Basic principles of family medicine

A general practitioner, or family doctor, is a specialist who provides first and systematic care that covers various areas of medicine. Family medicine is widespread in Europe and is central to helping the population, because only the family doctor and nurse are very familiar with their patients and are able to pay attention to minor changes in their health status. In no other section of medicine is so much attention paid to treating the patient in conjunction with his family members. A special feature of family medicine is the provision of therapeutic and prophylactic measures for different age categories of patients who are part of the family.

The activity of a general practitioner also covers diverse social and national categories of the population, as patients carry out an independent choice of a specialist in this field. The basis of the family medicine consists of four principles: constancy, thoroughness, synthesis of problems, professionalism of medical workers. The presence of the above characteristics of the family medicine service contributes to the early resolution of many issues of providing out-patient care to the population. The activity of specialists of the family medicine service provides joint participation with patients in the national project "Health", one of the most important items of which is mandatory medical insurance. The family doctor and nurse should be an expression of a high level of professionalism in the diagnosis, treatment of diseases and care of their patients. Specialists of this branch are the personification of the principle of healthy lifestyle, which should be developed and disseminated among the population. The most important function of the doctor and sister of the family medicine service is medical and preventive activities aimed at preserving the health of the family, eliminating serious diseases, preventing relapses and forming a lasting improvement in the condition of long-lasting diseases. These specialists work with certain groups of families and provide appropriate assistance and advice in the event of questions or health problems. The general practitioner and medical nurse should be highly competent in the early diagnosis and analysis of certain symptoms of the disease.

At present, the branch of family medicine is being initiated in Russia, as evidenced by the publication of the corresponding order of the Ministry of Health of Russia No. 237 of August 26, 1992, "On a step-by-step transition to the organization of primary medical care on the principle of a general practitioner( family doctor)."The general practitioner is a highly qualified specialist in various branches of medicine, such as pediatrics, therapy, geriatrics. He must be competent in matters of genetics and specialty areas - ophthalmology, gynecology, endocrinology, etc. The family doctor and nurse work on the basis of strong knowledge of hygiene, nutrition, psychology and pedagogy.

There are two types of work of specialists of the family medicine service. The first type assumes their joint activity with representatives of other specialties( gastroenterologists, endocrinologists, cardiologists, etc.).The second type provides for the implementation of functions without intermediaries, i.e. When a family doctor conducts appropriate activities without consulting his colleagues. Treatment and prophylactic complexes are widely used in many regions of Russia, which simultaneously provide assistance to patients with therapeutic, gynecological, and children's populations. The staff of these institutions consists of a significant number of family medicine specialists, who occupy a leading position in the structure of rendering assistance to the population and in the direction of which specialized specialists work with the patient. The organization of the family medicine service will improve the effectiveness of providing medical and preventive care to the population, form an orderly and clear coordinated activity of the health care system. In our country, the introduction of the family medicine service into practice is just beginning. This is a complex process, since it is necessary to find a solution to many problems, one of which is the division of the functional duties of the doctor and the sister of general practice. Also, it is necessary to establish true information about the patient's problems and determine the level of responsibility of the nurse according to the rights and the corresponding moral norms of her activity.

The general nursing nurse is obliged, first, to determine the satisfaction in which needs are violated in the patient. Its activities are directed at the relevant subject( the patient) and on his physiological, social and spiritual problems. The nurse in her work with the patient must set certain goals and diagnose the results for which she needs close cooperation with the family and friends of the patient. The average medical personnel of the family medicine service spend a considerable period of time with the patient and his family. They should form an opinion in the patient and his environment about the importance of maintaining their health, disease and the need for appropriate care. This event will ensure a successful outcome of medical personnel. At present, new principles of the system of rendering out-patient care to the population are being introduced. One of them is the gradual creation of primary care from the position of family medicine. The established basic package of health care bills provides for the independent selection of a medical specialist by the family and presupposes a high level of professionalism of the nurse of general practice. A family doctor and a nurse are required to carry out the appropriate types of medical and preventive measures, assigned to them by families, regardless of the availability of different age groups. The activities of medical personnel are often carried out at home. Decree of the Ministry of Health of Russia of August 26, 1992 provides for the introduction of new staff units - a doctor and a nurse of general practice.

Often draw analogy of the district nurse with the sister of the general practice. However, the range of family nurse duties is much greater. One of them is the implementation of a complex of hygienic and anti-epidemic measures. Also, the general practice sister should be competent in matters of immunization of the population. The pedagogical orientation of the family nurse's activity presupposes the training of patients and his family in elementary ways of mutual assistance. The general nurse should form and conduct appropriate nursing care for children, and also follow the recommendations of the family doctor. One of them is diagnosis, treatment and recovery in accordance with legal rights and obligations. The nurse must provide first aid in case of emergency conditions of the patient, such as traumatic injuries, various kinds of shock, stopping breathing and cardiac activity. The duty of paramedical personnel is to systematically monitor the activities of junior medical workers.

At present, much attention should be paid to the training of nurses with an emphasis on the organization of a multilevel education system and the introduction of new disciplines. The introduction of the above-mentioned developments into practice will make it possible to form one of the most important qualities of the activity of a medical worker of the family medicine service - independence. The activity of the average medical personnel of the family medicine service depends on his level of professional training. For example, a family nurse works with a general practitioner only if the 3-year course at the college ends. A nurse who has completed a two-year training course at the school can only help a general nurse. The activity, based on the help of a general practitioner, is assigned to a paramedic who has been in college for 3 years 10 months. This specialist works in the system of district departments of medical and preventive institutions. A nurse who graduated from the university is able to lead several branches of the family medicine service and direct the activities of the sisters of general practice. This post belongs to the group of academic specialties. The activity of the family medicine service is directed at the person, his family and the people around them, is part of the nursing structure. This organization is based on the principles of a healthy lifestyle and the main issues relating to society and hygiene in general. The nurse of general practice should be qualitatively prepared for work in the field of family medicine. She must deeply and comprehensively implement the nursing process in the disciplines of a narrow profile( such as endocrinology, gynecology, ophthalmology, etc.) and profoundly and comprehensively orient in knowledge in these fields of medicine. A family nurse must be competent in the humanities - be a good teacher and psychologist.

Currently, a family approach is being gradually formed in the provision of primary care to the population. In this case, the responsibility of the nurse for the patient's health is increased. One of the most important components of family medicine is the clear understanding and application of the basics of nursing. Possessing certain knowledge in various disciplines, the sister of general practice should not only perform various medical procedures, but also conduct all kinds of conversations with family members. These events contribute to the process of education in the areas of proper nutrition, physical education, psychology, etc. Different types of conversations on these issues will allow solving many social problems of our time. Activity of the nurse of general practice is regulated by the corresponding Decree No. 237 of the Ministry of Health of the Russian Federation. According to him, the sister of general practice is able to work both in municipal and in private medical and preventive institutions. Family nursing activities are carried out on a contractual basis, after choosing a family. The list of functional responsibilities of the nurse includes: the admission of patients in the clinic, emergency measures, assistance in the diagnosis of diseases, the appointment of a family doctor, the support of family members in addressing psychological and social issues. The competent and highly qualified work of the nurse of general practice is largely determined not only by the high level of performance, but also by careful consideration of each step.

The activities of each sister of general practice are subject to licensing, which implies a list of its main functions. In the perfect version, the average medical personnel working in the family medicine service should receive a higher medical education in the specialty of "Manager of Health".In this case, the academic sister of a general practitioner synthesizes the medical knowledge of sisters of specialized doctors( ophthalmologist, surgeon, gynecologist, etc.).The family nurse should be able to conduct electrocardiographic studies, diagnosis of respiratory system disorders( peakflowmetry).One of the duties of the general practice sister is to establish the function of the visual( measuring the clarity of vision and eye pressure) and the hearing aid. She must understand the interpretation of the results of tests for diseases of the circulatory, digestive, endocrine( glucose test) and urinary system. Also, the duties of the family nurse are physical therapy and hygiene and therapeutic massage. She must have the methods of providing emergency assistance in life-threatening conditions. So, for example, the nurse of general practice is obliged if necessary to restore the patency of the airways, to carry out artificial ventilation of the lungs and indirect heart massage. When the cardiac activity in the patient is stopped, the family nurse must start the heart using a special device - the defibrillator. It should be competent in the issues of medical statistics and have certain skills to carry out its activities with the help of modern computerized technologies.

The main goals of the Family Health Nurse are the maintenance of health and the prevention of diseases in their wards. Therefore, it is obliged to treat the family as a single structure and take into account its national and social characteristics, as well as the psychological links between its members. The family nurse must take into account the factors that negatively affect the health of the patients: smoking, alcohol abuse, drug addiction, as well as occupational hazards. At present, the number of patients belonging to a certain risk group for diseases of the cardiovascular and endocrine systems is increasing, which should be borne in mind by the nurse of general practice. Important elements of the family sister's activity are a thorough and comprehensive review of the health of family members, counseling in case of adverse changes, as well as a thorough analysis of the work done. Consequently, the nurse of general practice carries out the initial stage of development of all possible points of view, which relate to the state of health of the family.

Specialists of family medicine service carry out a whole complex of measures for the treatment and prevention of diseases in families attached to them. The competence of the general practice sister includes a special attitude towards his patients, implying recognition of their individual characteristics, as well as experiencing their problems within themselves. The function of the family sister is the ability to identify the patient's disrupted needs, which also includes conflict situations within the family. Patients assigned to certain medical specialists should conduct systematic correction of therapeutic and prophylactic measures. The most important elements of the effectiveness of the health care system are a drop in the level of diseases, deaths and an increase in the birth rate among people who inhabit a certain area. Approximation to these indicators, and then their stability in the characterization of the primary care system for the population is possible only with the joint coordinated cooperation of the family doctor and nurse. At present, a lot of work is being done in Russia related to the opening of appropriate forms of education for sisters of general practice. An important role in the organization and implementation of the principles of primary health care belongs to the family sister.

In the system of rendering assistance to the population there are two types: primary and qualified assistance. The first type is performed by all outpatient and inpatient medical and preventive institutions, which do not have in their structure cabinets and offices of a narrow profile. The second type of care is organized by institutions of relevant specialization, such as a dispensary, a research institute, etc. The primary care system implies a systematic impact on health of people living in a small area, certain initial structures of the health care system. The primary care operation is based on the activities of a general practitioner and nurse. For the successful operation of the primary care service, you must adhere to the basic positions. Firstly, this organization must comply with the characteristics of the life of people served by it, and, if necessary, conduct appropriate medical and preventive measures. Secondly, primary medical care is one of the most important items of the national project "Health".Other types of medical services are formed only in order to provide primary health care structures in consultative and technical assistance. The primary care service then interacts fully with the structures that provide assistance in educational, transportation and other needs. One of the principles of primary care is also the intensive participation of the population in its organization and implementation in order to ensure close cooperation with other services that help people in their lives. This interaction should be based on friendly and co-ordinated cooperation. The means on which the provision of medical care to residents is based should be accessible. Unfortunately, minimal funds have been allocated to the sphere of primary care, which makes the investments of the patients themselves widely spread. The activity of the primary care structure assumes the existence of a synthesis of prevention, treatment of diseases and measures to restore the health of each family member. The amount of work that is performed by this service should meet the level of the population's needs in it, which provides a certain balance in the system of rendering assistance to the population. The initial stage of the disease should be more affected by specially trained medical specialists. This position is formulated in order to reduce the difficulties and traumatization of this stage.

According to the corresponding item of the order of the Ministry of Health of Russia, primary health care for the population is carried out on the principles of accessibility and free of charge. This type of health care structure presupposes therapeutic and preventive measures in relation to the main diseases, injuries and emergency health conditions of patients. Primary care activities then include the implementation of measures related to the prevention and prevention of the spread of mass diseases. Most of the work of the primary care organization includes protecting the health of mothers and children. The state medical-preventive institutions and sanitary-epidemiological structure of public health services are engaged in the implementation of the activity plan of this service. Despite this, in Russia, private medical units that provide primary care to the population are widely used. The activities of these organizations are built on contracts with the relevant insurance companies. The activities of the primary care service include a wide range of activities that are developed and approved by municipal organizations according to specially formulated bills. Such a system underlies the planning stages of the implementation of primary care. Provision of financial resources is assigned to local authorities. This function is organized with the help of a trust fund and the expenditure of funds by the above structure. This sum is intended to protect the health and prevent disease in the population.

In Russia, the primary care service is built on certain principles. The first of these includes the formation of a new position - a medical doctor of general practice. The second principle is based on the development of a certain authority of the position of the family nurse. The third principle assumes continuous improvement of the most acceptable types of primary care services for the population, which are represented by nursing institutions and public organizations engaged in the implementation of medical care for the elderly. The fourth principle includes the initiative of the patients themselves in the resolution and resolution of issues related to the formation of a healthy lifestyle and the prevention of diseases. The large amount of work of the primary care service is reduced to the issues of the spread of infectious pathology among the population. This organization is engaged in the development and solution of the problems of etiology, pathogenesis, course and clinic of infectious diseases. Routes of transmission of the pathogen and preventive measures remain the main ones in this field. For this purpose, the structure of primary care continuously cooperates with the sanitary-epidemiological station. The Primary Care Service conducts systematic observation of the main indicators of the epidemiological situation in the region and the country as a whole.

One of the main functions of the health care system is the implementation of preventive measures among the population, which ensures an increase in the level of positive and negative health indicators of the population( fertility and mortality).Currently, there are several types of preventive care. The primary goal of primary prevention is to reduce the number of manifestations of pathological conditions among the population. This involves measures to protect the health of citizens through joint work of both a group of individuals and the society as a whole. The activities of these associations provide appropriate recommendations for proper nutrition, physical education, the formation of a state of mental equilibrium.

Important elements of work also include immunization of citizens against certain infectious diseases and implementation of measures to create safe living conditions for the population. Preventive measures of the second type suggest a reduction in the severity and duration of the disease. This is done by means of various diagnostic procedures and by carrying out emergency manipulations in conditions of the patient that threaten his life. These measures will ensure the successful treatment of many diseases and the long-term maintenance of a satisfactory state of health with long-term pathologies. Tertiary prevention consists in preventing the occurrence of complications of the corresponding disease. This implies a number of diagnostic measures after the disease and immediate treatment in case of a pathological focus. The activity of specialists in the implementation of the third type of prevention also involves a complex of restorative manipulations to patients who have undergone serious illnesses, such as myocardial infarction, rheumatism, etc. The main direction of this work is the patient's motivation for a healthy lifestyle and limiting the therapy with medicines.

For a better understanding of the system of conducting preventive activities, the primary health care service should refer to the example. The patient suffers from chronic bronchitis. Primary preventive measures include quitting smoking, avoiding hypothermia, etc. Secondary measures include systematic auscultation by a physician-therapist, observation of the nature of the cough and sputum. Tertiary prophylaxis implies a set of therapeutic and preventive measures to restore the patient's health after pneumonia, which developed after acute bronchitis. At present, prerequisites are created for the formation of two types of activities of the primary care service: the definition of "populations of increased danger."For the implementation of this type of activity, specially trained posts of a general practitioner and nurse who work in the primary care structure are established. The number of these specialists is determined depending on the density of the population of the serviced site and the volume of necessary medical and preventive measures. The indicator "an aggregate of increased danger" is defined for the purpose of detecting and carrying out a complex of restorative manipulations for patients with a high risk of an early lethal outcome. This group includes patients suffering from complicated chronic diseases. For example, the presence of arterial hypertension for 10 years leads to the formation of left ventricular hypertrophy of the heart. Also included here are patients whose illness has led to a life-threatening condition, such as myocardial infarction, pulmonary edema, etc. Currently, there are diseases, the presence of which already threatens the life of the patient. These include diseases such as diabetes mellitus, cardiac arrhythmias, etc. The definition of the number of these patients is also included in the tasks of the primary health care service. The identification of an aggregate of increased danger assumes the introduction of positive changes in the activity of the health care system. This manifests itself in an individualized approach to the needs of the patient and in the application of various forms of medical care. This work will make it possible to interest the specialists of the primary care service and the patients themselves in the implementation of measures to protect the health of citizens. The definition of the above set will significantly reduce the percentage of danger in the occurrence of diseases, their complications and is a financially beneficial measure for the patient. In addition to positive elements, there is a negative side to this activity.

First, the implementation of this program requires a significant investment of funds. Secondly, the work of specialists in the structure of primary health care is not capable of "improving" all citizens of our country. The population plan assumes early diagnostic activities in connection with various diseases characterized by poverty of symptoms or latent current. Such diseases include arterial hypertension, ischemic heart disease, chronic gastritis, glomerulonephritis, etc. The development of this indicator is also aimed at active work to prevent the occurrence of diseases, including mass vaccination against the most dangerous infectious diseases-pertussis, tetanus, diphtheria, and so on.e. The implementation of the "population plan" provides for a fundamentally new program in the organization of assistance to the population. It provides the greatest positive elements for the citizens of the country in comparison with the old systems of medical services, including requiring minimal financial costs. This program should work for the benefit of the entire population and meet its requirements. In addition to the positive points of activity of this system, there are also negative sides. This program has some flaws, resulting in an insufficient motive for many patients and the workers themselves of the structure of primary care for the population in understanding and accepting this system. In this case, a low level of danger is observed. One of the most important elements of successful practice of the nurse of general practice is an excellent understanding and ability to apply in practice all the principles of organizing primary care for the population. At present, the program of a radically new approach of the nurse to its activities has been formed. It includes the widespread introduction and use of nursing. This innovation, which concerns mainly the average medical personnel, already operates in many medical and preventive institutions, but, unfortunately, did not cover all structures of the health care system. The creation of nursing was a necessary measure, because for a long period of time there was a lack of excellence in the work of a nurse. This innovation is also due to the intensive processes of development of nursing education in many countries of the near and far abroad.