The anti-tuberculosis service consists of a network of state, specialized, independed medical establishments, which basic task is struggle with tuberculosis. Leading administrative establishment of this network is anti-tuberculosis dispensary. The anti-tuberculosis dispensary supervises over all parts of medical and preventive measures. Dispensaries are organized by a territorial principle. In small cities there is one dispensary. In large cities one dispensary serves one or two areas with the population from 200000 up to 400000 inhabitants. Dispensary provides with the treatment-diagnostic help of the inhabitants of the given area, and also all workers and employees of the enterprises, establishments, educational institutions, located on dispensary territory.
The basic objective of the dispensary is regular decrease of the tuberculosis incidence, morbidity, infectiousness and mortality among the population of served area. For achievement of this purpose dispensary should study well the area of its responsibility in the sanitary, socio economic attitude, have close contact to all treatment-preventive and sanitary establishments. Every anti-tuberculosis dispensary in territory of its authority provides functioning of the centralized control system based on two principles:
- unification of measures on revealing, diagnostics, treatment of tuberculosis according to the instruction on dispensary organization, supervision and registration of tuberculosis patients in anti-tuberculosis establishments;
- differentiation of the specified measures allowing to develop individual plan of supervision of each patient in urban and rural territories depending on geographical and economic features, condition of the communications, way of life and other social conditions, character tubercular process at the patient and other.
For the achievement of the basic objectives dispensary realizes the following actions:
- Organization and realization preventive activities:
- Anti-tuberculosis vaccination and revaccination.
- Improvement of the tubercular local centers by duly and long hospitalization MBT positive patients.
- Improvement of housing conditions of the patients representing epidemiological danger.
- Organization of chemoprophylaxis in (places) areas of tubercular infection among contacts.
- Admission of infected children to sanatorium.
- Sanitary – educational work with the population.
- Revealing the patients with (early symptoms of tubercular illness).
- Organization and realization skilled and successive treatment of the tuberculosis patients in outpatient and stationary conditions for achievement of clinical treatment. Organization of controllable treatment in outpatient and home conditions.
- Introduction of knowledge about tuberculosis among the doctors and paramedical personal in the responsible area.
Structure of the dispensary.
Dispensary should have following departments and cabinets:
- Therapeutical’s department for treatment of the adult tuberculosis patients.
- Child department, in which children from 3 up to 15 years are treated.
- Cabinet of bone-joint tuberculosis.
- Bronchological cabinet.
- Roentgenological cabinet.
- Laboratories: clinical and microbiological.
- Procedural cabinet.
- Stomatologic cabinet.
- Fluorographic station.
- Day tuberculosis inpatient facility.
In large dispensary it is recommended the organization of consultations of urologist, gynecologist, dermatologist and oculist.
The lung surgery in Russian Federation provided in large tubercular hospitals, where the lung surgical departments equipped with necessary instrumentation.
At every dispensary, where is present in patient department, it is recommended to organize a labor workshops, in which the patients at restoration of work capacity could be engaged in dosed work under the direction of the instructor or get a new specialty appropriate to their physical condition.
Organization of medical service. The open reception in dispensary is not present. At suspicion of tuberculosis, the patient directed to dispensary from regional polyclinic bye general doctor, surgeon, neuropathologist, pediatrician, school doctor or medical assistant of health point. Besides, to the important methods of duly revealing of the tuberculosis patients is preventive fluorographic examination.
Fluorography is a way of mass, fast and cheap examination of chest organs among the large groups of the population. At detection of changes in lungs, fluorographic cabinet directs the patients for diagnostics to dispensary. The early recognition of disease is possible only at preventive one and all examination of the practically healthy people.