Proceeding from the analysis of the organization of reception of patients in 4 city polyclinics having 104 therapeutic sectors, the study demonstrated decrease of the amount and breach of continuity of medical care rendered to the residents of the sectors where doctors were absent during the reception. It was proposed to appraise and monitor the work of sector physicians during their reception of patients through a complex indicator of intensity of consultation rates at other medical sectors. The introduced system of extra payment of physicians and paramedical staff for reception of patients from other sectors where the sector physician was absent could raise continuity of care and eliminate patients' complaints and discontent of medical workers.
The analysis of 2-year activity of psychotherapists in medical cooperative led the authors to the following conclusions: psychotherapeutic aid rendered to subjects seeking confidential medical advice was effective (improvement was achieved in 85.3% of the cases after 2 receptions); the number of the visits per each patient was not enough (2.5 visits per 1 patient); the number of the visitors was rather large, only 10% of them had applied for medical advice before; psychotherapeutic service should open new departments in general hospitals and outpatient facilities to provide confidential advice of the psychotherapist.
On the basis of a long-term experience of work of the Children Ophthalmologic Service in Moscow negative aspects of organization of the ophthalmologist's work in the children town polyclinic are shown, and arguments are presented in favor of a proposition to organize an ophthalmologic polyclinical department in basic children polyclinics with introducing medical nurse optometrists [correction of nurses-opticometrists] into the staff of children polyclinics. "A Provisional Statute of a Children Dispensary Polyclinical Department" and a scheme "The Structure of a Children Ophthalmologic Union (Regional, Town, District)" are subjoined.
[Preventive health examinations of pregnant women in Denmark. Anamnestic practice and discussion of prenatal diagnosis in early pregnancy examinations in general practice, birth clinics and birthing centers]
In Denmark, pregnant women are offered antenatal care in a nationwide programme. This programme is organized around health examinations in general practice, hospital outpatient departments and at midwives' centres. During winter 1986-1987, a nationwide investigation of antenatal care was carried out. A random sample of approximately 1/3 of the general practitioners, all of the midwives who had antenatal consultations and the medical staffs of 26 departments of obstetrics and gynaecology received a questionnaire about content of a definite antenatal examination. 62% of the general practitioners, 63% of the doctors at the place of delivery and 86% of the midwives replied. Among the pregnant women, 92% replied from general practice, 84% from hospital outpatient departments and 91% from midwives' centres. The interviews about date of delivery and genetic counselling at early visits in general practice, hospital outpatient departments and at midwives' centres were in agreement with the nationwide guidelines. Employment of routine ultrasound scanning was not associated with less detailed history taking by the doctors at hospital outpatient departments, where ultrasound scanning was employed only on special indications. It was concluded that there was a considerable overlap between the interview about the date of delivery and genetic counselling at early visits in general practice and in hospital outpatient departments and, to some extent, at the midwives' centres. The sharing of responsibility for care of pregnant women by three professional groups requires specification of the content of the consultation. Official guidelines should be more specific about this point.