Scientific journal
European Journal of Natural History
ISSN 2073-4972

General medical practice in the rural areas

Kalininskaya A.A., Dzugayev A.K., Chizhikova T.V.

Indicators of practice of a general practice doctor in rural areas are presented in the article: applications to DGP (treatment, preventive, dispensary, and at home) considering age and profile (therapeutic, surgery, specialized). Work strain of DGP depending on a number of bonded first-aid-obstetric points.

In 2010 625,7 thousand doctors worked in Russia, provision of medical care equaled 43,8 doctors per 10 thousand people. A number of doctors of general practice (DGP) equaled 9,7 thousand, and the provision was 0,7-10 thousand people. DGP´s part equaled 1,6% of the total number of doctors.

Almost one third of population of the Russian Federation lives in the country. DGP becomes a center figure in providing medical care in a village. At the same time, general medical practice (GMP) is introduced slowly in the country (I.N. Denisov, E.I. Cherniyenko, Y.A. Korotkov, 2008; Y.M. Komarov, 2008).

During the research we have carried out passport systematization of general medical practices that work in the countryside of Penza region. 1379,8 thousand of people lived in Penza region (1st of January 2009), among them 461,9 were villagers (33,5%). An analysis has shown that 30,2% of DGP work without any bonded first-aid-obstetric points (FOP), 20% of DGP serve the population of one bonded FOP, 15,6% - two bonded FOPs, 7,3% - three, 21,8% - four and more FOPs. Besides, 51,0% of DGP who work in village districts of Penza region serve the mature and children, and 49,0% of DGP - only for the mature.

GMP were selected as bases for the research according to the following criterions: presence of good material-technical basis, road-transport accessibility, distance form central regional hospital (CRH) of no more than 15 km, DGP serves the mature and children, length of service in the field of DGP is no less than 5 years.

An analysis has shown that for all four local GMP age structure of the population was identical and corresponded to age indicators of all village districts of Penza region (table 1).

 

Table 1 Age structure of population, bonded to DGP in basic practices and village districts  of Penza region (% of the total)

Age

Pilot practice

1st practice

2nd practice

3rd practice

Village districts of Penza region

Under 1 year

0,97

1,3

0,7

1,1

1,1

1-14

11,6

13,6

9,9

8,3

12,7

15-17

3,8

4,6

3,2

2,5

3,8

0-17 total:

16,4

19,5

13,8

12,0

17,6

18-59

58,4

56,3

55,2

67,6

58,9

60 and over

25,2

24,2

31,0

20,4

24,7

Total:

100,

100,0

100,0

100,0

100,0

As tables 2 and 3 show, structure of applications to DGP is identical in all basic practices depending on type and purpose of an application.

 

Table 2 Applications to DGP in basic practices and all practices where DGP serve the mature and children, depending on the application purpose (% of the total)

Application purpose

Pilot practice

1st prectice

2nd practice

3rd practice

All practices

Treatment

66,7

64,8

67,3

68,1

66,4

Preventive

23,8

22,3

25,4

24,2

22,7

Dispensary

9,5

12,9

7,3

7,7

10,8

Total:

100,0

100,0

100,0

100,0

100,0

Table 3 Applications to DGP in basic practices and all practices where DGP serve the mature and children, depending on the application type (% of the total)

Application type

Pilot practice

1st prectice

2nd practice

3rd practice

All practices

Ambulatory

82,3

81,3

83,2

81,8

81,6

At home

15,6

16,3

14,2

16,2

15,9

Emergency

2,1

2,4

2,6

2,0

2,5

Total:

100,0

100,0

100,0

100,0

100,0

GMP of Belinskiy village district was selected as a pilot base of the research. Staff of the GMP included: 1 DGP, 2 nurses of GP, 1 dentist, 2 junior nurses, 1 driver. DGP´s length of service equals 15 years (including 10 years in pediatrics and 5 years in general practice).

GMP of the pilot village district serves 1542 villagers, of which 82,6% are the mature, 16,4% are children of ages 0-17, of them 0,97% - under 1 year. Age structure of the population of pilot GMP was identical to that of GMP of village districts of Penza region in general that allows us to define this GMP as a basic model for Penza district. We have selected GMD of Belinskiy village district without bonded FOP as the research base. However, we should outline that a number of FOPs, bonded to a GMP in the country must serve as a foundation in corrections of indicators of demand for DGPs.

During the research we studied the volume and character of applications to DGP in the pilot village district. A DGP carries out reception of patients in 11 specialities. An application frequency equaled 5070,0 per 1000 of the corresponding population, 3863‰ of applications were made due to diseases. Table 4 contains frequency of applications to DGP of the population of pilot village district with a treatment purpose depending on age.

The received work strains of DGP must be considered while planning their activity and differential wage of a DGP.

Table 4 Number of applications to DGP among the population of pilot village district in specialities with a treatment purpose (per 1000 of the corresponding population)

Speciality

Total

Children
(0-14 years)

Teenagers (children
from 15 to 17 years)

The mature

Therapeutic profile, including:

2804,8

2598,0

5913,8

2696,2

Therapy

1143,3

-

-

1366,7

Pediatrics

548,0

2592,8

5896,6

-

Cardiology

1035,0

5,2

17,2

1235,7

Endocrinology

78,5

-

-

93,8

Surgery profile

55,1

36,1

155,2

53,5

Surgery

28,5

10,3

17,2

31,8

Traumatology

26,6

25,8

138,0

21,7

Special profile, including:

1003,1

237,2

555,5

1138

Otorhinolaryngology

137,4

128,9

310,3

131,0

Ophthalmology

197,8

82,5

172,4

216,3

Neurology

483,1

5,2

21,1

575,2

Gynaecology

52,5

-

-

62,8

Dermatology

132,3

20,6

51,7

152,7

Total:

3863,0

2871,3

6624,5

3887,7

To analyze a structure of patients´ flows to GMP we have outlined 4 types of applications:

  1. applications to DGP by residents of the point village (in the area of a rural outpatient clinic (ROC));
  2. applications to DGP by residents of a bonded FOP in ROC;
  3. applications to DGP by residents of the bonded FOP with a doctors trip to the FOP;
  4. applications to a medical assistant by patients of a bonded FOP within the FOP.

For each application type we have calculated the corresponding intensive indexes that allowed us to carry out a comparative analysis and reveal definite legislations.

Table 5 Applications of villagers to DGP and medical assistants (per 1 resident per year)

Number of bonded FOPs

FOP

Applications to a DGP
by residents
of bonded FOP in a ROC

Applications to a DGP
by residents
of bonded FOP with a doctor´s trip to a FOP

All application to aDGP

Applications to a medical assistant
by residents
of a bonded FOP at the FOP

General applications
(DGP + medical assistant)

1 FOP

2,92

2,01

0,94

2,93

5,78

4,27

2 FOPs

4,51

5,02

1,35

5,69

1,96

6,92

3 FOPs

7,3

3,09

0,7

5,3

4,07

7,61

4 FOPs and more

3,23

3,06

1,38

4,04

5,22

7,53

The analysis has shown that a number of applications to DGP in a ROC by residents of a point settlements oscillated from 2,92 to 7,3 applications per a resident per year; by residents of a bonded FOP - from 2,01 to 5,02. With a doctor´s trip to a FOP, a number of applications by villagers who live in the FOP service area oscillated from 0,94 to 1,38 per a resident per year.

Per one villager who lives in a FOP service area number of applications to a medical assistant within the FOP reaches 5,78 applications in a number of practices. All applications to a DGP (within ROC and with trips to a FOP) oscillated from 2,93 to 5,69 per a resident per year.

Total number of applications (to a DGP and medical assistant), that considers applications to DGPs and medical assistants reaches 7,61 applications per a resident per year (table 5).

Analyzing applications of villagers who live in a FOP service area, we can speak of a reason to preserve aid of medical assistants, even in presence of DGP, as applications to a medical assistant form more than a half of total applications of villagers.

References

  1. Development of primary medical-sanitary care in Russia. Methodical recommendations I.N. Denisov, E.I. Cherniyenko, V.P. Chudnova, T.V. Elmanova. - Moscow, 2008. - Р. 67-77.
  2. Komarov Y.M. Strategy to develop healthcare in the RF // Healthcare. - 2008. - № 2. - P. 53-62.

The work is submitted to the Scientific International Conference «Research on the priority of higher education on-directions of science and technology», on board the cruise ship MSC Musica, Italy-Greece-Croatia-Italy, June, 10-17, 2012, came to the editorial office оn 17.05.2012.