The Polyclinic in the USSR
The

Polyclinic

The polyclinic is a medical and preventive institution that provides specialized medical care to the incoming patients, as well as patients at home.

The polyclinic differs from the dispensary (see) with a large amount of activity and more specialized help (the number of specialized and auxiliary rooms for the provision of qualified medical care in the polyclinic is much larger).

In the USSR there are polyclinics of two types - combined with hospitals (see) and independent.

The polyclinic includes specialized offices (departments): therapeutic, surgical, obstetric-gynecological, ophthalmologic, otorhinolaryngological, neurological, dermatovenereological, traumatological. In large polyclinics, in addition, there are rooms: cardio-rheumatology, endocrinology, oncology, tuberculosis, dental, adolescent, the office of infectious diseases, etc. Auxiliary cabinets (departments) are: x-ray, physiotherapeutic, functional diagnostics, procedural; laboratories conducting biochemical, clinical, bacteriological and other studies.

The

The polyclinic includes a registry, a reference department and an administrative and economic unit, as well as a statistical office, a library, a medical archive. The polyclinic also includes health centers (medical and paramedical) at enterprises, vocational schools, higher and secondary special educational institutions.

In the clinic provide the first medical and emergency care for acute and sudden illnesses, injuries and poisonings; perform treatment of outpatients and patients at home with the provision, when necessary, of hospitalization; carry out anti-epidemic measures (preventive vaccinations, detection of infectious diseases, dynamic observation of persons who have been in contact with infectious patients, and for convalescents, signaling in necessary cases to Sanitary and Epidemiological Station , etc.).

The work of the clinic is based on the dispensary method (selection of persons subject to dynamic observation, specialized treatment, systematic study of working and living conditions of the population). Preventive measures are carried out in the clinic, which, in combination with medical work, are the main task of the polyclinic and play a decisive role in reducing the incidence among the population.

The clinic conducts dynamic observation (preliminary and periodic professional examinations) for the health of industrial workers, as well as for working teenagers and vocational school students. The selection of patients in need of sanatorium-and-spa treatment is carried out.

An important part of the work of the clinic is the examination of temporary disability of patients, their release from work in necessary cases, timely dispatch to VTEK of persons with signs of permanent disability .

The staff of the polyclinic conducts activities to organize sanitary and educational work among the serviced population and workers of industrial enterprises, attracts the community's public asset to assist the polyclinic; maintains statistical records of the activities of specialists in the polyclinic and indicators of public health; compiles reports on the forms approved by the CSB of the USSR; conducts a systematic analysis of statistical data characterizing the activity of a polyclinic, in particular an analysis of the overall morbidity and morbidity with temporary disability.

The polyclinic systematically carries out activities to improve the skills of health workers. From the clinic send doctors to the hospital through the system of alternation (for the duration of the doctor's work in the hospital, he is completely released from work in the clinic, and then the doctor returns again to his medical station). Seminars are organized in the clinic. Doctors of the polyclinic improve their qualifications in courses at the doctors' improvement institutes.

The polyclinic, united with the hospital, is headed by the head physician, who is the first deputy chief doctor of the hospital. Independent polyclinics are managed by the main doctors and their deputies by the medical unit.

The polyclinic in the countryside is located mainly at the central district hospital and is a part of it.

The states of doctors conducting a reception at the polyclinic and providing home care, as well as the staff of the average medical staff, are established on the basis of the standards stipulated by the order of the Ministry of Health of the USSR (see Physician's site).

The average medical staff in the polyclinic spends together with the doctors the care of patients in the offices of district and shop doctors and medical specialists; sisters are working independently in procedural, physiotherapeutic and other offices, fulfilling the appointment of doctors.

Nurses carry out appointments of doctors at home, in health centers and patronage of patients and conduct preventive vaccinations among the population at medical stations.

To receive patients in cases of acute need during the hours of absence of the local doctor appointed by the doctors on duty. On weekends, the clinic establishes the duty of doctors in all major specialties.

One of the most important functions of each clinic is the provision of medical assistance at home (see Help at home ), including emergency.

To provide emergency care in the out-of-hours hours of the polyclinic, emergency centers are organized at one or several health centers of the district, which provide assistance both at home and outpatient in the evening, at night, and on weekends (see Emergency Medical Care ).

For treatment and preventive care for children (from the first year of life to 14 years inclusive), special children's polyclinics are organized, in which all kinds of specialized care are provided. Similar to the medical sites for adults in pediatric clinics, pediatric sites are organized, maintained by permanent district pediatricians and attached to the sites by specialist doctors.

All the children of the serviced area are registered in children's polyclinics and are actually clinicized (in nursery, preschool and school age).

In large resort towns, spa clinics are organized, in which patients who come for treatment without vouchers receive specialized counseling and treatment assistance and recommendations on the use of local spa factors.

The polyclinic (from the Greek polis - city and klinike - treatment) is a medical and preventive institution designed to provide specialized medical care to the incoming patient and to treat them at home. From an outpatient clinic (see), the clinic differs in a vast amount of activity and reception in all medical specialties. As a rule, polyclinics are part of joint hospitals (see) or health-care units (see) of industrial enterprises, but can also exist as independent institutions.

Depending on the number of medical posts (from 100 to 30), polyclinics are divided into four categories (children's polyclinics - five).

In modern clinics there are: a registry; departments (or less - cabinets) for specialties - therapy, surgery, traumatology, ophthalmology, otorhinolaryngology, neurology, dentistry, helminthology, infectious diseases, emergency care; teenage rooms and preventive examinations; auxiliary cabinets - radiological, physiotherapeutic, therapeutic physical training, functional diagnostics (electrocardiographic), procedural (for the performance of medical appointments); laboratory - clinical diagnostic, biochemical, bacteriological, dental prosthetics; insulator; administrative and economic part, accounting, accounting and medical statistics office, medical archive, library with reading room. If there is no pediatric clinic, a special dispensary (see) and a women's consultation (see) in the polyclinic service area, they are organized as part of a polyclinic. Usually there is a pharmacy or a kiosk in the clinic. The corresponding specialized departments are created if there are at least 8 therapists and dentists in the polyclinic staff, 6 surgeons, 4 ophthalmologists and laryngologists, etc. With smaller number of medical posts, cabinets are organized.

When planning the activity of the polyclinic and its staff, they start from such indicators as the reception of patients, attendance. To draw up a plan for attendance at a polyclinic, it is necessary to have accurate data on the number of people served. For this purpose, polyclinics periodically (as necessary) produces by their local nurses with the account of the population, both residing and working in the territory of the given polyclinic. The entire territory served by the polyclinic is divided into medical stations. According to the standards established by the USSR Ministry of Health, there should be 3-4 thousand adult people per medical therapeutical site (see Physician site). According to the precinct principle, workers and industrial enterprises with medical units are served. If the company does not have a medical unit, its workers and employees have the right to receive medical assistance in a polyclinic in the territory of the service of which the enterprise is located.

As standards, the needs of the urban population for out-patient care are now taken to be based on an average of 10 clinic visits per resident per year. The Ministry of Health of the USSR established the norms of hourly workload of physicians in certain specialties in outpatient clinics. These requirements are consistent with the needs of outpatient clinics and polyclinics in doctors.

The bulk of the work on organizing the reception and distribution of patients visiting the clinic lies on the registry. A centralized system for registering is preferable to a decentralized system. Concentration in one place of all work on documentation relating to the reception of patients, it is expedient, allows to shorten the waiting time of medical reception, ensures the maintenance of a unified medical history in the clinic (see). Much attention should be given to the external design of the registry room and the rational arrangement of the workstation of the registrar. The most convenient for storing the case histories are drum cases rotating on a vertical axis. The main difficulty in the work of the registry is the correct distribution between the attending physicians of patients in those cases when there are no more free places for admission for doctors. In such cases, patients are offered either a preliminary appointment for another day, or (if they want to go to the reception on the same day), the question is left to the discretion of the doctor on duty who makes the decision according to medical indications. Premises where patients are waiting for reception should be furnished with beautiful furniture, provided with fresh newspapers, illustrated magazines, sanitary and educational literature. The main workplace of a doctor in an outpatient clinic is an office, so his device should be given proper attention. The area of ​​the offices should correspond to the conditions of the doctor's work, depending on the specialty. It is advisable to arrange in the medical room cabins for undressing and dressing patients, which increases the useful time of the doctor.

It interferes with medical work in the polyclinic high and, moreover, uneven load. The main reasons for the overload are: incompliance of the number of doctors with the needs of the population, irrational use of the doctor's time. A nurse who works continuously at the reception can help the doctor to arrange medical records and perform various procedures. As in hospitals, in the clinics it is necessary to introduce the most rational methods of office work, taking into account the specificity of medical labor (see the Medical Documentation). The professional development of a doctor in a polyclinic is facilitated by his work in a hospital at the patient's bed. The most rational is the alternate work of doctors in a polyclinic and a hospital, the so-called alternation system, in which a doctor sent to work in a hospital is completely released from work in a polyclinic, and then he returns to his workplace to his medical station. Promotes the professional growth of doctors and the quality of serving the population by the principle of localism. This principle is introduced not only in the work of physicians-therapists, but also doctors of all other specialties.

The

The largest department in the clinic is therapeutic, accounting for up to 40% of all physician visits to the polyclinic. Further specialization of out-patient care led to the organization of cardio-rheumatological and endocrinological rooms in the therapeutic departments. A special place in the work of the therapeutic department belongs to the office of infectious diseases, which replaced the so-called cabinet of intestinal infections. The offices of infectious diseases are organized to ensure that infectious disease specialists, together with local doctors, actively participate in the treatment and prevention of all infectious diseases. The surgical department of the clinic provides up to 20% of all visits. The expediency of separating the traumatology room in the surgical department is confirmed by practice. In large polyclinics, trauma clinics work around the clock, providing emergency and medical trauma care to all patients who have been treated for injuries.

One of the mandatory functions of each city polyclinic and the most important part of the activities of all its doctors is the provision of medical care at home, including emergency. If necessary, local nurses carry out nursing at home, perform physiotherapeutic procedures, take material for laboratory research, and provide dietary nutrition. Such a service system was called a home-based hospital. An important part of the work of the polyclinic is the organization of close communication with the hospitals when preparing patients for hospitalization. In the treatment after staging, continuity should be observed.

Up to 40% of all patients visiting the polyclinic are people with temporary disability. Accordingly, the importance in the work of the clinic of medical examination of work capacity and especially the examination of temporary incapacity for work (see Expertise). From the quality of medical examination of work capacity in a polyclinic, a decrease in the incidence of morbidity with temporary disability of workers and employees depends to a certain extent. In the clinic, if there are 15 doctors or more in the staff, who directly conduct ambulatory patients, a special position of the deputy head physician for examination of work capacity and the VKK is assigned, which is entrusted with the management of this branch of medical work in the clinic.

Along with medical work, the function of the polyclinic includes preventive activities: measures to improve working and living conditions, fight against infectious diseases. When prophylactic medical examination (see) of certain contingents of the population, preventive and therapeutic methods and purposes are combined. The staff conducts medical examination in close cooperation with the doctors of the enterprises. The central figure providing dispensary services to the population in the clinic is the district doctor as a therapist of both territorial and shop areas, he is primarily responsible for conducting direct dispensary care for the population of the site and for attracting doctors of other specialties to dispensary supervision: surgeons, neuropathologists, otolaryngologists , ophthalmologists and dentists.

The analysis of the activity of the clinic, that is, summing up the results and an objective assessment of the effectiveness of its work, serves as a basis for qualified management and control. The analysis of the polyclinic is carried out both according to the official report, and according to the established primary accounting records. The main work on accounting and reporting in the clinic is conducted by the accounting and medical statistics offices, in large polyclinics there is a statistician.

To analyze the activity of a polyclinic, a whole system of indicators is usually used. Among them the most important are: the service of the population by medical outpatient care (the number of outpatient visits per year per one resident of the served area); dynamics of visits to the polyclinic by year and by individual medical specialties, seasonal and daily fluctuations in the load of the polyclinic; the structure of visits and the ratio between the number of visits at home and outpatient visits for individual medical specialties. The next group of indicators is designed to characterize the activities of doctors in the clinic: the burden of doctors (at one hour of admission), the repetition rate, the activity of repeat visits at home and the degree of service by the various auxiliary departments. One of the most important indicators is the index of localization in servicing the population of the district and, ultimately, the indicator of paramount importance - the health status of the served population.

It is headed by a polyclinic on the rights of one-man management chief physician, who has three deputies: on the medical part, examination of disability and administrative-economic part.

The public is involved in all aspects of the polyclinic's activities, a public council has been created at the polyclinic.

See also Community-based care, Medical assistance, Home help, Emergency and first aid.