Functional duties of a nurse in a polyclinic

Functional, laboratory, X-ray methods of research are provided in the medical-diagnostic department. The leading diagnostic and treatment rooms include an X-ray room.

X-ray equipment allows you to diagnose diseases of various organs and systems( respiratory, musculoskeletal, vascular, nervous, etc.).It has been established that no more than 700 visits per day per device. So calculate the number of X-ray machines. Visits to the radiology department for the production of images account for 5% of the total number of visits to the clinic. The large polyclinic has an X-ray department consisting of 10 rooms with a total area of ​​350 m2.

All basic laboratory and diagnostic tests are conducted in the clinic. Currently, complex laboratory studies, such as immunological, microbiological analysis, are conducted in a single clinic for several polyclinics, cytology laboratories. This allows to increase the effectiveness and quality of diagnosis of diseases. With this organization of diagnostic assistance, the financial expenses for one study are significantly reduced. For the placement of laboratory facilities it is necessary to have from 400 to 600 m2.The power of the laboratory includes the ratio of the number of studies to the number of general visits. It is calculated that this ratio is on average 1:10.

The structure of the department of rehabilitation treatment includes the use of various methods of therapeutic effect: physical, mechanical, labor. This department helps patients with pathology of the cardiovascular, musculoskeletal and nervous systems. The result of the activities of the staff of the Department of Rehabilitation is a reduction in the length of stay of patients in the hospital regime, an early return to work, and a reduction in the number of disabled people.

The activity of the cabinets of physical methods of treatment occupies one of the leading places in the provision of medical care to the population. The structure of the physiotherapeutic service of the polyclinic is made up of: electrotherapy( 60 m2), mechanotherapy( 35 m2), light therapy( 80 m2), microwave therapy( 50 m2);gymnastics room( 45 m2), massage room( 40 m2).There is also a room for labor therapy, in which patients restore lost functions and professional skills.

Employees of the polyclinic carry out a medical examination of work capacity. This issue is handled by a specially trained physician, whose duties, in addition to treating patients, include determining the ability to work. He establishes temporary incapacity for work, predicts the duration of the illness and solves the issue of treatment and rehabilitation( in outpatient or inpatient settings).He also deals with the issue of extradition, renewal and closure of the disability sheet. Currently, about 30% of patients attending polyclinics need a temporary exemption from work. If the patient has sustained a permanent disability, prepare and execute his medical documents for VTEK.In the clinic there is a responsible person who is in charge of this procedure( deputy head physician of the polyclinic for medical examination of work capacity), and a medical and consulting commission on these issues is organized.

The most important function of a polyclinic is to conduct a medical examination, which includes the selection of patients for registration, approval of the relevant documentation, the definition of forms and methods for improving the health of the population, establishing a workload for medical specialists for medical examination. So, for a district therapist, it is 200 people;for the ophthalmologist - 210;for the neurologist - 150;for a dermatologist - 150. Patients who are on dispensary registration must visit the polyclinic at least five times a year. In such patients, outpatient and inpatient services should provide treatment that prevents the occurrence of relapses of the disease. To this end, the use of physiotherapy, exercise therapy, dietary nutrition and sanatorium treatment are invaluable. The department of prophylaxis is headed by the department of prophylaxis, in which the persons undergoing dispensary supervision are registered.

Polyclinics closely interact with hospitals, sending patients there in an emergency or planned order. Patients enter hospitals through a centralized and decentralized system. The first is organized by the "Emergency Medical Care" system, with the second the patients are hospitalized in the hospitals to which the polyclinic is attached. Particular attention is paid to the completeness and quality of examination of patients in the clinic, which will shorten the period of their stay in the hospital. When sending a patient to a hospital, doctors of a polyclinic are obliged to correctly and reliably fill out medical documentation and an appendix with a full list of examinations and their results, whereas a hospital after discharge of the patient must provide the clinic with information on further treatment or rehabilitation measures. One of the main offices that carry out preventive measures is the cabinet of sanitary education and hygienic education of the population, which is part of the prevention department.

One of the forms of activity of this office includes the conversation of the district doctor with the patient about various methods of disease prevention, hygiene issues, etc. Short-term meetings of doctors and patients are held in the clinic where this range of problems is discussed. Great importance in health education is attached to the creation of posters, bulletins, wall newspapers. Sanitary and educational work should be planned taking into account the time of year, the level and structure of diseases, the age characteristics of the population, etc. This work is carried out under the guidance of the city SES.An important activity of the clinic is the work with medical documentation, carried out in the cabinet of accounting and medical statistics.

Employees of this office produce statistical records in accordance with approved forms. Statistical indicators are subject to such indicators as the number of physician visits by patients, the number of issued leaflets and certificates of incapacity for work, preventive examinations. Recipes for narcotic and potent drugs and for preferential dispensing of medicines are especially strictly taken into account. Medical reporting also assumes an indication of the number of patients hospitalized in hospitals.

The evaluation of the polyclinic is carried out according to the indices of the two groups. The first includes a district indicator( the number of patients served by one district therapist), attendance of doctors by one patient per year, repeat visits. The second group of indicators include the quality of medical examinations( according to certain parameters), the number of sick people who are in the hospital regime, and the level of infectious morbidity. Specialized polyclinics differ from polyclinics of general practice by specialization in priority diseases and served by population groups. In small towns on the basis of city polyclinics, the department of the dispensary and the children's department are opening.

The structure of a polyclinic may also include an emergency department if this service is not available in the city. Of great importance are the diagnostic cabinets: endoscopic, X-ray, laboratory, functional diagnostic room. The structural subdivisions of such a polyclinic are also the registry, the administrative and economic part, the office for processing medical documents and medical statistics.

In the area of ​​its functioning, the polyclinic must perform certain tasks: organize and carry out complex measures for the prevention and reduction of diseases;provide qualified assistance to the population. One of the main activities organized by the polyclinic is a medical examination, which includes examination of persons with oncological, cardiological pathology. The medical examination also covers workers of industrial enterprises, students of schools and other educational institutions. Workers of the polyclinic, as well as other medical and preventive institutions, should promote a healthy lifestyle and lead it themselves.

Based on the above tasks, polyclinic institutions provide first aid in emergency cases( poisoning, injuries, etc.).A special feature of policlinic activity is the provision of medical assistance on calls to the house, for which doctors are given additional hours. As a rule, patients who are visited by specialists of the polyclinic are on bed rest and do not have the opportunity to come to the doctor. Specialists of polyclinic services should accurately diagnose and timely detect diseases in the early stages. The list of functions of the polyclinic also includes the provision of qualified medical care. If it is necessary to have inpatient treatment, the polyclinic is obliged to conduct a thorough medical examination of the patient and to submit in writing the opinion of specialists to the hospital where the patient is going to. Polyclinic services should provide rehabilitation and systematic observation of patients discharged from hospitals. The duties of the polyclinic also include continuous monitoring and assessment of the health status of schoolchildren, students and the conditions of their work and life. Close interaction with SES allows to carry out measures to prevent and reduce infectious diseases. Polyclinic services should provide a full survey of temporarily or permanently disabled patients. Then a sick leave is issued( and if necessary prolonged) a sheet of incapacity for work. Specialists of polyclinics should inform the patient with persistent disability, how to rationally choose the place of work. Qualification of employees of polyclinics( average medical workers and doctors) should be confirmed or increased every five years, which is achieved by certain activities that the polyclinic is obligated to perform.

As a rule, when a person falls ill, he first of all turns to the district therapist.

The working time of each of the doctors is strictly rationed, which reflects the schedule of their employment. A special feature of the specialists of the polyclinic is help at home. District nurses, in order to improve the organization of home care, are combined into teams and accompany the doctor on a call to the patient. In the majority of polyclinics, an emergency medical service is organized to leave for the sick at night. Currently, one of the effective forms of treatment is a day hospital, which allows the patient to receive qualified care without hospitalization. The mode of work, the number of employees, the availability of medical equipment in different day hospitals is not the same and is established by the head of the polyclinic. The contingent of patients who are prescribed this form of treatment are patients with chronic cardiovascular diseases, the pathology of the respiratory system. The course of restorative treatment in a day hospital is prescribed after a myocardial infarction or stroke. Another form of medical care involves the treatment of patients who refuse to be hospitalized - this is the organization of in-patient hospitals. A doctor should visit the patient at least eight times a month. In , the duties of the district nurse include fulfilling the doctor's appointments, which is why she is obliged to visit the patient more often.

The number of specialists in different polyclinics is not the same and is determined by many parameters: the number of the served population, industrial and transport enterprises in the area of ​​functioning of the polyclinic. The head physician of the polyclinic develops and approves the staff list, coordinating all actions with the management of the territorial medical association. The work of the polyclinic is carried out according to the territorial-territorial principle, therefore a certain number of residents are calculated for each specialist of the polyclinic institution. For example, 1,700 people are attached to one district doctor, 800 children to a district pediatrician. The number of narrow specialists( surgeons, oculists, etc.) in polyclinics is regulated by the need of the population for their care( approximately one doctor for 20 thousand people).The staff of average medical workers will depend on the number of procedural, bandaging, the availability of additional specialized departments and the number of doctors. It is established that one position of the district therapist has 1.5 nurse positions, with one other specialist a nurse must work. Today in most polyclinics there is a brigade method of work. Employees of teams in accordance with the amount of work in advance agree the necessary number of employees and distribute duties among themselves. The salary of each brigade specialist depends on the activity shown and initiative in the work.

The management of the territorial medical association( TMO) finances independent polyclinics. Financing of polyclinics, which are a structural unit of the hospital, is carried out from the budget of the joint institution.

There is additional funding for polyclinics, which is accrued from the funds coming from the implementation of additional services to employees of various organizations. The salary of employees of a polyclinic is calculated from the sources listed above. In many clinics, whose work is built on a budgetary basis, paid medical services are provided. Systematic management of primary medical documentation is necessary to monitor and evaluate the work of the polyclinic and its individual structures.

There are a number of indicators that characterize the activity of polyclinic services. These are the so-called medico-social indicators that reflect the health status of the population: disability, general morbidity, etc. An analysis is made of the frequency and causes of deaths. Complaints of patients on work of a polyclinic are also taken into account. Much attention is paid to the organization and timeliness of the

inoculations from tuberculosis, tetanus, whooping cough, hepatitis, poliomyelitis, etc., in evaluating the functioning of children's polyclinic institutions. In recent times, cases of perinatal mortality have increased, so the task of checking the work of a polyclinic includes a thorough examination of the causes of deaths;determination of the quality of examination, treatment and dispensary observation.

Polyclinic institutions cooperate with specialized medical institutions, emergency stations. A district therapist( pediatrician) is a specialist who must have all the necessary information about a patient. He should be given the conclusions of specialists of a narrow profile( oculist, surgeon, etc.).There is a local health authority, one of whose functions is to establish concrete forms of cooperation between the polyclinic and other medical institutions. In connection with the risk of complications development, the stations of the "First Aid" should have lists of patients observed in the polyclinic with incurable or chronic diseases. Information on the reasons for the call, the events carried out and their results should be received daily from the ambulance to the polyclinics.

The state of the environment and public health are closely related. Therefore, one of the main tasks of the polyclinic is the prevention of infectious diseases, which is carried out jointly with SES.One of the main units that provides communication between the doctor and the pharmacy worker is the pharmaceutical information cabinet. Experts of this office have all the necessary information about medicines and medical products, they know what the need of the population is for them.

Currently, intensive work is under way to speed up the development of the polyclinic network and improve their equipment with medical equipment. It is also planned to open preventive and rehabilitation departments in polyclinics. Much attention is paid to close cooperation of polyclinics with other medical institutions - hospitals and dispensaries. The result of the work of polyclinic services is largely determined by properly organized stages of medical care.

Today, work is underway to create polyclinics at several levels. The first include polyclinics, the main work of which includes the provision of primary care and the provision of preventive measures. Polyclinics of the second level provide outpatient medical care. The third level includes polyclinics, whose services include examination and treatment of patients on a narrow profile.

There are a number of documents for registration of treatment, diagnosis of a patient in a polyclinic. Each of them has its own format, type( form or magazine) and shelf life. The Ministry of Health of Russia approved the sample of each document and the rules for its execution. Currently, all documentation is unified, which significantly improves the data analysis and allows processing them with a computer. The clinic's medical documentation is necessary for carrying out various functions, such as providing qualified medical care, improving the health status of the population. Also, the registration of documents will allow analyzing the quality of functioning of polyclinic institutions and will inform various health structures about this.

All documentation is divided into groups. The first includes the "Medical Outpatient Card"( Form No. 25 / у-87) and the "History of Child Development"( form No. 112 / y);in female consultations - "Individual card of the pregnant woman and the mother"( form No. 111 / y), in pre-school and school institutions - "Medical card of the child"( form No. 026 / y).The above documents provide for the recording of the results of observations of the patient's condition at the stage of his treatment in a polyclinic. The next group of documents provides a link between the links of medical care, including important information about the patient. It includes "Extract from the medical card of an outpatient patient"( form No. 027 / y);"Emergency notification of infectious disease, food, acute occupational poisoning, unusual response to vaccination"( Form No. 058 / y), etc. The third group of documents include "Diary of the doctor of a polyclinic( outpatient clinic), dispensary, consultation"( form number 039/ y);"Journal of Procedural Accounting"( form No. 029 / y).They keep a record of the work that employees do, with a daily recording of hours worked. There is also documentation used at the ambulance stations, in forensic institutions, laboratories that are part of medical institutions, in sanitation facilities.

Recently, new accounting documents have appeared. One of them is the "Card for the account of medical examination"( form No. 131 / у-86).This document allows you to take into account the population and simultaneously keep a record of diagnostic and treatment activities.

Each of the health workers of the clinic must reliably, competently, fully and timely record in medical records. The content of medical records is not disclosed, refers to the notion of "medical secrecy" and is available to persons who are professionally associated with it.

The dental clinic provides specialized assistance to the population. It exists as an independent institution, and can enter the structure of a polyclinic, a sanatorium, and schools. Children under 15 years of age are assisted in children's dental institutions. Planned preventive work, including the sanitation of the oral cavity, is the main task of the dental service. At the heart of the work of the dental polyclinic is the district principle. At present, the number of dental clinics and the scope of their activities have increased significantly. There is a further specialization of dental care, new methods of treatment and prosthetics are being created.

There are 4 categories of dental polyclinics.

The first category includes polyclinics in large cities, which include 40 dentists. A typical project of such out-patient clinics provides 15 medical rooms, each office has modern equipment.

category 2 corresponds to polyclinics, which include 30 dentists. There are such polyclinics in medium-sized cities.

In polyclinics of the 3rd category, no more than 25 dentists work.

The most widespread polyclinics of the 4th category, with a membership of 20 doctors. Such polyclinics function in small towns and rural district centers. A typical project includes five treatment rooms.

Children's polyclinic is a medical and preventive institution that assists children up to 14 years of age. One children's polyclinic services from 8-10 to 40-50 thousand children but their place of residence. The list of its functions includes the organization and conduct of preventive measures, medical examination, provision of counseling and treatment, provision of specialized medical care, carrying out restorative treatment, carrying out measures for the prevention and reduction of diseases, and conducting sanitary and educational work. More often children's polyclinic is an independent institution, less often - it is a part of a children's hospital. According to the regulations approved by the Ministry of Health of the Russian Federation, the area of ​​the polyclinic, financing, staff, equipment is determined by a higher health authority. The work of children's polyclinics, like others, is built according to the precinct principle. The territory of the polyclinic is divided into several sections, each of which includes about 800 children. Each district is assigned one district therapist and 1.5 nurse positions. The pediatric outpatient clinic should be provided by pediatricians and nurses( paramedics) of the school and a home care unit. The staff of specialists includes otorhinolaryngologists, surgeons, ophthalmologists, neuropathologists, etc. If necessary, medical-genetic, endocrinological consultation patients are sent to larger children's polyclinics.

Much attention in the children's polyclinic is paid to preventive work. To do this, the office of a healthy child is functioning, there is a medical assistant for preventive work, and a number of methodical activities are carried out for the upbringing of a healthy child. Specialists in the office of a healthy child should be involved in health education, for which they spend 4 hours a month.

The layout of the children's polyclinic differs from that of the adult. In the nursery, two entrances are provided: one for healthy children, the other for a sick box. At admission, it is necessary to examine the skin and zoe of the baby and to measure body temperature. All these activities are carried out by the nurse of the admission department.

The special feature of the work of the specialists of the children's polyclinic is the patronage of pregnant women, which is carried out twice by the district nurse. Thus, already from the period of intrauterine life the state of the child is controlled. The district doctor and nurse visit the newborn during the first three days after discharge from the hospital. Then, patronage is performed twice a week before the beginning of the nursing period. Children from socially disadvantaged families and premature babies are subjected to special monitoring. After reaching the age of one month and during the first years of life with the correct development of the child, the doctor should examine it at the polyclinic at least once a month. In this case, the pediatrician evaluates the physical and mental development of the child, the body mass index, conducts laboratory diagnostics, if necessary. The results of the examination are recorded in the child's development map( form 112).

Complex preventive measures are carried out with the purpose of organization and implementation of preventive vaccinations, regular monitoring of the condition of healthy children;providing information on rational feeding, physical education, tempering. Much attention is paid to preparing children for enrollment in school or kindergarten. The work of specialists in children's polyclinics is carried out both in the polyclinic and at home. If it is necessary to provide night care assistance to children with chronic diseases, home health departments are organized. The organization of health education, hygiene education, control of nutrition, physical and labor education of children, health and preventive activities are the main factors that ensure the activities of the children's polyclinic in preschool and school. Currently, the number of socially disadvantaged families is growing, work with which is also included in the tasks of children's polyclinics.

Children's health directly depends on the quality of the preventive work of the district nurse. Starting with the patronage of a pregnant woman, which includes preparing the mother for childbirth and feeding the child, creating a favorable climate in the family of the future newborn, the nurse exercises control and moral support for the future mother. With the advent of the newborn in accordance with regulatory requirements, the visiting sister regularly visits the baby on the second day after his discharge from the hospital.

The nurse of a pediatric site carries out measures for the prevention of rickets and monitors the timely implementation of preventive vaccinations according to the calendar of preventive vaccinations. The data are recorded in the "Card of preventive vaccinations № 63".Each district nurse has a card file for vaccinations, followed by a systematic monitoring of the sister for timely vaccination. If the schedule of vaccinations is not observed, the sister is obliged to notify the parents of the child about the date of the preventive manipulation. The nurse also monitors the state of the baby's health after vaccination, recording all the data in the "Child Development History Card".

It is the responsibility of the local nurse to organize the prophylactic examination of patients by place of residence according to registration form No. 30. It must correctly and timely maintain the necessary documentation: the history of the child's development( registration form No. 112);statistical coupon( registration form number 256).In the children's clinic there is a special time for preventive reception of children under 3 years old. The district medical department compiles a list of the children of the site from the first days of life to 15 years, conducts rounds of their site twice a year( in April and September) for the purpose of the census of the children's population.

The resort polyclinic operates in the resort cities of Russia and provides medical assistance to those who arrived not for sanatorium treatment, but for rest. Patients live in private apartments, while the whole complex of medical activities and the supervision of a doctor are carried out in the resort polyclinic. Specialists of this kind of polyclinic can advise patients who are on a sanatorium treatment. Resort polyclinics are available in Sochi, Pyatigorsk, Kislovodsk.

The functions of a visiting nurse are:

• implementing measures to preserve breastfeeding;

• control of the child's hygiene;

• mother's education for childcare;

• health education talks with parents;

• Umbilical wound treatment.

Goals of the pediatric nurse:

• preventive;

• medical;

• health education.

The patient, who needs a more detailed examination, is sent to the clinic for consultative and diagnostic services.

This kind of outpatient clinic includes neurosurgical, ophthalmologic, otorhinolaryngological, gynecological, neurological, urological, cardiological, pulmonological, orthopedic, gastroenterological, endocrinological and other rooms. The structure of consultative and diagnostic polyclinics includes a diagnostic department, which includes laboratories: biochemical, bacteriological, cytological. You can not do without an X-ray, endoscopy cabinet, a functional diagnostic room.

Polyclinics of this kind should provide qualified medical assistance in a general and narrow profile;carry out the necessary laboratory, instrumental diagnostic studies;give appropriate recommendations for treatment under the control of a polyclinic at the place of residence. According to the above tasks, the staff of the polyclinics of consultative and diagnostic care includes highly qualified doctors: surgeons, pulmonologists, cardiologists, endocrinologists, gastroenterologists, hematologists, otolaryngologists, urologists, neurosurgeons, neurologists, ophthalmologists, etc. The examination includes laboratory, instrumentation, instrumental diagnostics. The results of all studies are sent to the institution, which sent the patient to the consultative diagnostic clinic. Polyclinics of this type are actively involved in working with patients with highly qualified doctors-specialists of multidisciplinary hospitals, professors, associate professors of medical universities.

Self-supporting polyclinics provide specialized medical advice to patients on a fee basis. The tasks of self-supporting polyclinics also include the provision of preventive medical examinations of persons entering the work, food workers, children's institutions. In this case, the use of hardware and laboratory research methods is mandatory. The inspection fee is borne by the relevant organization.

Physiotherapeutic polyclinics are being established in large cities. They provide restorative treatment, using physical methods, exercise therapy, occupational therapy, etc. All the activities of physiotherapeutic polyclinics reduce temporary or persistent work capacity, save labor resources.

guild polyclinics are organized in large cities in the area of ​​industrial enterprises, where employees of these enterprises are serviced. The creation of guild medical stations in industrial enterprises is carried out at the rate of 1,700 workers per section;in organizations of chemical, coal, oil refining industry - 1500 workers. Shop clinics are formed taking into account the specialization of technological production and the territorial location of the enterprise. The staff of these medical institutions includes various specializations of physicians: therapist, ophthalmologist, otolaryngologist, surgeon, etc. One of the main functions of the doctors of these polyclinics is: to study and improve the working conditions of the employees of the enterprise. The shop polyclinic is one of the structural subdivisions of the city hospital.

The peculiarity of the medical activity of the shop polyclinic is the provision of first aid at the place of production for injuries, sudden illnesses and occupational poisoning. An important role in the implementation of planned sanitary and hygienic and medical preventive measures belongs to the shop nurse.

One of the military-type medical institutions is the garrison clinic a. It is an independent institution that performs the following functions:

• provision of medical care to military personnel, as well as persons who are sent to a polyclinic for advice from garrison facilities;

• carrying out medical examinations;

• organization of preventive and diagnostic work in part;

• provision of medical care at home.

In garrison clinics, medical assistance is provided to servicemen and their families according to the order of the unit commander. The garrison polyclinic has the following main divisions:

• registry;

• diagnostic department( laboratory, X-ray room, functional diagnostics room);

• medical department( the rooms of the therapist, ophthalmologist, surgeon, neurologist, dentist);

• physiotherapy department( gym for physical therapy).

If necessary, the pediatric and obstetrics-gynecological departments are formed, as well as the offices of cardiology, allergology and endoscopy.

geriatric polyclinic or geriatric departments in city hospitals are organized for elderly patients, where not only the professionalism of doctors is important, but also the manifestation of human qualities: kindness, sensitivity and charity.

The head of the independent polyclinic is the chief doctor .He manages finances and represents a medical institution in the health care bodies.

The head of the polyclinics that make up the hospital is the head physician of the hospital.

In polyclinic institutions, strict accounting and control of the funds necessary for their activities are carried out in accordance with established norms.

In accordance with the allocation of budgetary funds, the activities necessary for the functioning of polyclinics are carried out: current and major repairs of premises, purchase of medical equipment, maintenance costs, etc.

. The polyclinic is operated in accordance with regulatory and other legislative acts of the Russian Federation.

One of the main functions of the clinic is the implementation of home care. At present, the number of patients with long-term chronic diseases, as well as those who need long-term treatment, care and constant supervision at home, is increasing. Therefore, home care is becoming increasingly socially and economically important. This assistance is especially important during the "off-season"( autumn and spring), when the number of patients increases. Most after the first aid is further examined in order to avoid complications.

The doctor needs to timely and competently draw up the necessary documents: calls for a doctor at home are registered in a special book - form number 031 / y, and an ambulance - in the journal. In the medical chart of an outpatient patient, form No. 025 /, the doctor makes the appropriate entries. The ambulance team draws up a call card.

It contains a brief information about the patient's complaints, the reason for the call, the actual condition of the patient, the treatment performed. In the work of the clinic, home care accounts for 30% of the work of the institution. The district therapist pays about 50% of the working time to help patients at home, the pediatrician - 60%.The qualitative level of performing medical care for patients at home contributes to a more rational work of the hospital.

In the work of polyclinics, various forms of home care are used: emergency rooms, nursing and elderly care units, active nursing departments, short-term or day hospitals with subsequent care of the patient at home, etc.

When addressing patients, reasons, goals, andalso the nature of the calls( primary or repeated), the forms of the diseases( chronic or acute), the seasonality of the calls, etc. In general, the treatment of the therapeutic profile predominates. The condition of the patient determines the duration of treatment. If a visit by a doctor to a patient with an acute illness is limited to 1-2 with the subsequent transfer of the patient to outpatient treatment, the chronic disease requires an in-depth examination in order to avoid complications. Only attention from the doctor, his experience and professionalism will help to avoid mistakes in treatment, not to subject the patient to physical and moral suffering. The care of relatives for the patient is important, as regular fulfillment of all appointments of the doctor at home will contribute to a full recovery.

Depending on the time of the year, the nature of patients' appeals for help at home changes. In the summer, the number of complaints in people with cardiovascular, respiratory and nervous system disorders increases, in autumn and winter - with respiratory exacerbations. The quality of the doctor's work at home significantly affects the frequency of repeated treatment of patients in the clinic. If the treatment is prescribed correctly, the doctor actively visits the patient at home, this patient will not need emergency care and he will soon return to an active lifestyle. A large role in the treatment of patients at home belongs to specialist doctors, who, if necessary, patients can be invited for consultation. It is extremely important for the treatment of patients at home laboratory and diagnostic and treatment and support services. Here there are difficulties with providing kits for laboratory express diagnostics, special medicines. An important role in the provision of assistance at home belongs to the average medical personnel in such forms of work as the patronage of children of the first year of life, lonely elderly citizens with cancer.

The functions of the district nurse are:

• fulfilling the doctor's appointments at home;

• carrying out sanitary and anti-epidemic measures on the site;

• preparation of the doctor's office for the admission of patients;

• control of delivery of outpatient cards from the registry;

• control over the receipt of test results and the timely appearance of patients;

• measuring the temperature of patients;

• registration and delivery of directions for consultations to doctors of a narrow profile;

• filling sick leaves.

It is extremely important for the medical worker to be able to establish the relationship between the medical personnel and the patient, the ability to convince the patient of the correct choice of his lifestyle in the most extreme situations. Conversations with patients and their relatives about the peculiarities of patients' behavior and about various rehabilitation measures for medical personnel should be carried out at each visit of patients at home.

Currently, due to state support, the activities of polyclinics are further developed. Close cooperation of polyclinic institutions with various companies through the system of medical insurance allows the high-quality and timely implementation of the main function of the medical institution - providing the population with medical assistance in market conditions. Massive and systematic examination of the population( fluorography, mammography, etc.), regular medical examinations and medical examination are mandatory for all population groups. All these types of preventive care polyclinic institution conducts in accordance with regulatory documents for this type of activity.

At the beginning of the XXI century. Thanks to the state policy in the field of public health, many problems are solved in the system of polyclinic institutions: the material base is being strengthened, modern medical equipment is being acquired, and the qualification of medical personnel is increasing. The salaries of nurses and doctors have been increased in accordance with the quality of medical services. The responsibility of medical workers for their activities has increased, and there is a need to increase professional competence and qualification.

The development of private clinics currently does not always successfully solve the problem of medical care. The majority of the population feels more confident and appeals to budgetary medical institutions, where the quality of provided medical services with the support of the state is constantly increasing.