health services;

Integrated and координированного rendering all-round medical,

Rational use of technologies of the secondary help and medical products;

Regenerative, palliative and preventive services and health propagation;

Economic efficiency.

Characteristics of the general medical practice

Ориентация на сообщество

Ориентация на сообщество

Ориентированность

на семью

Ориентированность

на семью

СотрудничествоСотрудничество Координированность

Координированность

ПолнотаПолнота

НепрерывностьНепрерывность

Общий подходОбщий подход

ОВПОВП

1. The general approachThe general medical practice is directed on the decision of all spectrum of problems with health at all population; it does not exclude those or other categories of the population to an age, sexual, social-class, racial or religious sign, as well as any categories of complaints or the problems connected with health. It should be easily accessible delay with a minimum; access to it is not limited by geographical, cultural, administrative or financial barriers.

2. Continuity

The general medical practice is directed mainly on the person, More likely than on disease. It is based on long personal relations between the patient and the doctor, covering medical aid in a longitudinal section during the long periods of life, and is not limited by one concrete episode or disease display.

3. Completeness

The general medical practice provides the integrated help directed on propagation of health, preventive maintenance and treatment of diseases, both rehabilitation and a reducer th the help to patients from the physical, psychological and social points of view.

The general practitioner during reception of the patient can pay attention to various aspects, and the exclusive potential of reception consists in it in общеврачебной to practice which covers:

And. Sharp conditions. Recurrent and chronic conditionsCentury propagation and development of a healthy way of lifeChange of model of behaviour and style of life of the patient

4. Co-ordinationPMCH can solve many of problems with health, ispyty-vaemyh patients at the first contact with ВОП, however if necessary PMSH is obliged to provide a correct and timely direction of the patient to the expert or to other medical worker. In such cases ВОП should inform the patient on existing services and how them is better to use, and also to carry out a role of co-ordinators of the councils received by the patient and the help.

5. Cooperation

PMSH should be ready to work together with other medical and social workers, charging them if necessary care of the patients taking into account area of expertise of other disciplines. They should take active part in work of harmoniously functioning multidisciplinary command and to be ready to take up leadership in a management of a command.

6. Orientation on a family

The general medical practice is directed on the decision of problems with health in a context of family circumstances of patients, their social and cultural environment and circumstances in which they live and work.

7. Orientation to community

Problems of the patient should be considered in his life/her life context local community. The family doctor should be well informed about requirements of the population of the given community for services of public health services and together with other workers and services from other areas, and also with self-help groups to develop positive changes in the decision of these problems.

Individual serviceGeneral practitioners work with the person, suffering any disease, instead of with the disease got by any person. While experts can spend the work with the patient on system or even cellular level, the general practitioner at studying of influence of disease considers the patient completely, taking into account its physical, mental, social and spiritual aspects of the person. Four directions of requirements are considered:Physical requirementsSocial requirementsPsychological requirementsSpiritual needs

Population service As well as at individual service, the

general practitioner knows эпидемиологию districts in which it works, the factors of environment influencing a state of health of the population, and also structure of social service in the given district. Thus, the doctor practises medicine in the микрокосме, and even supports carrying out of the actions which do not have medical character, for example, improvement of living conditions etc.

Independence of service of age, sex, disease and system of bodies

General practitioners learn to treatment and care of children, adults and older persons, them learn to assist everyone who addresses for it. The majority of general practitioners also are engaged in pregnancy conducting, planning of a family and vaccination.

Problems of health of all age groups are in the competence of general practitioners

Pregnancy neonatal and the infantile period of

development Children's age Youthful age The adult person The elderly person

The law of Republic Kazakhstan from June, 4th, 2003 About public health services system(With changes and additionsAbout a condition on 7/7/2006)

Article 3. Main principles and problems of a state policy in the field of public health services

1. Main principles of a state policy in the field of public health services: 1) Reference of health of the population to factors of maintenance of national safety;2) Observance of the rights of citizens in the field of health protection and maintenance with their state guarantees; 3) availability of medical aid to the population irrespective of social and a property status; 4) maintenance of sanitary-and-epidemiologic well-being of the population; 5) state regulation and the state control in the field of health protection of citizens throughout all life; 6) Social justice and equality of citizens in medical aid reception;7) responsiveness of system of public health services on requirement of citizens in the field of health protection; 8) responsibility of state structures for creation of the conditions providing preservation and strengthening of health of citizens. 2. The primary goals of a state policy in the field of public health services: 1) Maintenance of citizens Republic of KZ in the guaranteed volume of free medical aid;

About the Government program of reforming and development of public health services of Republic Kazakhstan for 2005-2010The decree of the President of Republic Kazakhstan from September, 13th, 2004 N 1438

In quality Priorities Are designated: Real carrying over of the centre of gravity on ПМСП,

carrying over of accent with stationary on out-patient treatment;

System transition to the international standards, new technologies, modern techniques of treatment and health services;

Strengthening of health of mother and the child; Creation of system of an independent expert appraisal with

attraction of independent experts; Preparation of managers of systems of public health

services, resource management and branch financing; Preventive maintenance, diagnostics and treatment of

socially significant diseases; Strengthening of material base of the organisations of public

health services.

Government program Developments of public health services of Republic Kazakhstan «Salamatty Қазақстан» on 2011 – 2015

The basic directions: Increase of efficiency of intersectoral and interdepartmental interaction

concerning protection of public health; Strengthening of preventive actions, скрининговых researches,

perfection of diagnostics, treatment and rehabilitation of basic socially significant diseases and traumas;

Perfection of sanitary-and-epidemiologic service; Perfection of the organisation, management and medical aid financing in

Uniform national system of public health services; Perfection of medical, pharmaceutical formation; development and

introduction of innovative technologies in medicine; Increase of availability and quality of medical products

For the population, improvement of equipment of the organisations of public health services by iatrotechnics.

Government program Developments of public health services of Republic Kazakhstan «Salamatty Kazakhstan» on 2011 – 2015

4 Direction: "Salamatty Қазақстан" for 2011-2015:Perfection of the organisation, management and medical aid financing in Uniform national system of health

Problem:Formation of effective system of the public health services basedOn priority development of socially focused model PMSH

Directions for achievement of objects in view on perfection and development PMSH

Working out and introduction of rational forms and methods of rendering PMSH on the basis of the general medical practice2.Development of a mediko-social orientation by introduction of institute of social work 3.Introduction partial Maintenance fund And an additional component to tariff PMSH :- For stimulationPreventive orientation, Increases of motivation of medical workers PMSH- Expansions of a spectrum and quality of rendered services, - Maintenance rational and an effective utilisation of means, 4. Perfection of organizational structure of polyclinic by creation of the centre of family health, service of the socially-psychological help

Standard legal base Socially-focused model PMSH

Order МЗРК from January, 5th, 2011 № 7 «About the Position statement about activity of the organisations of the public health services, rendering it is out-patient - the polyclinic help»,Creation of the Center of family health, Creation of branch of preventive maintenance and the socially-psychological help Delegation of a part of powers from the doctor to staff nursesOrder МЗРК from January, 5th, 2011 № 10 «About modification and additions in the order of Minister of Health РК from April, 7th, 2010 № 7« About the statement of typical states and regular specifications of organisations PMSH»

Introduction of the social worker, the psychologist in organisations PMSP, Finishing of a parity of doctors PMSH and staff nurses to a parity:1:3 for service of the general practice 1:2 for local service

The order of MZ РК № 630 from 30.10. 2009 (the standard of rendering of special social services)

Модель организации первичной медико-санитарной помощи

ВОП3 медсестры ОП

Кабинетыдоврачебного приёма

участковый терапевт2 участковые медсестры

Кабинет функциональной диагностики

Регистратура

Процедурныйкабинет

Кабинет статистики и анализа

Центр семейного здоровья(заведующий, старшая медсестра)

Кабинет забора мокроты ихимизатора

Прививочныйкабинет

Смотровой кабинет(акушерка)

Дневной стационар(зав.отделением, врачи дневного

стационара, медсестры)

Кабинет ультразвуковой диагностики

Физиотерапевтические кабинеты, массаж

Рентген, флюорография

Консультативно-диагностическое отделение(заведующий, старшая медсестра)

Хирург

Отделение профилактики исоциально-психологической

помощи

Социальныйработник

Психолог

Центры укрепления здоровья: школы диабета, АГ, астма, молодой матери

инициативные клубы, волонтерство, общественный совет и т.д.

Молодежный центр здоровья(услуги, дружественные к подросткам)

Кабинет эндоскопии

Информационное бюро

Клинико-биохимическая лаборатория

Окулист

ЛОР

Невропатолог

Гинеколог

Кардиоревматолог

Стоматолог

Эндокринолог

Дерматовенеролог

участковый педиатр2 участковые медсестры

Направление от ПМСП

Кабинетпрофилактики, ЗОЖ

Кабинет здоровогоребенка

The order of MZ РК № 124 from March, 21st, 2006 Position about activity of the medical organisations rendering primary medicosanitary помощь

The general practitioner (GP) is the expert, had training special versatile preparation on rendering

of the primary medicosanitary help, the carrying out independent out-patient mixed reception of

the adult and children's population, irrespective of a floor and the age, rendering the urgent medical

aid, the spending complex of preventive and rehabilitation actions promoting formation of a

healthy way of life, promoting the decision of mediko-social problems.

The literature World Health Organization the European Regional Bureau 1998

EUR/HFA Problem 28 Structure of professional and administrative development of the

general medical practice / family medicine in Europe Conference the CART, 1978, Alma-Ata, the Declaration «Health

for all by 2000» Government program

Developments of public health services of Republic Kazakhstan «Salamatty Қазақстан» on 2011 – 2015

Order МЗРК from January, 5th, 2011 № 7 «About the Position statement about activity of the organisations of the public health services, rendering it is out-patient - the polyclinic help»

Control questions Make definition PMSH What primary goals PMSH List characteristics of the general

medical practice Make definition PMSH What new model of organisation PMSH