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The study data are provided on the volume of curative and preventive care for 1740 infants at the outpatient department and at home, an analysis is made of the working time spent by a district pediatrician in two polyclinics of Nizhniy Novgorod. It has been shown that most of his time is devoted to sick children. Practically no time is spent on follow-up group of children pertaining to the populations "at risk". To improve preventive work among children of the first three years of life it is proposed to establish departments for young children in the territorial children's polyclinics. The organization of these departments makes it possible to improve the main qualitative indicators of child health.
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Today home injuries, as evidenced by a current survey, constitute 21.53 +/- 0.58% in the pattern of all referrals to traumatological care units. New and objective data have been obtained by age and sex, place of accident, circumstances and mechanisms of occurrence of home injuries, which present a certain interest for working out preventive measures and medical care organization. The materials are submitted for consideration to the city health department.
The experimental approbation of new conditions of economic activities revealed a discrepancy between the development of health service network and manpower potential and needs of population in medical care, the possibility of priority development of primary health care, promotion in the development of "semi-hospital" forms of medical care organization, the excessive level of hospital care, the interest among workers in increasing the volume of work and increase of effectiveness in the utilization of resources under normalization of economic relations in public health.
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An analysis is made of the findings of sample survey of population views on the state of ambulatory and hospital care, the data on time spent to reach an out-patient department and to wait for an appointment to the district physician and also data on the degree of satisfaction with the performance of ambulatory and hospital institutions and medical specialists are provided, the reasons for dissatisfaction with their performance are given, the findings on providing timely care to the population by medical specialists, waiting lists for hospitalization, hospital care efficacy and reasons for refusal in hospitalization are provided.
According to the findings of different authors somatic emergency hospitals admit about 0.3-40 percent of patients with psycho-somatic diseases: mental patients suffering from acute somatic diseases, patients with somatically conditioned mental disorders and also patients the somatic complaints of whom are manifesting symptoms of mental disease. An analysis was made of the consulting psychiatrist work at the multidisciplinary emergency hospital which had no somatopsychiatric department (SPD) in its structure. Medical care was provided to 2654 "mixed patients" with different mental disorders. Acute psychotic symptomatology was detected in 38 percent of these patients, however only 3.42 percent were transferred into mental hospitals and SPD of other hospitals. The remaining patients stayed at somatic hospital up to the end of treatment due to non-carriageable condition. Such situation considerably compicates the work of consulting psychiatrist. The optimization of curative and rehabilitative care for the patients requires efficient cooperation between consulting psychiatrist and resident physicians providing diagnosis, complex biological therapy, differentiated curative and rehabilitative regimen and also securing the rights of mental patients for confidential care in accordance with Code of medical ethics and ensuring continuous upgrading the skills of nurses and physicians of somatic hospitals.
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The paper outlines the issues related to expert evaluation of medical consultation quality provided at out-patient departments of central regional hospitals (CRH). The algorithm and programme of expertise were included into the special "Expert Assessment Schedule for Ambulatory Consultations" containing an assessment of eight major items. An expert assessment was carried out of 447 patients who made ambulatory visits to CRH, with a view of studying the reasons for failures, searching for the possibilities to overcome them and for the reserves of raising the quality of medical care for rural population. The findings of assessing the quality of ambulatory consultations at the CRH level showed that the physician's performance is in need of improvement taking into account the information acquired and shortcomings at each stage of medical consultation delivery.
The paper is devoted to the changes in the technology of health documentation keeping at Moscow city polyclinic No. 98 by using a special form of ambulatory case history and leaving it in the possession of patients while carrying over-all information on the patient to professional computers. The proposed system would be cost-effective.
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