Prophylactic examination, or dispensary observation, is a method of monitoring the he alth status of certain groups of people. These activities are characterized by frequency and accuracy of implementation. They are needed to clarify laboratory, radiological and other results of examinations carried out by persons registered in the dispensary.
Medical examination of he althy persons
Wrong is the opinion that only sick people are subject to clinical examination. Those who do not suffer from any diseases are also observed by specialists at regular intervals.
Among he althy people, the following persons undergo dispensary observation:
- all children until age 14;
- military conscripts;
- students of schools, colleges, higher educational institutions;
- child care workers;
- food or utility workers;
- working and non-workingwomen over 30;
- medical workers;
- disabled WWII, labor veterans.
The goal of monitoring he althy individuals is to maintain a high level of ability to work, maintain he alth status, detect diseases at an early stage and be able to take preventive measures.
Dispensary observation of patients
This group of people under observation includes patients with chronic diseases, convalescent patients after acute illnesses and persons with genetic abnormalities and congenital defects.
Organization of dispensary observation of patients is based on the following activities:
- detection of diseases and their etiological factors;
- prevention of exacerbations, relapses and complications;
- maintaining the level of working capacity and life;
- decrease in mortality and disability.
Dispensary observation after stopping the acute stage of the disease requires measures to extend the period of remission, as well as rehabilitation measures to restore the functioning of the main organs and systems of the body.
Main Tasks
Dispensary observation of patients has certain tasks, which are to identify individuals at risk, as well as patients with a disease at an early stage of its manifestation.
Shows observation and active measures for recovery, examination of patients, theirtreatment and recovery after illness. In addition, specialized databases are being created containing information on all persons under surveillance.
What are the types of preventive examinations?
- Preliminary examination - people who go to study or work pass. The main goal is to determine their ability to engage in the chosen business. During the examination, possible contraindications for the chosen profession and the presence of any pathological processes in the body are revealed.
- Periodic inspection - all persons pass in a planned manner with a certain frequency. Each appeal for help to a medical institution can be used by the local doctor to send the patient for a scheduled examination to narrow specialists.
- Targeted examination - has certain tasks and a narrow focus. For example, during such an event, patients who suffer from one specific disease are identified.
In addition, dispensary observation can be individual and mass. An individual is carried out if a specific person asked a doctor for help, or a home visit was made if the patient was admitted to a hospital for treatment or had contact with an infectious patient.
Mass inspections are carried out in educational institutions, military registration and enlistment offices, at enterprises. These examinations are usually comprehensive and combine periodic and targeted examinations.
Surveillance groups
After theexamination and assessment of the state of a person, the latter is assigned to a specific observation group:
- D1 "he althy persons" - have no complaints and deviations from he alth;
- D2 "practically he althy" - patients with chronic diseases in the past without exacerbations, convalescent persons after acute developments of the disease, people in borderline conditions;
- D3 "chronic patients" - patients with reduced ability to work and frequent exacerbations of the disease, as well as people who have persistent pathological processes that led to the development of disability.
What does medical examination consist of?
Dispensary observation consists of several main stages. The first of these includes registration and examination of patients, as well as the formation of groups that need further monitoring. The paramedical worker conducts a population count by transcribing the data for each patient.
The second stage consists of monitoring the he alth of those in need of treatment and preventive measures. The first group of patients undergoing medical examination is examined once a year at a pre-scheduled time. As for the rest of the patients, the GP or family doctor should use every opportunity to send them for scheduled checkups.
Group D2 is monitored to reduce risk factors for disease, correct hygiene behavior. Mandatory emphasis is placed on patients who suffered from acute diseases in order to avoid the development of a chronic process.
For the third group of dispensary observation, the specialist draws up a plan that outlines the principles of individual treatment and he alth measures, consultations of narrow specialists, the use of medications, elements of physiotherapy, preventive and rehabilitation measures.
During the year, after each examination, adjustments are made to the dispensary plan. At the end of the next year of dispensary control, an epicrisis is filled in, which indicates the following points:
- baseline patient;
- dynamics of survey results;
- measures taken for the purpose of treatment, rehabilitation and prevention of complications;
- final assessment of the patient's he alth.
In many medical institutions, an epicrisis plan is pasted into the patient's card, which saves time on filling out final and intermediate documents.
The third stage of clinical examination is based on the annual assessment of the results of the work of the medical institution, the consideration of positive and negative results. The ongoing activities are being reviewed and certain adjustments are being made for improvement.
Dispensary control diseases
Dispensary observation of chronic patients is carried out in case of the presence of the following diseases:
- pathologies of the gastrointestinal tract - peptic ulcer, chronic gastritis with reduced secretion, cirrhosis of the liver, chronic hepatitis, pancreatitis, chronic ulcerative colitis andenterocolitis;
- respiratory pathologies - bronchial asthma, lung abscess, bronchiectasis, chronic bronchitis, emphysema;
- diseases of the cardiovascular system - hypertension, coronary heart disease, heart failure;
- diseases of the urinary system - pyelonephritis, glomerulonephritis, urolithiasis;
- pathologies of the supporting apparatus - osteoporosis, osteoarthritis, rheumatoid arthritis.
Under the supervision of a surgeon are persons suffering from varicose veins, endarteritis, phlebitis, thrombophlebitis, post-resection consequences.
If there are narrow specialists of all directions in the clinic, then the patient is not registered with his local therapist, but with a doctor who deals directly with the clinical case.
Basic Orders
Dispensary supervision of all population groups is carried out on the basis of orders of the Ministry of He alth.
- Order No. 1006n dated December 3, 2012 "Approval of the procedure for conducting medical examinations for groups of the adult population."
- Order No. 87n dated March 6, 2015 on the approval of forms of documentation that is used during an event such as dispensary observation.
- Order No. 800 dated 06/18/11 on the procedure for conducting preventive examinations of military personnel and their dispensary observation. Order issued by the Ministry of Defense.
Accounting for medical examinations
To keep people in need of dispensary under controlobservation, and not to miss anything important, there is a special medical documentation.
1. Form No. 278 is compiled at enterprises, in educational and preschool institutions by the administration. This includes data on each person undergoing preventive examinations: full name, date of examination and final results.
The outpatient medical record is considered the main document. All cards are stored in the polyclinic file cabinet. In the upper right corner, the letter "D" is marked in red. It also indicates the reason and date of registration. After deregistration, the expiration date is also noted here. The card records data on all examinations of the patient by specialists, the results of examinations, and the appointment of treatment. This enables the local therapist to assess the completeness of the examination and the general condition of the patient.
3. The epicrisis, filled out at the end of each year, is made in duplicate. One is pasted into the outpatient card, and the second is transferred to the statistics department. All epicrises are checked and signed by the head of the department.
4. Form Zh30 - a control card consisting of a "D"-registration. The control chart is created solely for convenience. One document corresponds to one nosological form of the disease. They are placed in different boxes, depending on the month when the patient should next come for examination and examination. Every month, paramedical workers look through the file, select patients who should be examined this month, and send them a call about the need to come to the clinic.
Based on the results of the examination, doctors divide all patients into the following follow-up groups:
- 1 group - practically he althy;
- 2 group - patients with chronic diseases without disability;
- 3 group - patients with impaired ability to work in its minor manifestations;
- 4 group - patients with permanent disability;
- 5 group - completely disabled persons requiring constant care and treatment.
Developing an individual plan
At the beginning of each plan, the specialist indicates the task for a particular patient, since the workload on district doctors is quite large: a large number of people pass through them, and the therapist is not able to remember small details regarding the level of he alth of a particular patient.
The second section of the individual plan contains advice and recommendations about working capacity and possible working conditions. If the patient has a certain disability group, then the terms of dispensary observation and the date of re-examination are indicated.
The next item includes recommendations for dietary nutrition and the time frame during which the patient should adhere to it. The possible level of physical activity and activity is also indicated.
Features of therapeutic measures and prevention include not only a specific indication of medicines, doses and terms of their use, but also the definitionmethod of therapy (in the form of physiotherapy, spa treatment). Specific dates for the examination of the patient by specialists are also indicated, and, if necessary, the arrival of medical workers at home.
Dispanserization of children
Dispensary observation of children of the first year of life is carried out massively. The child is examined by a pediatrician every month. His anthropometric data, general condition, work of vital organs and systems are evaluated. This is necessary not only to detect pathologies, but also to prevent their occurrence and determine the tendency to certain diseases.
Dispensary supervision of children by a local pediatrician is indicated not only for newborns and infants, but also for patients at risk, people with chronic diseases and children who do not attend preschool institutions.
The role of a nurse in "D"-accounting
Dispensary observation of patients requires a lot of effort and time. Nursing staff play a huge role in the medical examination. Nurse responsibilities include:
- maintenance of a card file of medical examinations;
- sending a message to patients about the need to visit a clinic or a certain specialist;
- attendance control;
- preparation of documents before the next inspection;
- doing doctor's orders;
- monitoring the fulfillment of medical appointments by the patient;
- home patronage;
- record keeping.
First visit to a medical examinationit is better to spend at home with a doctor. Attention should be paid to the patient's living conditions and sanitary and hygienic standards in the place of residence, to find out who has the opportunity to provide him with everything necessary, with whom he lives.
