Korzh - doctor of medical sciences, professor, head of the department of general practice - family medicine of the Kharkiv Medical Academy for Postgraduate Education. Babynets - doctor of medical sciences, professor, head of the department of primary health care and general practice - family medicine I.Ya. Public health can contribute to the organization of health services through measures aimed at the entire population to improve the efficiency of the health system.
The levels of delivering medical care
This is a new stage in the development of modern health care based on the latest medical and organizational technologies, taking into account historical experience. Secondary care (health care) is provided by doctors who have the appropriate specialization and can provide more specialized treatment, consultation, diagnosis and prevention than a general practitioner. Tertiary (highly specialized) care is provided by a physician or group of physicians with appropriate training in diseases that are difficult to diagnose and treat, in the treatment of diseases requiring special methods of diagnosis and treatment, and in the purpose of the diagnosis and treatment of rare diseases.
The principles of family health service
The complexity of GM/FM also provides an assessment of the patient's physical, psychological and social perspectives. The scope of the family doctor's work extends from birth (and sometimes from the gestational period) to the patient's death. Family orientation emphasizes the importance of a close environment influencing the patient's health.
General practitioner (family medicine)
The most common forms of providing medical care to the population in Europe outside working hours are represented by the conclusion of special agreements between medical practitioners and the population. The scope of a general practitioner should include activities for socially significant population groups (pensioners, people with disabilities, people with antisocial behaviour). In Ukraine, the scope of requirements, rights, obligations and functions of a general (family medicine) practitioner is determined by the order of the Ministry of Health Care of Ukraine No.
Organizational forms of family medicine (family medicine models)
In the organizational aspect, family group practice involves working in a family medicine cell with a different number of family doctors who. A group of family doctors can also work at a clinic, and if there are more than 5-7 of them, then an independent division of family doctors can be formed. Family group practices can be recommended both in large cities and in small settlements, but this is a cost-effective model for the functioning of family medicine, in which family doctors also provide specialized types of medical care.
Interaction of general practitioners with doctors of particular specialties
In the future, if family doctors live directly on the territory of the assigned place and the relevant regulatory documents are adopted, they will have to provide fast and emergency medical care around the clock. The experience of successful health systems in many countries shows that in those states where there is a developed general medical practice, family doctors ensure the delivery of acute care to the population at a high professional level. The existing as well as the previous healthcare system cannot ensure continuity of work between ambulance stations and district services at territorial polyclinics.
Medical and social work, performed by a social worker, is a true embodiment of social security of the population. The medical and social assistance service is performed by specially trained employees based on the tasks assigned to them. One of the rational forms of organizing social assistance for the population are medical and social assistance offices, set up near territorial polyclinics.
Free choice of primary care doctor
The continued search for acceptable opportunities for cooperation between health and social workers will enable the comprehensive implementation of the program of providing health and social services to the population. The patient's freedom to choose a doctor forms a new character of the relationship between the provider (doctor) and the user of health services (patient) with significant activation of the latter and is a prerequisite for redirecting the health system from the health needs of institutions and services to the needs of the population. In Ukraine, the free choice of a doctor was declared already in 1989 by the order of the Ministry of
Transformation of the public health system
Sometimes medical rehabilitation is carried out throughout the patient's life, for example, insulin replacement therapy for type 1 diabetes. The doctor determines the patient's functional state, body reserves and at the end of the stage adjusts and prescribes the further program of rehabilitation activities. At the end of the period, after a complete examination with mandatory physical condition testing, doctors reach conclusions about the patient's functionality and his/her readiness to work.
Integrated medical care approach
Therefore, any attempt to find a job or hobby for the patient is justified, in which medical professionals, rehabilitators and relatives of the patient or victim should participate. Social rehabilitation is a set of measures aimed at developing the patient's abilities, ensuring self-care, overcoming the feeling of social inadequacy, and re-establishing normal relations in society. At the same time, the patient or disabled person is weakened by excessive attention to his illness and gains faith in his own strength.
Basic medical records at family medicine facilities
Knowledge and skills in the prevention and treatment of CVD and DM are required in accordance with uniform clinical protocols. Summary of medical records for morbidity and causes of death in the medical institution among children up to and including 17 years of age (f. 071 / o). Summary of medical records for morbidity and causes of death in the medical institution among the adult population (f. 071-1 / o).
Adequate communication involves a correct understanding of the patient and appropriate response to his/her behavior. High sensitivity to the patient's negative attitude makes the doctor doubt his/her professional competence. The doctor's relationship with the patient's relatives begins with the first moments of the patient's admission or the first visit to the clinic.
MEDICAL INFORMATION SYSTEMS
Implementation of telemedicine in the public health system The modern development of information technologies makes
In the technical aspect, MIS is a local network of personal computers (workstations) and the server on which the databases are stored and the main software is installed - the core of the system. Specialist-Patient-Specialist – when one doctor consults with his colleague about the treatment of the patient, where the patient can be present and take an active part in the conversation. Telecommunication facilities did not immediately begin to benefit the development and improvement of medicine.
It is difficult to find highly specialized employees who are responsible for the correct functioning of the system and for ensuring the security of all information. The basic concepts and principles of the term 'evidence-based medicine' (EVM) form the dominant ideology of modern medicine. The intensive process of standardization of diagnostics and treatment of diseases, introduction of the results of evidence-based medicine in the practice of doctors and their use in the educational process at medical universities is also underway in Ukraine.
According to the requirements of the Bologna process, the teaching of internal medicine in European countries must be unified and integrated. We believe that the standards of evidence-based medicine should be applied and the individual course of the patient's disease should be considered. 4 diseases are identified and the doctor decides which underlying disease to treat at this stage of the disease.
It should be emphasized that the lack of competence of doctors, scientists and administrations at different levels in the field of evidence-based medicine is the main reason for our lagging behind the medicine of developed countries.
Basic principles and provisions of evidence-based medicine Pharmacotherapy (treatment of patients with medications) has
Evidence-based medicine became known at the turn of the 1980s-1990s through the work of Canadian researchers at McMaster University (Toronto). The novelty of evidence-based medicine is that it has developed criteria for proving the results of clinical research for many methods of diagnosis, prevention and treatment, as well as new methods of managing the health system. One of the tenets of evidence-based medicine is the assertion that a cautious and critical approach to medical decision-making is necessary.
To determine the effectiveness of the study, researchers use a placebo, a pharmacological drug that has no active ingredient. Therefore, clinical guidelines are one of the most important tools to improve the quality of care. The "gold standard" is often used in evidence-based medicine - a well-conducted clinical trial with the right design and sample size organized to evaluate the effectiveness of a drug.
Evidence-based medicine allows for the creation of scientifically justified individual programs of highly effective, safe and cost-effective treatment of the patient and the prevention of polypharmacy (harmful direction of pharmacotherapy). One of the main principles of evidence-based medicine is to achieve maximum effect with a minimum number of medicines. Every student should have a good understanding of the culture of clinical evaluation of scientific publications.
The principle of using scientific medical information of only the highest level of evidence.
Глава 1. МЕСТО СЕМЕЙНОЙ МЕДИЦИНЫ В ОБЩЕЙ СТРУКТУРЕ ЗДРАВООХРАНЕНИЯ И ПРИНЦИПЫ
Исторические вехи первичной медико-санитарной помощи
После Европейской конференции ВОЗ по реформе системы здравоохранения (Любляна, Словения, июнь 1996 г.), на которой «ориентация на первичное здоровье» была объявлена одним из шести основных принципов организации систем здравоохранения, ЕРБ ВОЗ разработало в 1996 г. ) и организовал широкое обсуждение этого документа во всех странах Европы. Реализация политики здравоохранения, направленной на укрепление и дальнейшее развитие ключевых элементов ПМСП, также является одним из ключевых положений Всемирной декларации здравоохранения, принятой мировым сообществом здравоохранения на 51-й сессии Всемирной ассамблеи здравоохранения в мае 1998 г. Упоминание о первом лечебные учреждения в монастырях Киевской Руси датируются XI веком в сборниках правовых положений того времени («Русская правда»).
В 1995 году приказом МЗ Украины была утверждена должность «Врач общей практики (семейный врач)» и открыта интернатура по семейной медицине, позднее соответствующая специальность была добавлена в номенклатуру медицинских специальностей. В январе 2002 года Кабинет Министров Украины утвердил межотраслевую комплексную программу «Здоровье нации» на 2002-2011 годы, одной из основных задач которой является приоритетное развитие первичной медико-санитарной помощи, основанной на принципах семейной медицины. Знаковым событием в развитии семейной медицины стали четыре съезда семейных врачей, которые состоялись во Львове в 2001 г., в Харькове в 2005 г., в 2011 г. Днепропетровск имел честь принимать делегатов и участников III Съезда семейных врачей Украины.
Уровни оказания медицинской помощи
Первичная медико-санитарная помощь является центральной функцией и основным звеном в системе здравоохранения любой страны, а основной службой здравоохранения, построенной по принципу «от периферии к центру», является ПМСП, существующая как неотъемлемая часть системы здравоохранения. социально-экономическое развитие любой страны.
Принципы семейного обслуживания населения
Врач общей практики (семейной медицины)
Организационные формы работы семейной медицины (модели семейной медицины)
В ряде стран (Турция, Израиль, Финляндия, страны Скандинавии) ВОП работают в медицинских центрах, обслуживающих не менее 10 000 человек, в каждом центре имеется не менее 3 ВОП и в среднем 11 вспомогательного персонала. В ряде стран (Турция, Израиль, Финляндия, страны Скандинавии) ВОП работают в медицинских центрах, обслуживающих не менее 10 000 человек, в каждом центре имеется не менее 3 ВОП и в среднем 11 вспомогательного персонала.
Взаимодействие врачей общей практики с врачами
Взаимодействие врача общей практики (семейного врача) и службы социальной защиты
Свободный выбор врача первичного звена
Трансформация системы здравоохранения
Диагностика и лечение
Анализы и исследования
Наблюдение беременности и дети до 3-х лет
Обязательные профилактические осмотры
Рецепты на медикаменты
Визиты на дом и неотложная помощь
Паллиативная помощь и медицинские справки
Проблемы внедрения реформы
- Интегрированный подход к медицинской помощи
- Основная учетная медицинская документация в учреждениях семейной медицины
Глава 2. ОСОБЕННОСТИ ОБЩЕНИЯ СЕМЕЙНОГО ВРАЧА С ПАЦИЕНТОМ И ЕГО СЕМЬЕЙ
Следует помнить, что существует такое понятие, как «врачебная тайна», которая распространяется на многие заболевания и на разглашение сведений, в отношении которых существуют ограничения. В романе «Замок Броуди» Мэри Броуди рассказывает о профессии врача: «Врачи знают все, им можно доверять, они добры: лечат, дают советы, успокаивают, хранят вверенную им тайну». 34; медицинский психолог первым воспринимает недостатки и пороки века, как он первый сталкивается с жертвами этого века» (К. Юнг).
Недаром в XVII веке голландский врач Ван Тюльпанс предложил в качестве эмблемы медицины зажженную свечу с девизом: «Другим светю, себя сжигаю».
МЕДИЦИНСКИЕ ИНФОРМАЦИОННЫЕ СИСТЕМЫ
Внедрение телемедицины в систему здравоохранения
В США первые телемедицинские программы были разработаны почти 40 лет назад, и за последние 10-15 лет технология прошла большой путь.
ОСНОВЫ МЕДИЦИНСКОЙ СТАТИСТИКИ 4.1. Доказательная медицина и статистика
Основные принципы и положения доказательной медицины
Kreston GCG [Електронний ресурс] – Спосіб доступу: https://kreston-gcg.com/en/family-medicine-ukraine-not/. Проект Закону України "Про первинну медичну допомогу на засадах сімейної медицини: експертне роз'яснення".
Проект наказу МОЗ України «Про затвердження Порядку перевірки правильності оформлення листків непрацездатності» від 05.10.12 [Електронний ресурс].
