Unofficial translation
In accordance with subparagraph 81) of Article 7 of the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System” as of July 7, 2020, I hereby ORDER:
1. To approve the rules for the provision of medical care using mobile health units and medical trains in accordance with the appendix to this order.
2. In the manner prescribed by the legislation of the Republic of Kazakhstan, the Medical Aid Department of the Ministry of Healthcare of the Republic of Kazakhstan shall ensure:
1) the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;
2) the posting of this order on the website of the Ministry of Healthcare of the Republic of Kazakhstan;
3) the submission of information on the implementation of the measures provided for in subparagraphs 1) and 2) of this paragraph to the Legal Department of the Ministry of Healthcare of the Republic of Kazakhstan within ten working days of the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan.
3. Control over the execution of this order shall be entrusted to the supervising deputy minister of healthcare of the Republic of Kazakhstan.
4. This order comes into effect ten calendar days of its official publication.
|
Minister of Healthcare of the Republic of Kazakhstan |
A.Tsoi |
| Approved by Order № KR DSM-241/2020 of the Minister of Healthcare of the Republic of Kazakhstan as of December 8, 2020 |
Rules
for the provision of medical care using mobile health units and medical trains
Chapter 1. General provisions
1. These rules for the provision of medical care using mobile health units and medical trains (hereinafter referred to as the Rules) have been developed in accordance with subparagraph 81) of Article 7 of the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System” as of July 7, 2020 (hereinafter referred to as the Code) for ensuring the availability of primary healthcare and specialized medical care at the level of rural healthcare.
2. The terms and definitions used in these Rules are as follows:
1) specialized professional - a medical worker with a higher medical education who has a certificate in the field of healthcare;
2) diagnostics - a complex of medical services aimed at establishing the presence or absence of a disease;
3) dynamic observation - systematic observation of the patient’s health, as well as the provision of the necessary medical care based on the results of this observation;
4) planned medical care - medical care provided for diseases and conditions that are not fraught with a threat to the patient’s life, a delay in the provision of which for some time will not entail a deterioration in the patient’s condition, as well as during preventive measures;
5) mobile health units (hereinafter - MHU) - mobile clinics (offices) physically based at road transport, equipped with the necessary medical equipment, which are used to ensure the availability and expansion of the list of medical services provided to the population of rural areas and remote settlements or in the interests of defense and national security;
6) emergency medical care - medical care provided in case of sudden acute diseases and conditions, exacerbation of chronic diseases that do not pose an obvious threat to the patient’s life;
7) Quetelet index - an indicator for assessing the harmony of the physical development of the body, the ratio of body weight to height;
8) specialized medical care - medical care provided by specialized professionals in relation to diseases requiring special methods of diagnosis, treatment, medical rehabilitation, also using telemedicine services;
9) medical trains (hereinafter - MT) - mobile clinics physically based at railway transport, equipped with the necessary medical equipment, used to ensure the availability and expansion of the list of medical services provided to the population living near railway stations (tracks) and in the areas close to them;
10) primary healthcare (hereinafter - PHC) - the place of first access to medical care focused on the needs of the population, including prevention, diagnosis, treatment of diseases and conditions provided at the level of an individual, family and society;
11) healthcare information system (hereinafter - HIS) - an information system that ensures the management of processes of healthcare entities in electronic format;
12) screening studies - a complex of medical examination of the population without clinical symptoms and complaints, in order to identify and prevent the development of various diseases at an early stage, as well as risk factors for their occurrence;
13) BI-RADS classification - analysis and logging of the results of radiation studies of the breast - standardization of descriptions of mammographic studies;
14) coordinating center - a structure formed on the basis of a medical facility and appointed by local public health authorities to coordinate the activities of the MHU and (or) MT at the regional level (provision of activities, staffing with specialists, medical devices and medicines) (hereinafter - the Coordinating Center);
15) filter room (registration area) - the place of registration and for the initial examination of the patient;
16) informed consent - a procedure for a person’s written voluntary confirmation of his/her consent to receive medical care and (or) participation in a specific study after receiving information about all aspects of medical care and (or) research that are significant for his/her decision-making. Informed written consent is drawn up in the form approved by the authorized body in the field of healthcare;
17) emergency medical care - medical care provided in case of sudden acute diseases and conditions, exacerbation of chronic diseases requiring urgent medical intervention to prevent significant harm to health and (or) eliminate the threat to life.
Chapter 2. Procedure for the provision of medical care using mobile health units and medical trains
3. An indication for the provision of medical care using mobile health units and (or) medical trains (hereinafter referred to as MHU and (or) MT) is the need to promote health, to provide services for the prevention, treatment and rehabilitation for the rural population at all levels of rural healthcare outside a medical facility.
4. Medical assistance of the MHU and (or) MT is provided:
1) within the guaranteed volume of free medical care;
2) in the system of compulsory social health insurance.
5. Medical care through the MHU and (or) MT is provided without a referral from a PHC specialist, after obtaining the written voluntary consent of the patient or his/her legal representative for invasive interventions in accordance with paragraph 3 of Article 134 of the Code.
6. The list of medical services provided by the MHU and (or) MT includes:
1) consultative visit of specialized professionals, including patients with chronic diseases according to the list of diseases subject to dynamic observation by primary healthcare entities, in accordance with paragraph 2 of Article 88 of the Code;
2) screening studies and rehabilitation of the target population by specialists of a MHU and (or) MT, with the subsequent transfer of the identified cases with diseases for further dynamic monitoring at the PHC level in accordance with paragraph 2 of Article 87 of the Code.
7. For the provision of medical care using MHU and (or) MT, an involved medical worker of the PHC entity of a populated locality in the service area of a MHU and (or) MT:
1) makes lists of persons from the registered population subject to screening tests;
2) notifies persons of the target group from among the registered population about the need for screening tests, indicating the volume;
3) fixes the time and schedule of examination of persons subject to screening, also by specialized professionals in accordance with the work schedule of the MHU and (or) MT in this populated locality;
4) before the arrival of the MHU and (or) MT, conducts the first stage of screening for early identification of diseases (of the circulatory system, glaucoma, cancer of the cervix, breast, colorectal cancer and viral hepatitis B and C) and enters the data into the HIS in the required form;
5) registers persons who were invited and passed screening tests, and received consultative and diagnostic services at the MHU and (or) the MT;
6) provides assistance to specialists of the MHU and (or) MT in carrying out diagnostic and laboratory studies;
7) refers persons of the target group having risk factors for diseases based on the screening results to health schools by profile;
8) together with specialists in the formation of a healthy lifestyle, participates in training people with risk factors for diseases and patients in methods of prevention, formation of a healthy lifestyle;
9) enters data of patients, information on medical services provided in the HIS in accordance with the approved forms of recording and reporting documentation in the field of healthcare.
8. After providing specialized medical care in the conditions of the MHU and (or) MT, the specialized professional issues a preliminary medical opinion to the patient, which indicates the preliminary diagnosis, the results of the examination and treatment, as well as the reason for the referral.
9. In the absence of necessary instrumental and laboratory medical devices in the conditions of the MHU and (or) MT, a patient in need of specialized care, including high-tech medical care, is referred to a healthcare entity according to the profile of the disease for further examination and correction of treatment.
10. In the filter room (registration area):
1) patients are registered by filling in their passport data (surname, name, patronymic, if any, an individual identification number, date and year of birth and anthropometric data);
2) patients are subjected to physical examination: their general condition is determined, body temperature, blood pressure (hereinafter referred to as BP), heart rate (pulse), respiratory rate are measured and the saturation is determined;
3) anthropometric measurements (weight, height, waist) are made, calculated using the Quetelet index;
4) questionnaire survey;
5) double measurement of BP with an interval of 1-2 minutes in a sitting position. Before measuring BP, the examined person sits for 3-5 minutes.
11. In the general reception room, a therapist and (or) general practitioner:
1) examines a patient, collects complaints, anamnesis of life and disease, makes objective examination and a preliminary diagnosis;
2) identifies risk factors for diseases of the circulatory system, diseases of the respiratory system, digestion, the endocrine system, blood and hematopoietic organs, as well as other organs and systems;
3) prescribes and corrects treatment;
4) takes preventive measures to promote the formation of a healthy lifestyle;
5) provides qualified medical care to persons under dynamic observation with chronic non-communicable diseases in accordance with regulatory legal acts regulating the dynamic observation of persons with chronic non-communicable diseases using the laboratory diagnostic resources of the MHU and (or) MT;
6) issues a prescription for receiving free and subsidized medicines at the outpatient level;
7) enters the data of patients who received medical care in the HIS in accordance with the approved forms of recording and reporting documentation;
8) provides the relationship with the telemedicine center of the district, regional levels for consulting a specialized professional and interpreting the result of a diagnostic study;
9) organizes medical triage in case of emergency.
12. In the functional diagnostics room:
1) ultrasound examination of the heart, abdominal organs, small pelvis, thyroid gland is made;
2) electrocardiographic examination of the heart is made and read;
3) echoencephalography of the brain is made and read;
4) the data of patients who were subjected to medical research are entered in the HIS in accordance with the approved forms of recording and reporting documentation.
13. In the room of an obstetrician-gynecologist, an obstetrician-gynecologist:
1) makes a primary gynecological examination of the target group of women and samples material for cytological examination of a smear from the cervix with Papanicolaou stain (Rap stain);
2) makes colposcopy according to indications;
3) examines mammary glands to identify tumor pathology;
4) reads the mammogram and interprets it according to the BI-RADS classification;
5) identifies diseases of the reproductive system in women;
6) if necessary, provides emergency obstetric and gynecological assistance;
7) promotes the formation of a healthy lifestyle in terms of reproductive health;
8) examines persons of the dispensary group with complications of pregnancy, childbirth and the postpartum period;
9) if necessary, prescribes or corrects treatment, refers for further examination and determination of treatment tactics to the registered polyclinic, including using the capabilities of telemedicine;
10) provides information to the head of the Coordinating Center on existing or emerging problems related to the performance of screening;
11) is directly involved in determining the management tactics of identified patients with pathology of the reproductive system.
14. In the room of specialized professionals, a surgeon, otorhinolaryngologist, ophthalmologist:
1) make screening for the early identification of tumors of visual localization (prostate cancer, rectal cancer);
2) make early diagnosis and prevention of diseases of the eyes, hearing organs and upper respiratory tract;
3) perform outpatient surgical operations (otorhinolaryngological);
4) provide emergency trauma and surgical assistance in emergency situations;
5) promote the formation of a healthy lifestyle.
15. In the laboratory diagnostics room, a laboratory doctor or laboratory assistant:
1) examines the level of glucose in the blood, the level of cholesterol, blood triglycerides;
2) makes biochemical studies: general, prima bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, urea, total protein, potassium, sodium;
3) makes other clinical and biochemical studies prescribed by MHU and (or) MT specialists;
4) makes general clinical urine examination (general urine analysis);
5) enters the results of the research into the HIS in accordance with the approved forms of reporting and reporting documentation in the field of healthcare.
16. In the X-ray and mammography room, the specialists of radiation diagnostics conduct research for:
1) early identification of precancerous and neoplastic diseases of the breast;
2) diagnosing tuberculosis, lung tumors and other chronic lung diseases;
3) diagnosing traumatic injuries in the context of emergency medical care;
4) enter the results of the research into the HIS in accordance with the approved forms of recording and reporting documentation in the field of healthcare.
17. In the dentist’s room:
1) dental (surgical) care (sanitation, diagnosis, treatment, surgical treatment with removal, diagnosis of anomalies of the dentition) is provided to children and adults;
2) hygienic education and upbringing of children and adolescents, prevention of caries and its complications are carried out;
3) preventive and explanatory work is carried out to prevent anomalies of the dentition.
18. In the “pharmacy point” room, a senior pharmacist (pharmacist) provides storage of medicines and medical devices necessary for specialists of the MHU and (or) MT in providing medical assistance to the population in the service area of the MHU and (or) MT.
19. To coordinate the activities of the MHU and (or) the MT at the regional level (provision of activities, staffing with specialists, medical devices and medicines), the local public health authorities set up and determine a Coordinating Center on the basis of a medical facility.
20. MHU and (or) MT offices are provided with material and technical equipment in accordance with Appendix 1 to these Rules.
21. Staff standards of the MHU and MT are determined in accordance with Appendix 2 to these Rules.
| Appendix 1 to the rules for the provision of medical care using mobile health units and medical trains |
Material and technical equipment of rooms of a mobile health unit and a medical train
№ | Name |
Reception or filter room | |
1 | two chairs and one table with a table lamp |
2 | computer (laptop) |
3 | hanger and (or) hooks for the patient’s clothes |
4 | 0.4*0.4 m floor mats for patients |
5 | wall-mounted dispenser (sanitizer) |
6 | a screen or partition for the separation zone |
7 | thermometer |
8 | pulse oximeter |
9 | blood pressure monitor |
10 | phonendoscope |
11 | recirculator |
12 | waste container |
13 | stadiometer |
14 | floor scales |
General reception room (general practitioner, therapist) | |
1 | two chairs and one table with a table lamp |
2 | hanger and (or) hooks for the patient’s clothes |
3 | 0.4*0.4 m floor mats for patients |
4 | wall-mounted dispenser (sanitizer) |
5 | a screen or partition for the separation zone |
6 | blood pressure monitor |
7 | phonendoscope |
8 | slit lamp |
9 | patient card |
10 | recirculator |
11 | folding couch 1.8m*0.5m |
12 | wall cabinet (anti-shock installation) |
13 | computer (laptop) |
Obstetrician-gynecologist’s room | |
1 | wall-mounted dispenser (sanitizer) |
2 | gynecological examination table |
3 | one mobile height-adjustable doctor’s chair |
4 | sink with water supply |
5 | screen for undressing |
6 | two chairs and a table with a table lamp |
7 | hanger and (or) hooks for the patient’s clothes |
8 | 0.4*0.4 m floor mats for patients |
9 | mirror wall |
10 | table for medical instruments |
11 | gynecological instrument set |
12 | electrothermometer |
13 | two containers for clean and dirty waste |
14 | wall cabinet for storing linen |
15 | recirculator |
16 | video coloscope |
17 | stadiometer, centimeter tape |
18 | computer (laptop) |
Room of a surgeon (ophthalmologist, otorhinolaryngologist) | |
1 | two chairs and a table with a table lamp |
2 | sink with water supply |
3 | hanger and (or) hooks for the patient’s clothes |
4 | 0.4*0.4 m floor mats for patients |
5 | wall-mounted dispenser (sanitizer) |
6 | wall cabinet for medical devices |
7 | a screen or partition for the separation zone |
8 | thermometer |
9 | blood pressure monitor |
10 | phonendoscope |
11 | otoscope |
12 | ophthalmoscope |
13 | non-contact fundus tonometer |
14 | patient card |
15 | recirculator |
16 | waste container |
17 | sigmoidoscope |
18 | dressing table |
19 | transportation splints for immobilization |
20 | computer (laptop) |
21 | examination table |
Functional diagnostics room | |
1 | one table with a table lamp |
2 | one mobile height-adjustable doctor’s chair |
3 | hanger and (or) hooks for the patient’s clothes |
4 | 0.4*0.4 m floor mats for patients |
5 | sink with water supply |
6 | wall-mounted dispenser (sanitizer) |
7 | patient card |
8 | recirculator |
9 | electrothermometer |
10 | 1.8m*0.5m folding couch |
11 | 6-channel electrocardiograph |
12 | portable ultrasound diagnostic apparatus (scanners) |
13 | echoencephalography examination of the brain with reading |
14 | waste container |
15 | computer (laptop) with printer |
Laboratory diagnostics room | |
1 | one chair and a table with a table lamp |
2 | one mobile height-adjustable doctor’s chair |
3 | screen or partition for the separation zone |
4 | sink with water supply |
5 | mirror |
6 | wall-mounted dispenser (sanitizer) |
7 | recirculator |
8 | refrigerator for storage of reagents |
9 | biochemical blood analyzer |
10 | glucometer |
11 | white blood cell counter |
12 | coagulometer |
13 | electrothermometer |
14 | waste container |
15 | urine analyzer |
16 | examination table |
X-ray (mammography) room | |
1 | one chair and one table with a table lamp |
2 | wardrobe |
3 | hanger and (or) hooks for the patient’s clothes |
4 | 0.4*0.4 m floor mats for patients |
5 | wall-mounted dispenser (sanitizer) |
6 | patient card |
7 | recirculator (2 pcs) |
8 | sink with water supply |
9 | waste container 2 pcs. |
10 | digital x-ray machine (mammography) |
11 | wardrobe for special aprons |
12 | computer (laptop) |
Dentist’s room | |
1 | dentist chair |
2 | dental unit |
3 | table for medical instruments |
4 | sink with water supply |
5 | wall mirror |
6 | wall-mounted dispenser (sanitizer) |
Pharmacy | |
1 | one chair and one table with a table lamp |
2 | sink with water supply |
3 | wall-mounted dispenser (sanitizer) |
4 | refrigerator for storing medicines |
5 | wall cabinet for medical devices |
6 | electrothermometer |
7 | recirculator |
8 | waste container |
| Appendix 2 to the rules for the provision of medical care using mobile health units and medical trains |
Staff standards for a mobile health unit and a medical train
Staff standards for a mobile health unit | ||
№ | Position | Number |
The mobile team includes | ||
1 | Head of MHU | 1 staffing position |
2 | Therapist and (or) general practitioner | 2 staffing positions |
3 | Surgeon | 1 staffing position |
4 |
Otolaryngologist | if required |
5 | Obstetrician-gynecologist | 1 staffing position |
6 | Radiologist and (or) X-ray laboratory assistant | 1 staffing position |
7 | Dentist | 1 staffing position |
8 | Doctor-laboratory assistant or laboratory assistant | 1 staffing position (can be replaced by a laboratory assistant who knows the methods of express diagnostics) |
9 | Functional diagnostics doctor | 1 staffing position |
10 | Senior pharmacist (pharmacist) | 1 staffing position |
11 | Driver | 2 staffing positions |
12 | Medical device maintenance engineer | 1 staffing position |
13 | Medical record clerk | 1 staffing position |
14 | Nurse | 2 staffing positions |
Staff standards for a medical train | ||
№ | Position | Number |
The mobile team includes | ||
1 | Head of MHU | 1 staffing position |
2 | Therapist and (or) general practitioner | 2 staffing positions |
3 | Surgeon | 1 staffing position |
4 |
Otolaryngologist | if required |
5 | Obstetrician-gynecologist | 1 staffing position |
6 | Radiologist and (or) X-ray laboratory assistant | 1 staffing position |
7 | Dentist | 1 staffing position |
8 | Doctor-laboratory assistant or laboratory assistant | 1 staffing position (can be replaced by a laboratory assistant who knows the methods of express diagnostics) |
9 | Functional diagnostics doctor | 1 staffing position |
10 | Senior pharmacist (pharmacist) | 1 staffing position |
11 | Medical record clerk | 1 staffing position |
12 | Nurse | 2 staffing positions |
13 | Medical device maintenance engineer | 1 staffing position |
