Method of analysis of morbidity with temporary disability. Number of cases of temporary disability Accounting and analysis according to official statistics
number of cases of TD x 100 / average number of employees
3. Number of days of temporary disability per 100 workers
number of days of VUT x 100 / average number of employees
4. Average duration of one case of temporary disability
number of days of incapacity for work/average number of cases of incapacity for work
5. The percentage of patients transferred to disability.
Clinical examination v dentistry
Patients with active dental caries, diseases of the periodontium and oral mucosa, chronic osteomyelitis of the jaws, malignant neoplasms of the face and oral cavity are under dispensary observation. congenital splitting of the lip and palate, anomalies in the development and deformation of the jaws, etc.
The selection of patients is carried out during preventive examinations and planned sanitation, when applying to dentists for medical care.
The main tasks of medical and labor expertise, the levels of its implementation. The composition and functions of the clientnico-expert commission (medical commission).
Medical and labor examination (VTE) is a field of medical and scientific knowledge that studies a person’s ability to work if he has a disease, injury, injury, anatomical defect, pregnancy, and some other reasons regulated by state social insurance legislation and pursuing social and preventive goals (care for a sick family member, sanatorium treatment, quarantine, stationary prosthetics, etc.).
The main tasks of VTE:
1. Scientifically based assessment of the working capacity of workers with various diseases, injuries, injuries, anatomical defects
2. Establishing a fact temporary disability and release from work due to the presence of social and medical indications provided for by law
3. Determination of the nature of disability(temporary, permanent, full or partial)
4. Establishing the cause temporary or permanent disability to determine the amount of benefits, pensions and other types of social security
5. Rational employment workers who do not have signs of disability, but who, for health reasons, need to alleviate the load in their profession
7. Studying the causes of morbidity and disability to develop medical, social and preventive measures
8. Definition of various no social assistance working with temporary disability and disabled people
9. Conducting social and labor rehabilitation
Let's clarify some concepts.
Working capacity is usually understood as such a state of the body in which the totality of physical and spiritual capabilities allows you to perform work of a certain volume and quality.
Disability should be understood as a condition caused by illness, injury, its consequences or other reasons, when the performance of professional work in whole or in part, for a limited time or permanently, is impossible.
Disability can be temporary or permanent.
Temporary Disability (T)- the state of the human body due to illness, injury and other reasons, in which dysfunctions are accompanied by the impossibility of performing professional work in normal production conditions for a certain period of time, i.e. are reversible. Establishing the fact of VL is a medical action, because. it is aimed at eliminating adverse factors and means the beginning of treatment. Distinguish between full and partial temporary disability. Complete disability- the complete impossibility of performing any work for a certain period, accompanied by the need to create a special regime and conduct treatment.
Partial disability- temporary incapacity for work in relation to their usual professional work, while maintaining the ability to perform other work with another lightweight mode or reduced volume.
When determining the ability to work, it is necessary to take into account both medical and social criteria.
Medical Criteria include a timely complete clinical diagnosis, taking into account the severity of morphological changes, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications, determining the clinical immediate and long-term prognosis.
Social Criteria reflect everything that is connected with the professional activity of the patient: a characteristic of the prevailing stress (physical or neuropsychic), organization, frequency and rhythm of work, the load on individual organs and systems, the presence of unfavorable working conditions and occupational hazards.
Establishing the fact of incapacity for work is of great legal importance, because it guarantees the citizen the appropriate rights: in case of temporary disability, to be released from work and receive benefits at the expense of compulsory state social insurance, and in case of disability, to retire at the expense of the pension fund of Russia.
Expertisetemporary disability - a type of medical activity, the main chain of which is the assessment of the patient's state of health, the quality and effectiveness of the examination and treatment, the possibility of carrying out professional activities, as well as determining the degree and timing of temporary disability.
Levels of examination of temporary disability:
5. Chief specialist in the examination of temporary disability of the Ministry of Health of Russia
4. QEC of the health management body of the subject of the Federation
3. QEC of the health management body of the territory included in the subject of the Federation;
2. Clinical expert commission (CEC) of health facilities
1. Attending physician
KEK makes a decision on the provision of the attending physician and head. department and makes a decision - when extending the sick leave for more than 30 days.
in complex and conflict situations during the examination of VN,
when sent for treatment outside the administrative territory,
when sent to MSEC
bet on the need to transfer able-bodied persons to other jobs or rational employment of persons with limited ability to work.
at the request of organizations and institutions. on the issue of examination of VN and counter N.
in case of claims and claims of insurance organizations. and bodies of the social fund. fear.
when exempting from examinations at school, etc. uch. head
when providing an academician
in case of need according to comp. healthy in add. living area.
includes leading specialists of LPU.
The role of the attending physician in the examination of disability.
Functions of the attending physician:
1. Determines the signs of VL based on an assessment of the state of health, the nature and working conditions, social factors
2. In the primary medical documents, he fixes the data necessary for making a diagnosis, formulates a diagnosis of the disease, taking into account the degree of functional disorders, complications and their severity
3. Appoints additional studies and consultations, medical and recreational activities
4. Determines the timing of the VN (taking into account the individual characteristics of the course of the underlying and concomitant diseases and the approximate terms of disability for various diseases and injuries)
5. Issues a certificate of incapacity for work (certificate) and sets the date for the next visit to the doctor, fixing it in the primary medical documentation
6. At subsequent examinations, it reflects the dynamics of the disease, the effectiveness of treatment, justifies the extension of the patient's release from work
7. Refers the patient in a timely manner for consultation at CEC
8. In case of violation of the prescribed medical and protective regimen (including in case of alcohol intoxication), makes an appropriate entry in the disability certificate and in the medical history (outpatient card) indicating the date and type of violation
9. Reveals signs of persistent disability and permanent disability, timely organizes the referral of the patient to the CEC and the medical and social expert commission (MSEC);
10. Carries out medical examinations for long-term and frequently ill patients (citizens who have 4 or more cases per year by 40 days of VL for one disease, or 6 cases and 60 days, taking into account all diseases);
11. When restoring working capacity and being discharged from work, it reflects in the primary medical documents the objective status and reasoned justification for closing the sick leave;
12. Analyzes the causes of morbidity with LN and primary disability
Documents certifying temporary disability. Registration of a certificate of incapacity for work by the attending physicians of health facilities. private practitioners, paramedics. The list of institutions that do not have the right to issue disability certificates.
Documents: BC, Certificate of a student, student, graduate student, Certificate of any form signed by the head physician and stamped.
The right to conduct an examination of temporary incapacity for work and issue documents confirming temporary disability is granted to attending physicians of medical institutions of the state, municipal and private healthcare systems on the basis of a license obtained by the institution to conduct an examination of temporary incapacity for work.
Physicians in private medical practice outside the institution should have license for the main type of medical activity and examination of VN, as well as certificate (certificate) of completion of the advanced training course for the examination of temporary disability.
In some cases (in hard-to-reach remote areas, in the regions of the Far North, etc.), by decision of the health authority, an examination of temporary disability may be allowed paramedical worker.
Medical workers do not have the right to issue documents certifying temporary disability:
ambulance stations (departments);
blood transfusion stations;
institutions of forensic medical examination;
balneological and urban spa water and mud baths;
rest houses and tourist bases;
sanitary institutions.
The attending physician issues a certificate of incapacity for work individually and at a time for up to 10 calendar days and extends it singly for a period of up to 30 calendar days.
Private practitioners also have the right to single-handedly issue documents certifying temporary disability for a period not exceeding 30 days.
An average medical worker who has the right to issue a certificate of incapacity for work, alone and at the same time issue it for a period up to 5 days and extends up to 10 days in exceptional cases, after consultation with the doctor of the nearest health facility, for up to 30 days.
With a VUT period of more than 30 days, the decision on the issue of further treatment and extension of the disability certificate is carried out KEK.
By decision of the CEC, with a favorable clinical and labor prognosis, the sick leave can be extended until full recovery of working capacity, but for a period not exceeding 10 months, and in some cases (injuries, conditions after reconstructive operations, tuberculosis) no more than 12 months, with a frequency of extension of the CEC no less than 30 days later.
A private practitioner, if it is necessary to extend the sick leave for more than 30 days, sends the patient for consultation and to decide on further treatment at the CEC of a healthcare institution that provides him (the patient) with medical care in accordance with the compulsory medical insurance program.
Temporary disability is the inability for an employee to perform their professional duties. Such disability occurs due to illness, injury or other reasons and is of a transitory nature. Examination of temporary disability is carried out by doctors of medical institutions. The duties of the attending physician include establishing the fact of temporary disability in the patient with the issuance of a certificate of incapacity for work. In case of diseases and injuries, a sick leave certificate can be issued in institutions of both outpatient and inpatient types.
A certificate of incapacity for work is issued in connection with an illness, injury, when caring for a sick family member, for quarantine, for sanatorium treatment, for pregnancy and childbirth, when transferring to another job due to an occupational disease, for prosthetics, etc. The doctor alone has the right issue a certificate of incapacity for work for a period not exceeding 30 days. The right to extend the sick leave is granted to the head of the department, the medical commission and the head physician. In case of long-term disability, a certificate of incapacity for work can be issued for up to 10 months, in some cases up to 12 months, and then the patient must be referred to a medical and social expert commission.
In case of an industrial injury, a certificate of incapacity for work is issued from the first day of the injury in the presence of an accident report.
A quarantine disability certificate is issued by an epidemiologist or the attending physician. The terms of disability in this case depend on the infectious disease (determined by the instructions).
A certificate of incapacity for work in case of illness during a vacation is issued if the illness began during the next or additional vacation; in this case, the vacation is subject to extension by the number of days specified in the sick leave. In case of illness during the period of vacation without maintenance (at one's own expense), the sick leave is not paid.
In the event of disability outside the place of permanent residence and work, a sick leave is issued to the sick person for the entire period of disability, but with the obligatory approval of the head physician of the medical institution.
A disability certificate for pregnancy and childbirth is issued to a woman at 32 weeks of pregnancy for 70 days - before childbirth, in the postpartum period - for 70 days, and in cases of severe complications, operations, the birth of a premature baby - for 86 days, at the birth of 2 children or more - for 110 days.
The composition of the medical commission includes the attending physician, the head of the department and the deputy chief physician for examination, who is the chairman. The commission is organized in a polyclinic if there are at least 15 doctors in its staff. Its functions are: consultations of doctors on diagnostics and treatment; control over the quality of treatment, examination of working capacity and resolving the issue of temporary disability in complex and conflict cases; referral of patients for examination; granting vacations for sanatorium-and-spa treatment; issuance of conclusions on the transfer to facilitated working conditions.
In a hospital, sick leaves are issued to patients for the entire period of treatment, signed by the attending physician and the head of the department.
Registration of disability certificates by doctors of health facilities. Terms of lump-sum and single-handedly registration of disability certificates by the attending physician, the timing of referral to the CEC (VK). Types of violation of the regime and the issuance of a certificate of incapacity for work in case of violations of the regime.
Documents certifying temporary disability and confirming temporary release from work (study) are sick leave certificate and, in some cases, references of the established form, issued to citizens in case of diseases and injuries, for the period of medical rehabilitation, if it is necessary to care for a sick family member, a healthy child and a disabled child, during maternity leave, during prosthetics in a prosthetic and orthopedic hospital.
Certificate of temporary disability issued by the attending physician upon presentation of an identity document of the patient after a personal examination and is confirmed by an entry in the medical records.
The certificate of incapacity for work is a multifunctional document that serves as the basis for
1. Exemptions from work in case of VL (legal function)
2. Accrual of benefits for VN (financial, function).
3. Prescribes a certain type of medical and protective regimen (medical function)
4. Is the primary document for the analysis of morbidity with VUT (statistic function)
In order for the disability certificate to perform these functions, it is necessary to strictly follow the rules for its execution.
Front side sick leave form is filled in by the attending physician, reverse side - the administration of the enterprise (institution, organization) where the patient works.
Entries in the disability certificate (certificate) are made blue, purple, black ink, in Russian. Corrected or strikethrough text is confirmed by recording "corrected to believe", signature of the attending physician and the seal of the health facility. On the form no more than two corrections are allowed.
Depending on whether a certificate of incapacity for work is issued for the first time or is a continuation, the corresponding entry is underlined in the spine and on the form of the certificate of incapacity for work. ("primary" or "continuation sheet"). When issuing a "continuation", it indicates the number of the previous sick leave.
V sick leave stub recorded: surname, name, patronymic of the patient (in full); age; home address; place of work; surname of the attending physician; date of issue of the certificate of incapacity for work; signature of the patient who received the disability certificate.
On sick leave form the following is recorded: the name of the medical institution, its address (for a private practitioner - last name, first name, patronymic, license number); surname, name, patronymic (in full), gender. patient's age; full name of the place of work.
WITH for the purpose of maintaining medical secrecy, columns "diagnosis" and "final diagnosis" are not filled.
In the graph "cause of disability" the corresponding type of disability (disease, accident at work or at home, quarantine, patient care, child care, sanatorium treatment, prenatal or postnatal leave) is underlined and written below ^ additional information given on the form in brackets.
In the graph "mode" the type of prescribed medical and protective regimen is noted (see below), in the column "mark of violation of the regime" the date of the violation and its type are put.
In case of continued disability of the patient, the extension of the leaflet is carried out from the day of the appearance at the doctor's appointment; if the patient is recognized as able-bodied in the column "get to work" it is noted "was (date) able-bodied".
In chapter "exemption from work" it is written in Arabic numerals from what date, month, year and in words to what day and month inclusive the patient is released from work. The position of the doctor, his last name are clearly indicated and a signature is put. In case of a collegial extension, the names of the members of the clinical expert commission (at least three) are indicated and their signatures are put.
In the graph "get to work" the date of restoration of working capacity is noted the next day after the examination and recognition of the patient as able-bodied. Other cases of completion of the disability certificate are indicated: the date of death, the date of registration of the MSEC document when establishing a disability group.
The disability certificate cannot be closed at the request of the patient or at the request of the administration from his place of work.
In case of continuing disability, the disability certificate emphasizes "continuation", the date and number of the new sheet are recorded, in which (in the spine and at the top of the form) the "continuation of the sheet of incapacity for work No." is underlined and the number of the primary sheet is indicated.
In case of loss of sick leave a duplicate is issued by the attending physician if there is a certificate from the place of work stating that the allowance for this sheet has not been paid. In the upper corner of the form, a "duplicate" is written, in the "exemption from work" section, the entire period of disability is recorded in one line, certified by the attending physician and the deputy head of the health facility for clinical and expert work. At the same time, a corresponding entry is made in the medical documentation and the number of the issued disability certificate is affixed.
Printing facility(for non-resident citizens stamped) or a private practitioner is placed in the upper and lower right corners of the form when discharged from work or continuing the sick leave. When continuing treatment in another health facility, the corresponding entry in the sick leave is certified by the signature of the attending physician, the deputy head for clinical and expert work (in complex and conflict cases - by three members of the CEC), the seal of the institution that issued the sick leave.
The numbers of forms of disability certificates, the date of their issue, the date of extension or discharge from work are recorded in the outpatient card (medical history).
Terms of referral to CEC: Attending physician - on the 30th day, Private practitioner - on the 30th day to the clinic at the place of residence, Nursing worker - to the attending physician.
Registration of temporary disability during the period of the next vacation, leave without paycontent. Registration of temporary disability of non-resident patients with Ambulatorny and inpatient treatment.
In the event of temporary disability due to illness (injury) during the stay on your next vacation the allowance is issued for all days of release from work, certified by a sick leave.
Upon the occurrence of temporary incapacity for work during the period leave without pay or holidays for child care no allowance is given. If the incapacity for work continues after the end of unpaid leave or partially paid parental leave, the benefit is paid from the day when the employee was supposed to start work.
Registration of temporary disability for the care of a sick child in outpatient and inpatient treatment. Registration of temporary disability to care for a sick adult family member.
A disability certificate for caring for a sick child is issued by the attending physician to one of the family members (guardian) who is directly caring for.
Deadlines for issuing a certificate of incapacity for work:
caring for a child under 7 years old in outpatient treatment - for the entire period acute illness or before the onset of remission in case of exacerbation of a chronic disease;
caring for a child over 7 years of age with outpatient treatment - for up to 15 days, unless a longer period is required by a medical report;
care for a child under 7 years of age with inpatient treatment - for the entire period of treatment, over 7 years - after the conclusion of the CEC for the period necessary for care.
care for children under 15 years of age infected with HIV, suffering from severe blood diseases, malignant neoplasms, burns - for the entire period of treatment in a hospital.
The disability certificate records the name and age of the person being cared for.
If two or more children fall ill at the same time, one certificate of incapacity for work is issued to care for them.
In case of a multi-temporal illness of several children, for the care of them, the second certificate of incapacity for work is issued only after the closure of the first one, excluding the days that coincided with the days of release from work on the first certificate of incapacity for work.
Certificate of incapacity for work is not issued care:
for chronic patients in remission
during the period of the next vacation and leave without pay
during maternity leave
during part-paid parental leave
Registration of disability for pregnancy, childbirth and in case of termination of pregnancy(v including, for medical and social reasons and for induced abortion).
For pregnancy and childbirth, a certificate of incapacity for work is issued by an obstetrician-gynecologist, and in his absence, by a general doctor.
The issuance of a certificate of incapacity for work is carried out from 30 weeks of pregnancy at a time for a duration of 140 calendar days (70 before childbirth and 70 after childbirth).
The disability certificate indicates: in the column "diagnosis" gestational age at the time of application in the column "Final Diagnosis" estimated date of birth in the column "kind of disability""maternity leave"
in the column "mode""-"outpatient + inpatient" in the column "Release from work" the total duration of the vacation in one line.
The certificate of incapacity for work is signed by the attending physician and the head of the antenatal clinic (for those who did not attend the antenatal clinic and those from other cities, the head of the department of the maternity hospital).
At multiple pregnancy and childbirth, a certificate of incapacity for work is issued from 28 weeks of pregnancy, while the total duration of prenatal and postnatal leave is 180 days.
At complicated childbirth sick leave issued for an additional 16 calendar days. In these cases, the total duration of prenatal and postnatal leave is 156 calendar days.
In case of multiple pregnancy and complicated childbirth, a new form is issued for additional days of the postpartum period.
At childbirth before 30 weeks of gestation and the birth of a living child, a certificate of incapacity for work is issued for 156 calendar days, and in the case of the birth of a dead child or his death within 7 days after birth - for 86 calendar days.
artificial interruption pregnancy is carried out at the request of a woman with a gestational age of up to 12 weeks, according to social indications - with a gestational age of up to 22 weeks, and if there are medical indications - at any time with the consent of the woman.
At abortion surgery a certificate of incapacity for work is issued on the general basis provided for by the procedure for issuing a certificate of incapacity for work in case of diseases and injuries for the entire period of incapacity for work, but not less than 3 days (including with mini-abortions).
In case of termination of pregnancy for medical reasons, in the column "type of disability" the entry "disability for medical reasons" is made in the sick leave.
Registration of a sick leave during quarantine. Form of incapacity for workprosthetics in outpatient and inpatient settings.
A certificate of incapacity for work is issued by an infectious disease doctor or the attending physician on the proposal of an epidemiologist, if necessary, temporary suspension from work of persons who have been in contact with infectious patients or due to bacterial carriage.
The duration of the quarantine is determined by the approved periods of isolation.
The disability certificate indicates the mode - "home".
For caring for a healthy child under 7 years of age or an incompetent family member, on the basis of a certificate from an epidemiologist, a certificate of incapacity for work is issued to one of the working family members for the entire quarantine period.
Employees of public catering establishments, water supply, children's institutions, if they have helminthiasis, are issued a certificate of incapacity for work for the entire period of deworming.
Medico-social expertise (ITU) its value and tasks. Organization of medical and social expertise. The procedure for sending citizens to the ITU and the rules for issuing a sick leave certificate.
Medical and social expertise - determination in accordance with the established procedure of the needs of the examined person in measures of social protection, including rehabilitation, on the basis of an assessment of the limitations of life activity caused by a persistent disorder of body functions.
Medico-social examination (MSE) is carried out on the basis of a comprehensive assessment of the state of the body based on an analysis of clinical, functional, social, vocational, psychological data of the person being examined using classification criteria in the manner determined by the Government of the Russian Federation.
ITU is carried out by the ITU State Service, which is part of the system (structure) of the bodies of social protection of the population of the Russian Federation. The decision of the ITU public service body is binding on the relevant state authorities, local governments, as well as organizations, regardless of organizational and legal forms and forms of ownership.
Tasks of medical and social expertise:
1) Establishing the fact of the presence of disability, determining the group, cause (circumstances and conditions of occurrence), the timing and time of the onset of disability;
2) Determining the needs of disabled people for social protection measures, including medical, vocational and social rehabilitation measures and developing individual rehabilitation programs (IPR), monitoring their implementation;
3) Assistance in the implementation of measures for the social protection of persons with disabilities, including their rehabilitation, and evaluation of the effectiveness of these measures;
4) Determining the degree of loss of professional ability to work (in percent) of employees who have been injured, an occupational disease or other damage to health associated with the performance of their work duties, the need for additional measures for their social protection and rehabilitation;
5) Determining the needs of disabled people in special vehicles;
6) Determination of the causal relationship of the death of the injured person with an industrial injury, occupational disease, stay at the front and with other circumstances in which the legislation of the Russian Federation provides for the provision of benefits to the family of the deceased;
7) Data shaping state system accounting for disabled people, studying the state, dynamics of disability and the factors that lead to it;
8) Participation in the development of comprehensive programs in the field of disability prevention, medical and social expertise, rehabilitation and social protection of disabled people.
Citizens are sent at ITU by a health care institution or a social welfare authority. The basis for referral to the ITU is:
the presence of signs of disability or loss of professional ability to work.
end of disability
early re-examination of a disabled person due to aggravation of the condition,
availability of indications for providing a disabled person with special transport,
the need for face-to-face consultation.
The healthcare institution sends the patient to the ITU after the necessary diagnostic, therapeutic and rehabilitation measures have been taken. Based on the results of the measures taken, the health care institution issues the patient "Referral for medical and social examination" form No. 088 / y-97 (for persons over 18 years of age) or form 080 / y-97 (for persons under 18 years of age). It includes information about the development of the disease, the course, frequency and duration of temporary disability, clinical examination data, diagnosis, the nature and degree of violation of the basic functions of the body, the category and degree of disability, and therapeutic and prophylactic and rehabilitation measures taken. The direction is signed by the chairman of the KEK and members of the commission, sealed by the seal of the medical institution.
ITU procedure defined by the “Regulations on Recognizing a Person as a Disabled Person”, approved by a decree of the Government of the Russian Federation (1996). The examination is carried out in the ITU bureau at the place of residence of the patient or at the place of attachment to the healthcare institution. It can be carried out both in person at the ITU office, at home or in a hospital where the patient is being treated, and (with the consent of the patient) in absentia based on an analysis of the submitted medical documents.
ITU is carried out upon a written application of the patient (or his legal representative) addressed to the head of the ITU bureau. The application is accompanied by: a referral to the ITU, issued by a healthcare institution or a social protection authority, medical documents confirming the patient’s health impairment, as well as documents necessary to make a decision on the cause of disability, the degree of loss of professional ability to work, and other issues of expertise.
The composition of the bureau specialists who make the expert decision is appointed by the head. The patient has the right to involve in the examination with the right of an advisory vote any specialist at his own expense. The specialists conducting the ITU consider the information provided (clinical-functional, social, vocational, psychological and other data), conduct a personal examination of the patient, assess the degree of limitation of his life activity and collectively discuss the results.
If the patient is recognized as a disabled person, an ITU certificate is issued confirming the fact of disability, the head of the ITU bureau announces an expert decision to the patient.
A patient referred to ITU with disability certificate, The ITU Bureau indicates in the disability certificate the start date of the examination (the date the patient’s application was received by the ITU Bureau with the attached documents), the date of its completion, as well as the expert decision: “Recognized as a disabled person of group I (II or III)”, or “Not recognized as a disabled person” . The date of establishment of disability is the day when the ITU Bureau receives the application of the patient with the documents attached to it. In the event that the patient is recognized as disabled, the medical institution closes the disability certificate that day. If the patient is recognized as able-bodied, all are counted. days of examination, from the next day he is discharged for work. If aftercare is necessary, the certificate of incapacity for work is extended in the usual manner,
Based on the results of the examination, they are also issued "Notice of LPU on the conclusion of the establishment of the public service of the ITU"(for persons over 18) or "Tear-Off Ticket"(for persons under 18 years of age), which indicate the diagnosis, degree of dysfunction and disability, group, cause of disability (and for persons under 18 years of age - the decision to recognize the child as disabled), the period for which the disability was established, the date of the next re-examination; recommendations are made on the medical, professional and social rehabilitation of a disabled person.
Disability. Grounds for recognizing a citizen as disabled. disability groups. Creterii to determine the disability group. Violations of health and limitations of the life workerness. Recertification deadlines. Individual programs rehabilitation of the disabled.
Organization of medical care to the population.
Life restriction- deviation from the norm of human activity due to a health disorder, which is characterized by a violation of the ability to carry out self-service, movement, orientation, control over one's behavior, training and work.
health disorder- physical, mental and social ill-being associated with the loss, anomaly, disorder of the psychological, anatomical and physiological structure and function of the body.
Disability- social insufficiency due to a health disorder with a persistent disorder of body functions, leading to a limitation of life and the need for social protection.
Disabled person- a person who has a health disorder with a persistent disorder of body functions due to a disease, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection.
Grounds for recognizing a citizen as disabled are: a health disorder with a persistent disorder of body functions due to diseases, consequences of injuries or defects; limitation of life activity (complete or partial loss by a person of the ability or ability to carry out self-service, move independently, navigate, communicate, control their behavior, study or engage in work activities); the need to implement measures of social protection of a citizen due to the presence of social insufficiency.
Allocate three groups of disabilities, of which the third is the lightest and the first is the heaviest.
I group- social insufficiency requiring social protection or assistance due to health problems with a persistent, pronounced a disorder of body functions caused by a disease, a consequence of injuries, defects leading to a sharp violation one or more categories of life*.
II group- social insufficiency requiring social protection or assistance due to a health disorder persistent pronounced a disorder of body functions caused by a disease, a consequence of injuries, defects leading to pronounced violation and one or more life categories.
III group- social insufficiency requiring social protection or assistance due to a health disorder with persistent disability significant or moderate a disorder of body functions caused by a disease, a consequence of injuries, defects leading to mild or moderate impairment one or more life categories.
For a person under the age of 18, when determining disability, a category is established "disabled child".
Deadlines for determining disability:
disability group 1 - 2 years
II and III groups - 1 year
"disabled child" - 1 year, 2 years or until the age of 18
TO main categories vital activity relate ability To self-service, Tability To independent movement, ability To learning, downtime ability activities, ability To orientation, ability To communication, demolition control his behaviorTo true- ability
After that, it is necessary to undergo a re-examination to extend the disability. Criteria for establishing permanent disability
(without further examination):
1. The impossibility of eliminating or reducing the social insufficiency of a disabled person due to a long-term limitation of life (with a follow-up period of at least 5 years) caused by health disorders with persistent irreversible morphological changes and dysfunction of organs and body systems.
2. Age over 60 for men and over 55 for women
3. Inefficiency of rehabilitation measures, dictating the need for long-term (permanent) social protection
4. Other criteria provided by law
When establishing disability, the ITU institution also decides on the cause of disability, which determines the features of social protection measures (pension amount, benefits, and a number of others). The following causes of disability are established:
"General illness": in the absence of grounds or supporting documents for an industrial injury, occupational disease, military injury, illness associated with military service or radiation exposure, as well as disability in childhood.
"Labor injury": persons whose health damage occurred in the performance of work duties
"Occupational disease": persons whose disease that led to disability is recognized as an occupational disease, about which there is a conclusion of specialized institutions (occupational pathology center, clinic or department of occupational diseases).
"Disability since childhood": persons who had a disability before the age of 18 (or there is reliable information that there were disabilities at a specified age).
"Military injury": if an injury (wound, trauma, contusion) is received by a military person in the line of duty military service(official duties).
“The disease was received during military service” if the disease occurred during the period of military service or injury (wound, trauma, contusion) was received by a soldier as a result of an accident not related to the performance of military service duties.
Rehabilitation of the disabled - a system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or, if possible, more fully compensating for limitations in life activity caused by a health disorder with a persistent disorder of body functions.
The goal of rehabilitation is restoration of health, ability to work, personal and social status disabled people, their achievement of material and social independence, integration (or reintegration) into the normal conditions of society.
In accordance with the WHO classification, there are three main types (directions) of rehabilitation:
1) Medical rehabilitation - a set of therapeutic measures aimed at restoring impaired or lost functions and health of patients and disabled people. Its purpose is the elimination or mitigation of the consequences of an illness, injury or injury until the full or partial restoration or compensation of disorders in the mental, physiological and anatomical state of the patient. Medical rehabilitation of the disabled is carried out within the framework of the compulsory medical insurance program.
2) Vocational rehabilitation - a system of state and public measures aimed at the return or inclusion of a disabled person in socially useful work in accordance with his state of health, ability to work, personal inclinations and desires. Includes: medical and social expertise; professional orientation; preparation of a disabled person for professional work (including vocational training); preparation of production for the use of the labor of disabled people (with the creation of appropriate conditions for their labor activity); measures to ensure employment (employment) of the disabled; dynamic observation and control of the rationality of employment - measures but social and labor adaptation (fixing) of disabled people at work.
In normal production conditions (at ordinary enterprises and ordinary workplaces, together with healthy workers), the employment of disabled people of group III is mainly carried out: in a new profession with the performance of work in full; in the former profession with a decrease in the volume of work or with a decrease in qualifications. In specially created conditions, the employment of disabled people of groups 1 and 2 is mainly carried out: at special workplaces; in special workshops, special stages, at specialized enterprises intended for the work of disabled people; at home.
3) Social rehabilitation - a system of social, socio-psychological, pedagogical, legal and economic measures aimed at creating conditions for disabled people to overcome life restrictions and social insufficiency by restoring social skills and connections, achieving free and independent life together and on an equal footing with healthy citizens.
The main document in the current system of rehabilitation of the disabled, on the basis of which a disabled person can receive the rehabilitation services he needs, is an individual rehabilitation program (IPR), which is developed for him in the ITU institution.
The IPR is developed by a rehabilitation specialist with the involvement of expert doctors, a social work specialist, a psychologist and other specialists of the ITU bureau. The IPR is advisory in nature for a disabled person.
The role and place of outpatient clinics in the healthcare system of the Russian Federation. struk tour and performance of the clinic. The main directions of reforming outpatient care. Functions of a general practitioner (family doctor).
The activity of the polyclinic is based on territorial principle, those. provision of medical care to the population living in the assigned territory.
The territorial-district principle gives many advantages in organizing medical care for the population, the main of which is the full awareness of the polyclinic and individual doctors about the population, i.e. about the demographic situation, morbidity, living conditions, work, etc.
The modern polyclinic is a large multidisciplinary, specialized medical institution designed to provide medical care and implement a set of preventive measures to improve the health of the population and prevent diseases.
Functions of the clinic:
1. Providing first aid for acute and sudden illnesses, injuries
2. Treatment of patients when contacting the clinic and at home
3. Organization of medical examination
4. Examination of temporary disability, release of patients from work and referral for medical and social examination of persons with signs of permanent disability
6. Timely hospitalization of those in need of inpatient treatment.
The main structural divisions of the polyclinic:
1. Polyclinic management
2. Registration
3. Department of prevention
4. Treatment and prevention units (therapeutic, surgical, traumatological and other specialized departments and offices)
5. Auxiliary diagnostic and treatment departments (X-ray department, laboratory, department of functional diagnostics, physiotherapy, etc.).
6. Cabinet of accounting and medical statistics
7. Administrative and economic part
Currently, the structure of the polyclinic may include a day hospital, an emergency department, an outpatient surgery center and other services.
Functions precinct doctor:
1. Provision of timely therapeutic assistance to the population of the site in the clinic and at home
2. Provision of emergency medical care to patients who applied
3. Timely hospitalization of therapeutic patients
4. Consultation of patients, if necessary, with specialists
5. Use in their work of modern methods of prevention, diagnosis and treatment of patients
6. Conducting an examination of temporary disability
7. Dispensary observation
8. Organization and conduct of preventive examinations
9. Early detection, diagnosis and treatment of infectious diseases
10. Conducting an examination of working capacity
11. 11 preventive work on site
12. Medical care for patients at home
Main indicators work polyclinics
There are many indicators of the work of the polyclinic, the most basic ones.
(1) Indicators of provision of the population with outpatient care
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Temporary disability refers to such conditions of the body when the disorders caused by the disease and making it difficult to perform professional duties are reversible, transient. The study of morbidity with temporary disability of various contingents of the working population is of great scientific and practical, as well as economic importance.
Features of the work of individual professional groups of engineers have a "specific" impact on their health. A large share in the structure of diseases of employees is occupied by diseases of cardio-vascular system, nervous system and others. The emergence of these diseases is facilitated not only by the modern lifestyle of the urban population, a decrease in the level physical activity, which is most strongly manifested in the engineering and technical group, but also the features of labor activity.
We have conducted a study of the incidence of temporary disability of engineers and managers of the plant management and the main workshops of the plant by registering cases and the number of days of temporary disability in special "Cards for the study of temporary disability". 1261 people were under observation.
The bulk of the employees in both groups were persons with 5-9 and 10-19 years of work experience at the enterprise - 67.9% and 64.9%, respectively. Among the engineering and technical personnel of shop services, there were more persons with work experience of more than 10 years (76.0%) than those of plant management engineers (61.7%), and those with more than 20 years of experience - 26.3% and 16.8%, respectively. When comparing indicators of temporary disability, we took into account these differences, calculated standardized indicators in a direct way by gender and length of service. The composition of the engineering staff of the plant management by gender and length of service was adopted as a standard.
When comparing the levels of morbidity with temporary disability for all diseases over the 5 years studied, it turned out that they remained higher among the engineering workers of shop services than those of the factory management engineers.
Standardization by gender and length of service did not change the ratio of indicators of temporary disability.
Temporary disability, both in terms of the number of cases and by days, in all the years studied was higher for the engineering workers of shop services than for the engineering workers of the plant management. The average level of incapacity for work among the engineering and technical personnel of shop services was 79 cases, 790 days, and for the engineering and technical personnel of the plant management, respectively, 74 cases and 676 days per 100 employees. It should be noted that as a result of the prophylactic medical examination of this contingent carried out under our leadership, the incidence of morbidity with temporary disability has somewhat decreased over the years indicated.
The increased morbidity of engineering and technical workers in shop services is explained by less favorable working conditions than in factory management. Engineers and heads of shop services from 15 to 40% of the working time are in the shops, and foremen and section chiefs - up to 60% of the working time.
The engineering and technical workers of the shops are likely to develop diseases that are characteristic of the respective industries. So, at the engineering and technical departments of machine shops, where the concentration in the air is high working area aerosols of coolant, during medical examinations revealed a tendency to diseases of the upper respiratory tract(pharyngitis, laryngitis, etc.). Among the causes of disability of engineers and managers, influenza, acute respiratory viral infections, pneumonia and other respiratory diseases. Of the listed nosological forms, the incidence rates of pneumonia and chronic respiratory diseases are slightly higher among engineers and managers of shop services - 2.27 cases and 41.8 days per 100 workers versus 1.4 cases and 25.7 days of disability among engineers and plant management managers ( Table 1).
Standardization by gender and length of service did not change the ratio of indicators. The composition of the engineering and technical staff of the plant management was adopted as a standard. So, for influenza, temporary disability with standardization by gender for engineering and technical personnel of shop services was 11.4 in cases, 64.5 in days, and 12.3 and 67.6 in terms of length of service, respectively. The same picture for pharyngitis and tonsillitis, pneumonia and chronic diseases respiratory system, disease gastrointestinal tract, sensory organs, nerves and peripheral ganglia and some other diseases.
Table 1
Standardized by gender and length of service indicators of temporary disability of engineers and managers of plant management and shop services (per 100 employees)
|
Name- ing diseases | Groups | Temporary disability, in cases | |||
|
inten- gray show- body |
standard- tyz. on semi |
standard- teez by seniority |
|||
| 1 | Flu | Plant-up management | 8,6 | 8,6 | 8,6 |
| Shop services | 10,2 | 11,4 | 12,3 | ||
| 2 | Acute forms tonsil- litas | Plant-up management | 6,1 | 6,1 | 6,1 |
| Shop services | 6,8 | 7,3 | 8,2 | ||
| 3 | Pneumo- nii and chro- nothing care- a lion. org- new dy- chania | Plant-up management | 1,4 | 1,4 | 1,4 |
| Shop services | 2,3 | 2,6 | 2,7 | ||
| 4 | Diseases stomach and 12-finger. guts | Plant-up management | 2,1 | 2,1 | 2,1 |
| Shop services | 3,2 | 3,3 | 3,5 | ||
| 5 | Hyper- nic disease | Plant-up management | 2,0 | 2,0 | 2,0 |
| Shop services | 1,1 | 1,5 | 1,6 | ||
| 6 | Diseases bodies feelings | Plant-up management | 1,7 | 1,7 | 1,7 |
| Shop services | 2,5 | 2,7 | 2,8 | ||
| 7 | Ishemi- chesky disease hearts | Plant-up management | 0,7 | 0,7 | 0,7 |
| Shop services | 1,1 | 1,8 | 1,9 | ||
| 8 | Diseases nerves and periphery rical ganglia | Plant-up management | 0,25 | 0,25 | 0,25 |
| Shop services | 4,86 | 5,3 | 5,5 | ||
Thus, the morbidity rate with temporary disability of the engineer of shop services for the above nosological forms of diseases, even with the same gender and length of service, would be higher than the engineer of plant management, as evidenced by standardized indicators.
Further study of temporary disability was carried out by us in a professional context. The engineering staff of the enterprise was divided into 3 professional groups: managers, engineers and foremen.
The age and sex characteristics of these groups have already been mentioned in the section characterizing the incidence according to the data of negotiability.
The study of temporary disability of persons belonging to the indicated professional groups showed that the highest average long-term levels of it were revealed in the group of engineers, in the second place - foremen, in the third - managers (Table 2).
table 2
Temporary disability of engineers and managers (per 100 employees)
|
№ pp |
Professional- groups | Intensive indicators |
Standardized indicators |
|||||
| in cases | in days |
v cases |
v days |
|||||
|
on semi |
on seniority |
on semi |
on one hundred zhu |
|||||
|
Leaders | ||||||||
|
Engineers | ||||||||
Standardization of indicators of temporary disability by sex and age showed that with the same age and sex composition as managers, the temporary disability of engineers and foremen would be even higher. The higher level of temporary disability of persons of these professional groups compared to managers is explained by the significant frequency of influenza, SARS and colds, the spread of which is due to high crowding in the office, where one worker has less than 4.5 m2 of area. The reason for the low rates of temporary disability among managers is a great responsibility, lack of time, and therefore they do not always apply for medical care and, as a rule, do not draw up a certificate of incapacity for work.
In this study, we were primarily interested in the frequency of temporary disability due to cardiovascular diseases. In the structure of the causes of temporary disability of managers for this group of diseases, the first place belongs to vascular diseases (40.9% of cases and 40.5% of days), the second - to hypertension (29.1% of cases) and coronary disease(21.3% of days). Vascular diseases (40.5% of cases and 27.0% of days), hypertension (respectively 35.5% and 25.4%) were also the main causes of temporary disability of engineers. Temporary disability of masters is due to hypertension(60.0% of cases and 66.9% of days), as well as rheumatism (respectively 23.3% and 14.5%).
As can be seen from Table. 3, the temporary disability of managers due to cardiovascular diseases in cases is more than twice as high, in days - 2.5-4.9 times higher than the same indicator for engineers and craftsmen. Managers get sick more often and longer than engineers and foremen with vascular diseases, hypertensive and coronary heart disease. The average duration of one case of coronary heart disease among managers stands out especially sharply - 38.9 days, while this figure was 17.4 days for engineers, 18.5 days for foremen, although the number of cases of temporary disability of managers and engineers is approximately the same. This indicates a significant severity of coronary heart disease in managers.
Table 3
Temporary disability of various groups of managers and engineers for cardiovascular diseases (per 100 employees)
|
№ |
This type of special accounting was introduced for the registration of diseases among workers and covers cases of illness accompanied by temporary disability (TSD). Morbidity with VUT is important both for assessing the health of the working population, as well as economic and social.
The Council of Ministers of the Republic of Belarus adopted Decree No. 664 dated May 6, 1999 “On the establishment of state statistical reporting on the causes of morbidity among the employed population with VUT”. approved by the Ministry of Statistics and Analysis State statistical reporting by f. No. 16-VN "Report on the causes of morbidity of the employed population with temporary disability." The Ministry of Health has compiled a "List of diseases, injuries and other causes of temporary disability" (LL), adapted to the ICD-10.
To conduct a statistical analysis of morbidity with VUT, medical institutions must ensure that diagnoses are encrypted in medical records (disability certificates) based on ICD-10.
The study of morbidity with VUT is carried out continuous method. Unit of account- each case of disability due to illness in a worker in a given year. Primary accounting document- "Sick leave certificate", which is filled in by a doctor of a health facility and presented to those working at their place of work. Cause Report population with VUT according to f. 16-VN is filled in by enterprises, institutions, organizations on the basis of the encryption of the final diagnosis in the disability certificate at the end of the case of VN. The data of this report allow us to calculate indicators characterizing the incidence with VUT.
The calculation of indicators can be carried out in general according to the reporting form, for line 69 "Total for diseases" and for each line (diagnosis).
The main indicators for the analysis of morbidity with VUT.
1) the number of cases of disability per 100 employees:
List number of employees - (number of employees as of 1.01 + number of employees as of 31.12) /2
In the Republic of Belarus in 2004, there were 65 diseases per 100 employees.
2) the number of days of disability per 100 employees
In the Republic of Belarus in 2004, for 100 employees - 692 days of temporary work.
3) average duration one case of morbidity with VUT:
4) structure of morbidity with VUT (in cases and days):
In the analysis of morbidity with VUT, these indicators represent not only general view, but also for individual diseases, workshops, professions, etc.
Form 16-VN does not allow an in-depth study of the incidence among workers, since this reporting document does not contain information on the number of sick people, on the frequency of diseases in each worker. This is possible on the basis of police records of morbidity according to special personal cards filled out for each worker. Such accounting allows you to identify frequently and long-term sick people and calculate the “health index”:
5) the proportion of those who have never been ill (“health index”):
Year-round worker - who has worked at this enterprise for at least a year.
6) the proportion of those who are often (long-term) ill:
7) the proportion of those who are often and long-term ill:
TO Often ill include workers who had 3 or more cases of disability during the year for homogeneous diseases or 4 or more cases for heterogeneous diseases. TO Long-term ill- who had 30 or more days of disability for homogeneous diseases or 40 or more days for heterogeneous diseases. Some of the workers do not have cases of disability, a significant part is ill 1-2 times a year, and only a small number of workers are ill 4 or more times a year. The share of frequently and long-term sick people gives the largest number of days of incapacity for work.
8) multiplicity of diseases - the number of diseases per 1 patient:
9) the percentage of incapacity for work (the percentage of persons who conditionally did not work in the reporting year):
To identify patterns, morbidity rates with VUT are calculated by sex, age; professions, workshops, etc.
Levels and structure of morbidity with VUT in the Republic of Belarus in 2004.
1) The structure of morbidity by the number of cases of disability(per 100 employees)
1st place: ORI - 22.91
2nd Place: Nursing - 12.97
3rd place: traumatic injuries of the limbs - 5.86
4th place: neurological manifestations of lumbar and thoracic osteochondrosis - 5.06
2) The structure of morbidity by the number of days of disability(per 100 employees):
1st place: ORI - 143 days
2nd place: traumatic injuries of the limbs - 110.66 days
3rd Place: Nursing - 88.59 days
4th place: neurological manifestations of lumbar and thoracic osteochondrosis - 51.87 days
Incidence with temporary disability (TD) is the frequency of all cases (days) of disability due to illness, injury or other health-related medical problems among certain groups of the working population.
In accordance with the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens (1993), normative and methodological materials have been developed to improve the examination of temporary disability (TS) - the right of a citizen of the Russian Federation to the secrecy of information about his illness has been implemented. In the primary accounting document (sick leave), which is payable at the place of work, there is no information about the diagnosis of the disease, and only the cause of temporary disability is indicated.
Since 1996, an accounting document "Coupon for a completed case of temporary disability" has been introduced with information about the patient's diagnosis.
The methodology for studying MTD has the following features:
- the emphasis in organizing the study of VL (collection of information, processing and analysis) is shifted to health facilities. However, this does not exclude the study and analysis of MTD in enterprises that have medical units or other forms of departmental medical care;
- the second feature is the use of MTD indicators: in the new methodology, MTD indicators are supposed to be used more widely to assess the quality of medical care; organization of examination of VN;
- due to significant changes in the production sector and the loss of the principle of medical care for workers, taking into account adverse conditions and characteristics of work, the analysis of MTD indicators presents certain difficulties;
- unfortunately, the methodology for studying the MTD according to f. 16-VN in polyclinics and hospitals makes it possible to analyze the health status of the working contingent only taking into account the most significant biological factors (gender and age).
The unit of observation is each completed case of VL during the year.
Accounting documents and rules for filling them out
The certificate of incapacity for work has statistical, legal and financial significance. The front side of the form is filled in by the attending physician (middle medical worker with a license), the reverse side - by the enterprise where the patient works. Columns "diagnosis" and "final diagnosis" are not filled; in the column "cause of incapacity for work" the type of incapacity for work "disease", "injury", "health resort treatment", etc. is underlined or recorded. In the section "release from work" the days of incapacity for work are recorded.
The coupon for a completed case of VL contains, in addition to the patient's passport data, information about the cause of VL, including the final diagnosis indicating the disease code according to the ICD X revision. The final diagnosis is the underlying disease that caused (reason) temporary disability.
The total number of days of incapacity for work includes the total number of days on the occasion of VN, regardless of the number of issued certificates of incapacity for work.
All coupons are collected, encrypted, combined and developed using computer technology. The report "Information on the causes of temporary disability for ____year" for further statistical generalization is provided to the Bureau of Statistics of the Health Department (medical information and analytical centers).
Based on the data of the report on f. 16-VN, containing information on all cases and days of disability, it is possible to study, basically, the structure and levels of VN as a whole for all types of VN, by sex, age, individual groups of diseases, in dynamics by years, regions (Table 1) .
Table 1. MTD indicators calculated according to the report f. 16-VN and their application
| Indicator | Where and by whom are used | ||
| I. health care facility | II. Territory health authority | III. Russian Health Authority | |
| The structure of cases (days) of disability for reasons of VL | To establish the most significant reasons VN diseases, economic losses | ||
| Structure of VL cases by diseases (classes of diseases) | For further study of the frequency of VL by contingents of workers, industries | -||- | |
| The structure of VL cases by sex and age, both in general and for individual causes, diseases | To study distributions by sex and age | To establish the effect of gender and age on the incidence of VUT; determining their significance | -||- |
| The average duration of the case of LN, both in general and for individual causes, diseases | To assess the quality of medical care. assistance, examination of VN, by doctors, department, institution. Assessment can be carried out according to indicative terms (standards) | To organize quality control of honey. help and expertise | |
| The number of cases of VN per 100 average annual employees (in general, form 16-VN, by individual classes, diseases, sex, age) * | To establish VL trends | To establish dynamics for individual health facilities; gender, age | To establish dynamics for individual regions |
| Number of TS days per 100 average annual employees (as a whole by disease, sex)* | * Used if there is information on the number of employees in the service area of the health facility | ||
However, the introduction of new information systems and programs allowed to receive full information about temporarily disabled persons, which is very important not only for establishing causal relationships, but, first of all, for organizing departmental and non-departmental quality control of medical services, controlling economic losses due to diseases, injuries and other causes.