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Healthcare of the former USSR No. 938; today, a mechanism has been created for the extensive use of this human right.
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receive medical care from the selected doctor. In this regard, the doctor decides whether to go to his/her patient’s home on call or the patient will be able to come to him/her personally.
Payment for such a service will be carried out from the budget. It is believed that the patient has already paid his/her
“contribution” by regularly paying taxes and fees on his/her income.
In July, an important stage in the transformation of the healthcare system began. The first communal and private medical institutions that signed agreements with the National Health Service will begin to receive funding on the principle of “money follows the patient.” At the same time, a new list of primary health care services starts to operate, which is mandatory for all primary healthcare institutions, regardless of the funding model.
Diagnosis and treatment
Family doctors, therapists and pediatricians will monitor your or your child's health, diagnose and treat the most common illnesses, injuries, and poisonings. If necessary, your doctor will refer you to a secondary or tertiary care specialist or consult with this specialist about your treatment.
Analyses and studies
At the level of primary care, the package of services includes the following analyzes and studies:
Complete blood count with leukogram
Complete analysis of urine
Blood glucose test
Total cholesterol
Measurement of blood pressure
Electrocardiogram
Measurement of weight, height, waist circumference
Quick pregnancy test
Quick troponin test
Quick tests for HIV, viral hepatitis
Other tests and analyses are performed by your doctor’s referral to a specialist care facility.
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Prenatal care and monitoring children under the age of 3 years
A family doctor or therapist may manage uncomplicated pregnancy by the patient’s request. The doctor can register the pregnant woman at up to 12 weeks of gestation. When needed or required by protocol, he/she will refer the pregnant woman to the gynecologist. The primary care doctor will also explain how the pregnant woman and adult members of her family who live with her should act when giving birth. At the right time, the doctor refers the patient to the maternity hospital.
After the birth of the child, the pediatrician or family doctor should carry out routine mandatory examinations, even when the child is healthy: 10 examinations by the doctor and 6 examinations by the nurse in the first year of life, 2 examinations in the second year of life and 1 examinations in the third year of life.
Routine mandatory examinations
The new Primary Care Procedure provides for preventive examinations and analyzes for at-risk populations of seven diseases.
Every year
Diabetes mellitus: age of 45 years and older, all – at risk factors
HIV: age of 14 years and older
Tuberculosis: all – at risk factors Every other year
Breast cancer: age of 50-69 years, after the age of 40 – at risk factors
Once every 1-2 years, depending on risk factors
Hypertension and other cardiovascular diseases – women aged 50 years and older, men aged 40 years and older
Colorectal cancer: women and men over the age of 50 years
Prostate cancer: age of 40 years depending on the degree of risk Doctor will tell you about the risk factors, always ask him or her about it.
Doctor's role in preventing illness will also be important. Your doctor will identify health risks in time. He will advise you on how to gradually get rid of bad habits, where to find extra help, and how
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to switch to a healthy lifestyle.
Prescriptions for medicines
Doctor will prescribe prescriptions for medicines, including those available through the “Affordable Medicines” program.
Calling a doctor and emergency aid
The doctor will determine the need for a visit to the patient's home, depending on the medical indications. The doctor may advise you on the relief of the condition by telephone and, later, during admission to the medical facility, refer you for analyzes and studies, clarify the diagnosis and prescribe the necessary treatment.
Doctor may also call for emergency help if needed.
Emergency care in acute conditions and sudden deterioration of health will be provided at a medical facility.
Paliative assistance and medical certificates
Services of palliative treatment are also within the competence of the primary care doctor – monitoring and evaluation of the condition of a seriously ill patient, prescribing treatment for pain management.
Doctor will also issue the required certificate, disability certificate, referrals for medical and social examination, etc.
Rehabilitation in the family doctor’s practice
Rehabilitation is a socially necessary functional, social and labor restoration of patients and persons with disabilities, which is carried out by comprehensive medical, psychological, pedagogical, professional, legal, state, social and other measures, and can help victims to return to normal life and work, according to their condition.
The main tasks of rehabilitation are: a) functional recovery (complete restoration or compensation in the absence of recovery or incomplete recovery); b) adaptation to daily life and work; c) involvement in the labor process; d) dispensary supervision of the rehabilitated person.
The main purpose of rehabilitation is adaptation to work in the previous workplace or readaptation, that is, work with less neuro- mental and physical activity in a new workplace, but at the same enterprise. In other cases, the purpose of rehabilitation will be to re- qualify and work at the same enterprise, and in the case of
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impossibility, to re-qualify at the rehabilitation center and to find employment in accordance with the new profession and condition.
In pediatrics, the goal of rehabilitation is not only to return a child to the condition before the disease and to the infants’ team, but also to the development of his/her age-appropriate physical and mental abilities.
Principles of rehabilitation. Early beginning of rehabilitation activities. It helps to restore the body functions faster, prevent complications and in case of disability – to deal with it in the first stages of treatment. Continuity of rehabilitation measures. This principle is the basis for effectiveness of rehabilitation, because only the continuity and phased sequence of rehabilitation measures is the key to reducing the time for treatment, reducing disability and the cost of rehabilitation, long-term material support for disabled people.
Under the guidance of a doctor, rehabilitation is carried out by other specialists: sociologist, psychologist, teacher, lawyer, etc.
Individuality of rehabilitation measures. Rehabilitation programs are made individually for each patient or disabled person, taking into account general condition, peculiarities of the disease course, the initial level of physical condition, the patient's personality, age, sex, profession, etc.
Need for rehabilitation in the team. Undergoing rehabilitation together with other patients or persons with disabilities creates the patient's feeling of a team member, morally supports him/her, eliminates the discomfort associated with the consequences of the disease. Good attitude of others surrounds and gives confidence in the forces and promotes faster recovery. The return of a patient or disabled person to active work is the main purpose of rehabilitation.
Its achievement makes a person a financially independent, morally satisfied, mentally stable and active participant of public life.
Rehabilitation is achieved through a complex of medical, psychological, professional, social, pedagogical and legal measures. Therefore, in medical practice, different types of rehabilitation are distinguished. They have branching and specific tasks.
Medical rehabilitation (rehabilitation treatment), which
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combines treatment and rehabilitation activities aimed at restoring health or maintaining it at a certain level. All this is provided by doctors of various specialties and medical workers of the departments of rehabilitation treatment at polyclinics, hospitals, rehabilitation departments (centers), sanatoriums, etc. The measures of medical rehabilitation should be started immediately after the diagnosis and should be carried out in combination with the use of surgical, medical, psychotherapeutic, sanatorium and resort methods. Sometimes medical rehabilitation is carried out throughout the life of the patient, for example, insulin substitution therapy for type 1 diabetes.
Medical rehabilitation is a type of care provided to patients in an outpatient or inpatient setting and includes a system of medical and other measures aimed at restoring impaired or lost functions of the body, to identify and activate compensatory organism in order to create conditions for a person to return to normal life, to prevent complications and relapses. Medical rehabilitation is prescribed for patients: after the end of acute period of the disease in case of limitations of vital functions; with congenital and hereditary pathological conditions, acquired disorders of the musculoskeletal and speech apparatus, impaired vision and hearing; in case of permanent disability.
Medical rehabilitation is provided free of charge by state and municipal health care institutions with which contracts are concluded for medical care of population, by referral from state or municipal health care institutions, where the patient was provided secondary (specialized) or tertiary (highly specialized) aid.
In medical rehabilitation, according to the recommendations of WHO experts, there are two periods: hospital and post-hospital, and each of which has defined stages. The first period includes stage I of rehabilitation – hospital (inpatient), and the post-hospital period – stage II – polyclinic or rehabilitation, sanatorium, and stage III – dispensary.
Stage I of rehabilitation – hospital (inpatient) – begins at the hospital, where, after diagnosis, the doctor prepares a patient's rehabilitation program. It contains therapeutic or surgical methods of treatment and aims to eliminate or reduce the activity of the
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pathological process, prevent complications, develop temporary or permanent compensation, restore the function of organs and systems affected by the disease, gradual physical activation of the patient. At this stage rehabilitation treatment includes therapeutic physical training, therapeutic massage, means of physiotherapy, elements of occupational therapy. The doctor determines the functional state of the patient, reserves of the body and at the end of the stage, he/she adjusts and outlines further program of rehabilitation activities.
Stage II of rehabilitation – polyclinic, or rehabilitation, sanatorium, – begins after the patient’s discharge from the hospital, at the polyclinic, rehabilitation center, sanatorium with improvement and stabilization of the patient's condition, considerable expansion of motor activity. At this stage, physical rehabilitation prevails and all its means are used. The main attention in the program of rehabilitation is given to the gradual increase of physical activity, general training, increase of functional capacity, acclimatization training of the organism, revealing its reserve possibilities; preparing a person for work; self-handling devices and means of transportation for the disabled. At the end of the period, after a thorough examination with mandatory testing of physical condition, doctors come to conclusions about the functionality of the patient and his/her readiness to work.
Accordingly, the person returns to his/her workplace or another workplace with less physical and mental activity. With significant residual functional disorders and anatomical defects, patients are offered retraining, home-based job, and in case of deep, severe and irreversible changes, they further extend the area of self-care and home skills.
Stage III of rehabilitation – dispensary. The primary purpose of this stage is to monitor the rehabilitated person, maintain and improve his/her physical condition and performance during life.
The program provides preventive measures, periodic stay in the sanatorium, physical exercises at the offices of therapeutic physical education, health groups; medical examinations with exercise tests to determine the functionality of the body. A set of measures, closely related to medical rehabilitation, is aimed at preparing the
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patient for the necessary adaptation or retraining with the fullest restoration of his/her professional skills. Most often, psychological rehabilitation is performed by a supervisor, although it is more effective when a psychotherapist or psychologist is involved, taking into account the patient's psychological characteristics, interests and attitudes to his/her illness. Psychological preparation is of particular importance before surgery because it gives the belief that after surgery, the patient will be able to live a full life, continue his/her work and resume social activity.
Professional rehabilitation is the preparation of a patient or disabled person for work. Options for this rehabilitation can be: a) preparation (adaptation) to work at the previous place; b) readaptation – work at a new workplace with changed working conditions, but at the same enterprise; c) work at a new place in accordance with the acquired new qualification, which is close to the previous one, but is characterized by reduced workload; d) in case of impossibility of realization of the previous clauses – complete retraining with the subsequent employment at the same enterprise; e) retraining in a rehab center with a job search for a new specialty. Professional rehabilitation is provided by specialists in vocational training (under the supervision of a doctor) in vocational schools, special centers of vocational rehabilitation (vocational workshops), as well as at industrial enterprises, where, if necessary, special conditions are created. It is also possible to organize work for people with disabilities at home. Large groups of patients have a misconception about the disease, and they think that work can adversely affect its course and harm their health.
Occasionally, health workers also make tactical mistakes due to underestimation of the body's functional reserves. However, literature and practical experience indicate that it is not needed to instill the patient fear of physical labor. The patient should be reassured that the illness and even the surgery do not lead to complete disability and the patient can return to his/her previous job or choose another profession. Practice confirms that work that meets the functionality of the human body is a compensatory factor. Unreasonable inaction is detrimental to health, psychological and socio-economic aspects. There are rarely
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patients who really cannot be helped. Therefore, any attempt to find a job or a hobby for the patient is justified, and health professionals, rehabilitation specialists and relatives of the patient or victim should work together.
4. Pedagogical rehabilitation mainly concerns children and adolescents with birth defects or acquired defects. For their education and upbringing, a network of special kindergartens, schools, secondary and technical schools has been created for children with hearing, visual, speech, physical, and combined defects. It is very important to start rehabilitation activities from an early age and carry them out continuously, sometimes throughout life. The conclusion on the conduct of rehabilitation measures is made by a special commission, which decides whether the child will be able to withstand special load at school, master a certain specialty, whether the combination of training with measures of medical and professional rehabilitation is possible.
5. Social rehabilitation is a set of measures aimed at developing the patient's skills, providing self-care, overcoming the sense of social inadequacy, restoring normal relations in the society. At the same time, the patient or the disabled person's excessive attention to his/her illness is weakened, and he/she gains faith in his/her own strength. For this purpose, there are widely used achievements of scientific and technological progress. Various means of transportation (motorized carriage, cars with manual control), improvement of existing prostheses and development of new ones, special designs of many household appliances (spoons, forks, toilets, clothes, etc.), architectural and building structures (special extended doors, sloping walkways, special elevators, etc.) greatly facilitate the lives of many disabled people and involve them in the work and community activities.