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Book "Rheumatology. Standards medical care"

ISBN 978-5-9704-4467-2

Part 1 of Article 37 came into force on January 1, 2013 Federal Law No. 323-FZ "On the fundamentals of protecting the health of citizens in Russian Federation", which establishes the norm on the organization and provision of medical care in accordance with the procedures for the provision of medical care, mandatory for implementation on the territory of the Russian Federation by all medical organizations, as well as on the basis of standards of medical care approved by the Ministry of Health of Russia and registered with the Ministry of Justice of Russia.

This reference book contains all the current procedures and standards for the provision of medical care in the field of rheumatology to adults and children. Special attention focused on the application of standards for various types arthritis and arthrosis, systemic lupus erythematosus, dermatopolymyositis, polyarteritis nodosa and other diseases affecting connective tissue. The standards are grouped according to etiopathogenetic principles, which makes it easier to find the necessary information. There is a short reference guide at the end of the book. medicines, specified in the standards, and the corresponding ICD-10 codes.
The publication is intended for rheumatologists, therapists, doctors general practice, clinical pharmacologists, healthcare organizers, employees of compulsory medical insurance and voluntary medical insurance funds, as well as specialists responsible for monitoring the quality and safety of medical activities.

1. Procedures for providing medical care

The procedure for providing medical care to the adult population in the profile of “rheumatology” (order of the Ministry of Health of the Russian Federation No. 900n dated December 22, 2012)

The procedure for providing medical care to children in the field of “rheumatology” (order of the Ministry of Health of the Russian Federation No. 441n dated October 25, 2012, as amended on October 12, 2016)

2. Standards of medical care

Rheumatoid and juvenile arthritis

Standard of primary health care for rheumatoid arthritis (order of the Ministry of Health of the Russian Federation No. 1470n dated December 24, 2012)

Standard of primary health care for children with youthful (juvenile) arthritis (order of the Ministry of Health of the Russian Federation No. 865n dated November 9, 2012)

Standard of primary health care for children with juvenile arthritis with systemic onset (order of the Ministry of Health of the Russian Federation No. 777n dated November 9, 2012)

Standard of specialized medical care for children with juvenile arthritis with systemic onset (order of the Ministry of Health of the Russian Federation No. 668n dated November 7, 2012)

Ankylosing spondylitis and other spondyloarthritis

Standard of primary health care for primary coxarthrosis, rheumatoid arthritis, gout with lesions hip joints, osteonecrosis and glans cysts femur(Order of the Ministry of Health of the Russian Federation No. 1132n dated December 20, 2012)

Standard of primary health care for ankylosing spondylitis, psoriatic arthritis, and other spondyloarthritis (order of the Ministry of Health of the Russian Federation No. 866n dated November 9, 2012)

Standard of specialized medical care for ankylosing spondylitis, psoriatic arthritis, and other spondyloarthritis (order of the Ministry of Health of the Russian Federation No. 687n dated November 7, 2012)

Standard of specialized medical care for ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis (maintenance therapy in day hospital) (Order of the Ministry of Health of the Russian Federation No. 822n dated November 9, 2012)

Standard of specialized medical care for degenerative diseases of the spine and spinal cord(Order of the Ministry of Health of the Russian Federation No. 653n dated November 7, 2012)

Standard for specialized medical care for lesions intervertebral disc and other parts of the spine with radiculopathy ( conservative treatment) (Order of the Ministry of Health of the Russian Federation No. 1547n dated December 24, 2012)

Standard of specialized medical care for children with other spondylosis with radiculopathy, lesions intervertebral disc lumbar and other parts of the spine with radiculopathy, radiculopathy (order of the Ministry of Health of the Russian Federation No. 1202n dated December 20, 2012)

Other diseases primarily affecting the joints

Standard of primary medical care for patients with lumbago with sciatica, low back pain (order of the Ministry of Health of the Russian Federation No. 797 of December 24, 2007)

Primary health care standard for bursitis shoulder joint and (or) humeroscapular periarthritis (order of the Ministry of Health of the Russian Federation No. 1246n dated December 20, 2012)

Standard of primary health care for pseudarthrosis humerus(Order of the Ministry of Health of the Russian Federation No. 1403n dated December 24, 2012)

Standard of primary health care for polyarthrosis (defeat elbow joint) (order of the Ministry of Health of the Russian Federation No. 1474n dated December 24, 2012)

Standard of primary health care for olecranon bursitis (order of the Ministry of Health of the Russian Federation No. 1262n dated December 20, 2012)

Standard of primary health care for arthrosis of the wrist joint and small joints of the hand and foot (order of the Ministry of Health of the Russian Federation No. 1503n dated December 24, 2012)

Standard of primary health care for dysplastic coxarthrosis due to congenital hip dislocation and other dysplastic coxarthrosis (order of the Ministry of Health of the Russian Federation No. 1258n dated December 20, 2012)

Standard of primary health care for post-traumatic coxarthrosis (order of the Ministry of Health of the Russian Federation No. 1108n dated December 20, 2012)

Standard of primary health care for gonarthrosis and similar clinical conditions(Order of the Ministry of Health of the Russian Federation No. 1498n dated December 24, 2012)

Primary health care standard for bursitis knee joint(Order of the Ministry of Health of the Russian Federation No. 1408n dated December 24, 2012)

Standard of primary health care for other enthesopathies (order of the Ministry of Health of the Russian Federation No. 1263n dated December 20, 2012)

Systemic lupus erythematosus

Standard of primary health care for systemic lupus erythematosus (order of the Ministry of Health of the Russian Federation No. 761n dated November 9, 2012)

Standard of specialized medical care for systemic lupus erythematosus (order of the Ministry of Health of the Russian Federation No. 613n dated November 7, 2012)

Standard of medical care for systemic lupus erythematosus (in a day hospital) (order of the Ministry of Health of the Russian Federation No. 654n dated November 7, 2012)

Dermatopolymyositis

Standard of primary health care for dermatopolymyositis (order of the Ministry of Health of the Russian Federation No. 1463n dated December 24, 2012)

Standard of specialized medical care for dermatopolymyositis (order of the Ministry of Health of the Russian Federation No. 617n dated November 7, 2012)

Standard of specialized medical care for dermatopolymyositis (maintenance therapy in a day hospital) (order of the Ministry of Health of the Russian Federation No. 749n dated November 9, 2012)

Systemic sclerosis

Standard of primary health care for systemic sclerosis (order of the Ministry of Health of the Russian Federation No. 1460n dated December 24, 2012)

Standard of specialized medical care for systemic sclerosis (order of the Ministry of Health of the Russian Federation No. 686n dated November 7, 2012)

Polyarteritis nodosa and related conditions

Standard of primary health care for polyarteritis nodosa and related conditions, other necrotizing vasculopathies and other systemic connective tissue lesions (order of the Ministry of Health of the Russian Federation No. 795n dated November 9, 2012)

Standard of specialized medical care for polyarteritis nodosa and related conditions, other necrotizing vasculopathies, and other systemic connective tissue lesions (order of the Ministry of Health of the Russian Federation No. 706n dated November 9, 2012)

Standard of specialized medical care for polyarteritis nodosa and related conditions, other necrotizing vasculopathies and other systemic connective tissue lesions (order of the Ministry of Health of the Russian Federation No. 631n dated November 7, 2012)

3. Directory of medicines

Abataceptum

Adalimumabum

Azathioprine (Azathioprinum)

Azithromycin (Azithromycinum)

Alprostadil (Alprostadilum)

Amoxicillin + Clavulanic acid (Amoxycillinum + Acidum clavulanicum)

Aceclofenac (Aceclophenacum)

Acetylsalicylic acid (Acidum acetylsalicylicum)

Benfotiamine

Betamethasonum

Vancomycinum

Gentamycin (Gentamycinum)

Heparin sodium (Heparinum natrium)

Hydrocortisone (Hydrocortisonum)

Hydroxychloroquine (Hydroxychlorochinum)

Golimumabum

Dexamethasonum

Diclofenac (Diclophenacum)

Zoledronic acid (Acidum zoledronicum)

Ibandronic acid (Acidum ibandronicum)

Ibuprophenum

Iloprost (Iloprostum)

Imipenem + Cilastatin (Imipenemum + Cilastatinum)

Indomethacin (Indomethacinum)

Infliximab

Calcitonin

Calcium carbonate + Colecalciferol (Calcii carbonas + Colecalciferolum)

Kanamycin (Kanamycinum)

Ketoprophenum

Ketorolacum

Colecalciferol (Colecalciferolum)

Xefokam/Xefokam Rapid

Leflunomidum

Lidocaine + Tolperisonum (Lidocaine + Tolperisonum)

Lornoxicamum

Meloxicam

Metamizole sodium (Metamizolum natrium)

Methylprednisolone

Methylprednisolone aceponate (Methylprednisoloni aceponas)

Methotrexate (Methotrexatum)

Metronidazole (Metronidazolum)

Nimesulidum

Nifedipine (Nifedipinum)

Paracetamol (Paracetamolum)

Penicillamine

Pentoxifylline (Pentoxyphyllinum)

Piroxicamum

Prednisolone

Strontium ranelas

Sulfasalazine (Sulfasalazinum)

Tizanidinum

Tobramycin (Tobramycinum)

Tolperisonum

Tocilizumabum

Triamcinolone

Celecoxib (Celecoxibum)

Certolizumab pegol (Certolizumabi paegolum)

Cefazolin (Cefazolinum)

Cefalexin

Cefoperazon + Sulbactamum (Cefoperazonum + Sulbactamum)

Cefotaxim (Cefotaximum)

Ceftazidimum

Ceftriaxone (Ceftriaxonum)

Cyclosporin (Cyclosporinum)

Cyclophosphamide (Cyclophosphamidum)

Ciprofloxacin (Ciprofloxacinum)

Etanerceptum

Etoricoxib (Etoricoxibum)

4. ICD-10 codes (for the profile “rheumatology”)

List of information sources

inpatient (in conditions that provide round-the-clock medical supervision and treatment).

ORGANIZATION OF ACTIVITIES OF THE RHEUMATOLOGY DEPARTMENT

ORGANIZATION OF ACTIVITIES OF THE GENETIC ENGINEERING THERAPY OFFICE

BIOLOGICAL PRODUCTS

1. These Rules establish the procedure for organizing the activities of the genetic engineering therapy room biological drugs(hereinafter referred to as the Office), providing specialized, including high-tech, medical care.

2. The office is created as a structural unit of a medical organization.

3. A specialist who meets the requirements set by the Qualification Requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and social development Russian Federation dated July 7, 2009 N 415n, in the specialty "rheumatology", passed vocational training on the use of therapy with genetically engineered biological drugs.

4. The structure and staffing of the Cabinet are established by the head of the medical organization in which the Cabinet is created, and are determined based on the volume of diagnostic and treatment work carried out and the number of the population served, taking into account the recommended staffing standards provided for in Appendix No. 8 for assistance to the adult population in the profile "rheumatology" ", approved by this order.

6. The Cabinet is equipped in accordance with the equipment standard provided for in Appendix No. 9

7. The Cabinet performs the following functions:

Carrying out therapy with genetically engineered biological drugs for patients for medical reasons;

Analysis of effectiveness and tolerability when using therapy with genetically engineered biological drugs;

Providing information to specialists and the public about various aspects of the use of therapy with genetically engineered biological drugs;

Carrying out advisory activities on the use of therapy with genetically engineered biological drugs;

Implementation modern methods therapy with genetically engineered biological drugs for rheumatic diseases;

Participation in development and implementation regional programs and other documents on public health protection;

Providing organizational, methodological and advisory assistance to medical organizations on therapy with genetically engineered biological drugs;

Maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law.

Appendix No. 8

to the Procedure for providing medical

assistance to adults

on the profile "rheumatology",

approved by order

Ministry of Health

Russian Federation

OFFICE OF GENETIC ENGINEERING THERAPY

BIOLOGICAL PRODUCTS

┌─────┬───────────────────────────────── ┬───────── ────────────────────────┒ ├─────┼── ───────────────────────────────┼──────── ────────── ───────────────┤ │1. │Rheumatologist │1 per 500 patients │ ├─────┼──────────────────────── ───────── ┼───────────────────────2. │Procedural nurse │1 for 1 position of doctor- │ │ │office │rheumatologist │ ├─────┼──────────────── ───────── ────────┼─────────────────────────────── ──┤ │3. │Orphan │0.25 per office (for cleaning │ │ │ │premises) │ └─────┴────────────────── ─────── ────────┴─────────────────────────────── ──┘

2. For areas with low population density and limited transport accessibility of medical organizations, the number of positions for a rheumatologist in an office for therapy with genetically engineered biological drugs is established based on the smaller size of the adult population.

3. For organizations and territories subject to service by the Federal Medical and Biological Agency, in accordance with the order of the Government of the Russian Federation of August 21, 2006 N 1156-r, the number of rheumatologist positions is established regardless of the size of the attached population.

Appendix No. 9

to the Procedure for providing medical

assistance to adults

on the profile "rheumatology",

approved by order

Ministry of Health

Russian Federation

STANDARD

EQUIPPING THE THERAPY OFFICE WITH GENETIC ENGINEERING

BIOLOGICAL PRODUCTS

┌─────┬───────────────────────────────── ────────── ───┬────────────────────┐ │ N │ Name of equipment (equipment) │ Required │ │ │ │ quantity, pcs. │ ├─────┼─────────────────────────────── ─────────── ────┼───────────────────1. │Treatment couch │ 2 │ ├─────┼────────────────────────── ─────────── ─────────┼─────────────────2. │ Workplace rheumatologist │ 1 │ ├─────┼─────────────────────────── ────────── ─────────┼──────────────3. │Nurse's workplace │ 1 │ ├─────┼────────────────────────── ───────── 4. │Table for medicines and medical │ 1 │ │ │products │ │ ├─────┼──────────────────── ──────── ──────────────────┼────────────────────┤ │5. │Tripod for long-term infusions │ 2 │ ├─────┼─────────────────────── ─────────── 6. │Cabinet for medicines and medical products ──────── ──────────────────┼────────────────────┤ │7. │Medical refrigerator │ 1 │ ├─────┼────────────────────────── ─────────── 8. │First aid kit │ 1 │ ├─────┼────────────────────────── ────────── 9. │Cardiac monitor (ECG) │ 2 │ ├─────┼───────────────────────── ───────── 10. │Infusion pump-dispenser (regulator │ 2 │ │ │infusion) │ │ ├─────┼───────────────── ────────── ───────────────────┼──────────────────── ┤ │11. │Multichannel electrocardiograph │ 1 ​​│ ├─────┼───────────────────────── ──────────── ─────────┼────────────────────┤

1. This Procedure establishes the rules for the provision of medical care to the adult population in the “rheumatology” profile in medical organizations.

2. Medical care for the adult population in the “rheumatology” profile (hereinafter referred to as medical care) is provided in the form of:

primary health care;

specialized, including high-tech, medical care.

3. Medical care can be provided in the following conditions:

outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);

inpatient (in conditions that provide round-the-clock medical supervision and treatment).

4. Primary health care includes measures for the prevention, diagnosis, treatment of rheumatic diseases and conditions, medical rehabilitation, formation healthy image life and sanitary and hygienic education.

5. Primary health care includes:

primary medical care;

primary specialized health care.

Primary health care is provided in an outpatient setting.

Primary medical care is provided by a local physician, general practitioner (family doctor) to patients:

osteoarthritis of small and medium joints, as well as osteoarthritis large joints without synovitis, not requiring endoprosthetics - after consultation with a rheumatologist;

inflammatory diseases of the joints and spine and systemic diseases connective tissue outside of exacerbation - on the recommendation of a rheumatologist;

metabolic diseases of the joints (gout, pseudogout, ochronosis and others) - on the recommendation of a rheumatologist;

chronic rheumatic diseases heart defects (defects) without signs of inflammatory activity;

primary osteoporosis (postmenopausal and senile) - on the recommendation of a rheumatologist or other medical specialist.

Subject to availability medical indications to the provision of medical care to patients with rheumatic diseases (suspected, identified or exacerbated rheumatic diseases), which does not require its provision in inpatient conditions, a local therapist, a general practitioner (family doctor) refers the patient to the office of a rheumatologist at a medical organization to provide primary specialized health care.

Primary specialized health care is provided by a rheumatologist.

When a patient is referred to a rheumatologist by local therapists, general practitioners (family doctors) and doctors of other specialties, an extract from medical documentation the patient, which must contain the diagnosis of the disease (condition), information about the patient’s health status, diagnosis and treatment carried out, with the application of the results of laboratory, instrumental and other types of studies.

If it is impossible to provide medical care to a patient within the framework of primary health care and there are medical indications, the patient is sent to a medical organization that provides specialized medical care.

6. Specialized, including high-tech, medical care is provided by rheumatologists in medical organizations and their structural divisions.

7. If there are medical indications, the provision of medical care is carried out with the involvement of medical specialists in the specialties provided for by the Nomenclature of Specialties of Specialists with Higher and Postgraduate Medical and Pharmaceutical Education in the Healthcare Sphere of the Russian Federation, approved by order of the Ministry of Health and Social Development of the Russian Federation dated April 23, 2009 . N 210n (registered by the Ministry of Justice of the Russian Federation on June 5, 2009, registration N 14032), as amended by order of the Ministry of Health and Social Development of the Russian Federation dated February 9, 2011 N 94n (registered by the Ministry of Justice of the Russian Federation on March 16, 2011 ., registration N 20144).

8. If there are medical indications for therapy with genetically engineered biological drugs, patients are sent to therapy rooms with genetically engineered biological drugs.

9. The provision of specialized, with the exception of high-tech, medical care is carried out in federal state medical organizations under the jurisdiction of the Ministry of Health of the Russian Federation, if it is necessary to establish a final diagnosis due to the atypical course of the disease, the lack of effect from the therapy and (or) repeated courses of treatment with the probable effectiveness of other treatment methods, high risk surgical treatment due to the complicated course of the underlying disease or the presence of concomitant diseases, the need for additional diagnostic examination difficult cases and (or) comprehensive preoperative preparation in patients with complicated forms of the disease, concomitant diseases, if necessary, re-hospitalization on the recommendation of the specified federal state medical organizations in accordance with the Procedure for referring citizens of the Russian Federation to federal government agencies, under the jurisdiction of the Ministry of Health and Social Development of the Russian Federation, for the provision of specialized medical care, given in the annex to the Procedure for organizing the provision of specialized medical care, approved by order of the Ministry of Health and Social Development of the Russian Federation dated April 16, 2010 N 243n (registered by the Ministry of Justice Russian Federation May 12, 2010, registration N 17175), as well as if the patient has medical indications in federal state medical organizations providing specialized medical care, in accordance with the Procedure for referring citizens by executive authorities of the constituent entities of the Russian Federation in the field of healthcare to the place of treatment in the presence of medical indications, approved (registered by the Ministry of Justice of the Russian Federation on October 27, 2005, registration N 7115).

10. If the patient has medical indications for the provision of high-tech medical care, referral to a medical organization providing high-tech medical care is carried out in accordance with the Procedure for referring citizens of the Russian Federation to provide high-tech medical care at the expense of budgetary allocations provided for in the federal budget to the Ministry of Health and Social Affairs development of the Russian Federation, through the use of specialized information system, approved by order of the Ministry of Health of the Russian Federation dated December 28, 2011 N 1689n (registered by the Ministry of Justice of the Russian Federation on February 8, 2012, registration N 23164).

11. Patients with rheumatic diseases, if there are medical indications, are sent for rehabilitation activities to specialized medical and sanatorium-resort organizations.

Rules
organizing the activities of a rheumatologist’s office

1. These Rules establish the procedure for organizing the activities of a rheumatologist’s office (hereinafter referred to as the Office), which is a structural unit of a medical organization.

2. The office is created to provide advisory, diagnostic and therapeutic assistance in the field of rheumatology.

by order of the Ministry of Health and Social Development of the Russian Federation dated July 7, 2009 N 415n (registered by the Ministry of Justice of the Russian Federation on July 9, 2009, registration N 14292), as amended by order of the Ministry of Health and Social Development of the Russian Federation dated December 26, 2011 . N 1644n (registered by the Ministry of Justice of the Russian Federation on April 18, 2012, registration N 23879), in the specialty "rheumatology".

4. The structure and staffing of the Cabinet are established by the head of the medical organization within which the Cabinet is created, and are determined based on the volume of diagnostic and treatment work carried out and the number of the population served, taking into account the recommended staffing standards provided for in Appendix No. 2

Appendix No. 3 to the Procedure for providing medical care to the adult population in the “rheumatology” profile, approved by this order.

7. The main functions of the Cabinet are:

consultative and diagnostic medical assistance patients with rheumatic diseases and high risk their development;

referral of patients with rheumatic diseases for medical care in inpatient settings;

dispensary observation of patients with rheumatic diseases;

implementation of diagnostic and therapeutic intra-articular and periarticular manipulations;

referral of patients with rheumatic diseases for medical and social examination;

organizational and methodological assistance and participation of a rheumatologist in the medical examination of patients with rheumatic diseases;

development and implementation of sanitary and educational activities;

participation in the organization and operation of schools for patients with rheumatic diseases;

introduction into practice of new methods of prevention, diagnosis, treatment and rehabilitation of patients with rheumatic diseases;

	Job titles	Number of positions
	Rheumatologist	1 per 50,000 attached population
	Nurse	1 to 1 rheumatologist
		0.25 per office

2. For areas with low population density and limited transport accessibility of medical organizations, the number of positions for a rheumatologist in a rheumatologist’s office is established based on the smaller size of the adult population.

Order of the Government of the Russian Federation dated August 21, 2006 N 1156-r (Collected Legislation of the Russian Federation, 2006, N 35, Art. 3774; N 49, Art. 5267; N 52, Art. 5614; 2008, N 11, Art. 1060; 2010, art. 336; 2011, art. 2303; 51, Art. 7526; 2012, No. 19, Art. 2410) the number of rheumatologist positions is established regardless of the size of the attached population.

Standard
equipping a rheumatologist's office

		Quantity, pcs.
	Work table
	Working chair
	Fridge
	Height meter
	Desk lamp
	For children under one year old
	Cabinet for storing medical documents
	Centimeter tape
	Germicidal air irradiator
	Stethoscope
	X-ray viewer
	Medical thermometer
		on demand

Rules
organizing the activities of the rheumatology department

1. These Rules determine the procedure for organizing the activities of the rheumatology department of a medical organization providing medical care in the profile of “rheumatology” (hereinafter referred to as medical care).

3. The Department is headed by a head, appointed and dismissed by the head of the medical organization within which the Department was created.

Specialists who meet the requirements of the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order, are appointed to the positions of head of the Department and rheumatologist

4. The structure and staffing levels of the Department are established by the head of the medical organization within which the Department is created, and are determined based on the volume of diagnostic and treatment work carried out and the number of the population served, taking into account the recommended staffing standards provided for in Appendix No. 5 to the Procedure for providing medical care to the adult population according to the profile "rheumatology", approved by this order.

5. The Department is equipped in accordance with the equipment standard provided for in Appendix No. 6 to the Procedure for providing medical care to the adult population in the “rheumatology” profile, approved by this order.

7. The department carries out the following functions:

providing diagnostic, therapeutic and preventative care patients with rheumatic diseases;

providing advice to doctors of other departments of the medical organization on the prevention, diagnosis and treatment of patients with rheumatic diseases;

development and implementation of measures aimed at improving the quality of diagnostic and treatment work and reducing mortality from rheumatic diseases;

development and implementation of measures to improve and implement new methods of diagnosis, treatment, medical examination and prevention of rheumatic diseases, as well as medical rehabilitation of patients;

implementation and maintenance of educational programs for patients with the aim of preventing rheumatic diseases;

conducting sanitary and hygienic training for patients and their relatives;

carrying out examination of temporary disability;

maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law.

8. To ensure its activities, the department uses the capabilities of the diagnostic, treatment and auxiliary units of the medical organization within which it is organized.

9. The department can be used as a clinical base for medical educational organizations secondary, higher and additional vocational education, as well as scientific organizations.

	Job titles	Number of positions
	Head of department - rheumatologist	1 for 30 beds
	Rheumatologist	1 for 15 beds
	Ward nurse
		1 for 30 beds
	Senior nurse	1 per department
	Junior nursing nurse	4.75 for 15 beds (to ensure round-the-clock operation)
	Sister-hostess
		1 (for working in a buffet); 1 (for cleaning premises); 1 (for sanitary treatment of patients)

Standard equipment for the rheumatology department

1. Standard of equipment for the rheumatology department (with the exception of treatment room for intra-articular manipulation)

	Name of equipment (equipment)	Quantity, pcs.
	Functional bed	by number of beds
	Oxygen line	1 per bed
	Anti-decubitus mattresses	on demand
	Bedside table	by number of beds
	Bedside information board (marker board)	by number of beds
	Wheelchair
	Trolley (gurney) for transporting patients
	Interhull cargo trolley
	Fridge	at least 2
	Height meter
	X-ray viewer
	Tonometer for measurement blood pressure with cuff	1 to 1 doctor
	Stethoscope	1 to 1 doctor
	Germicidal air irradiator, including portable	on demand
	Cardiac monitor with non-invasive measurement of blood pressure, respiratory rate, blood oxygen saturation	on demand
	Containers for collecting household and medical waste

2. Standard for equipping a treatment room for intra-articular manipulation

	Name of equipment (equipment)	Quantity, pcs.
	Work table
	Fridge
	Cabinet for storing medicines and medical instruments
	First aid kit with anti-shock drugs for emergency medical care
	Blood pressure tonometer with cuff
	Stethoscope
	Containers for collecting household and medical waste

Rules
organizing the activities of a treatment room for genetically engineered biological drugs

1. These Rules establish the procedure for organizing the activities of a therapy room with genetically engineered biological drugs (hereinafter referred to as the “Office”), which provides specialized, including high-tech, medical care.

2. The office is created as a structural unit of a medical organization.

3. A specialist who meets the requirements of the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of the Russian Federation dated July 7, 2009 N 415n, is appointed to the position of a rheumatologist in the Cabinet. specialty "rheumatology", who has undergone professional training in the use of therapy with genetically engineered biological drugs.

4. The structure and staffing of the Cabinet are established by the head of the medical organization in which the Cabinet is created, and are determined based on the volume of diagnostic and treatment work carried out and the number of the population served, taking into account the recommended staffing standards provided for in Appendix No. 8 to the Procedure for providing medical care to the adult population according to the profile "rheumatology", approved by this order.

6. The Cabinet is equipped in accordance with the standard of equipment provided for in Appendix No. 9 to the Procedure for providing medical care to the adult population in the “rheumatology” profile, approved by this order.

7. The Cabinet performs the following functions:

carrying out therapy with genetically engineered biological drugs for patients for medical reasons;

analysis of effectiveness and tolerability when using therapy with genetically engineered biological drugs;

providing information to specialists and the public about various aspects of the use of therapy with genetically engineered biological drugs;

carrying out advisory activities on the use of therapy with genetically engineered biological drugs;

introduction of modern methods of therapy with genetically engineered biological drugs for rheumatic diseases;

participation in the development and implementation of regional programs and other documents to protect public health;

providing organizational, methodological and advisory assistance to medical organizations on therapy with genetically engineered biological drugs;

maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law.

	Job titles	Number of positions
	Rheumatologist	1 in 500 patients
	Treatment room nurse	1 for 1 position of rheumatologist
		0.25 per office (for cleaning premises)

2. For areas with low population density and limited transport accessibility of medical organizations, the number of positions for a rheumatologist in an office for therapy with genetically engineered biological drugs is established based on the smaller size of the adult population.

3. For organizations and territories subject to service by the Federal Medical and Biological Agency, in accordance with the order of the Government of the Russian Federation of August 21, 2006 N 1156-r, the number of rheumatologist positions is established regardless of the size of the attached population.

Standard
equipping the therapy room with genetically engineered biological drugs

	Name of equipment (equipment)	Required quantity, pcs.
	Treatment couch
	Workplace of a rheumatologist
	Nurse's workplace
	Table for medicines and medical products
	Long-term infusion stand
	Cabinet for medicines and medical products
	Medical refrigerator
	First aid kit
	Cardiac monitor (ECG)
	Infusion dosing pump (infusion regulator)
	Multichannel electrocardiograph
	Defibrillator
	Tracheostomy kit
	Manual breathing apparatus
	Medical digital thermometer (electronic)
	Phonendoscope
	Membrane manometric blood pressure meter	2. The center is created as an independent medical organization or a structural unit of a medical organization. 3. The Center is headed by a director appointed and dismissed by the founder of a medical organization or the head of a medical organization in the case when the Center is organized as a structural unit of a medical organization. A specialist is appointed to the position of head of the Center who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by Order of the Ministry of Health and Social Development of the Russian Federation dated July 7, 2009 N 415n, in the specialty “rheumatology”. 4. The structure and staffing of the Center are established by the founder of a medical organization or the head of a medical organization in cases where the Center is organized as a structural unit of a medical organization, based on the volume of diagnostic and treatment work, the number of the population served, taking into account the recommended staffing standards provided for in Appendix No. 11 to The procedure for providing medical care to the adult population in the field of rheumatology, approved by this order. 5. The Center is equipped in accordance with the equipment standard provided for in Appendix No. 12 to the Procedure for providing medical care to the adult population in the “rheumatology” profile, approved by this order. 6. The main functions of the Center are: provision of specialized, including high-tech, medical care to patients with rheumatic diseases; carrying out therapy with genetically engineered biological drugs; coordination, organization and implementation of activities for the prevention of rheumatic diseases; interaction with the rheumatologist’s office, rheumatology department; monitoring and analysis of the main medical and statistical indicators of morbidity, disability and mortality from rheumatic diseases; holding health schools for patients with rheumatic diseases; information support on the organization of medical care in the field of rheumatology, treatment and prevention of rheumatic diseases; organizational and methodological guidelines for prevention, diagnosis, treatment, medical rehabilitation and dispensary observation of patients with rheumatic diseases; organization of identification of persons with early stages rheumatic diseases or suspected of their development; development of modern methods of prevention, diagnosis and treatment of rheumatic diseases and introduction of new medical technologies; organization dispensary observation for patients with the following inflammatory rheumatic diseases: rheumatoid arthritis, seronegative spondyloarthritis, acute rheumatic fever, systemic lesions connective tissue and systemic vasculitis, as well as gout and osteoarthritis; carrying out examination of temporary disability; maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law. 7. In its work, the Center interacts with clinical, educational and research organizations, scientific communities of doctors. 8. The center can be used as a clinical base for educational organizations of secondary, higher and additional vocational education, as well as scientific organizations. Appendix No. 11 to Order Recommended staffing standards Center for Medical Rheumatology (with the exception of rheumatology departments, therapy rooms with genetically engineered biological drugs included in the structure of the Medical Rheumatology Center) Job titles Number of positions Head of the Rheumatology Center - rheumatologist 1 per center Chief nurse 1 per center Appendix No. 12 to Order Equipment standard Center for Medical Rheumatology (except for rheumatology departments included in the structure of the Medical Rheumatology Center) Name of equipment (equipment) Quantity, pcs. Operating table Shadowless lamp Syringe pump on demand Oxygen line First aid kit with anti-shock drugs for emergency care Ambu bag on demand Manipulation table Fridge Cabinet for storing medicines and medical products Fume hood Bactericidal air irradiator of recirculating type Containers for collecting household and medical waste Blood collection chair First aid kit with anti-shock drugs for ambulance, anti-AIDS first aid kit, first aid kits for SARS Refrigerated chamber for storing blood products Thrombomixer Plasma defrosting device Work table Table for storing medicines and medical products Medical instrument storage cabinet First aid kit with antishock drugs for emergency care Blood pressure tonometer with cuff Stethoscope

2. Medical care for the adult population in the “rheumatology” profile (hereinafter referred to as medical care) is provided in the form of:

Primary health care;

Specialized, including high-tech, medical care.

3. Medical care can be provided in the following conditions:

Outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);

Inpatient (in conditions that provide round-the-clock medical supervision and treatment).

4. Primary health care includes measures for the prevention, diagnosis, treatment of rheumatic diseases and conditions, medical rehabilitation, promotion of a healthy lifestyle and sanitary and hygienic education.

5. Primary health care includes:

Primary medical care;

Primary specialized health care.

Primary health care is provided in an outpatient setting.

Primary medical care is provided by a local physician, general practitioner (family doctor) to patients:

Osteoarthrosis of small and medium joints, as well as osteoarthrosis of large joints without synovitis, which does not require endoprosthetics - after consultation with a rheumatologist;

Inflammatory diseases of the joints and spine and systemic diseases of connective tissue without exacerbation - on the recommendation of a rheumatologist;

Metabolic diseases of the joints (gout, pseudogout, ochronosis and others) - on the recommendation of a rheumatologist;

Chronic rheumatic heart diseases (defects) without signs of inflammatory activity;

Primary osteoporosis (postmenopausal and senile) - on the recommendation of a rheumatologist or other medical specialist.

If there are medical indications for the provision of medical care to patients with rheumatic diseases (suspected, identified or exacerbated rheumatic diseases), which does not require its provision in a hospital setting, the local physician, general practitioner (family doctor) refers the patient to the office of a rheumatologist of the medical organizations for the provision of primary specialized health care.

Primary specialized health care is provided by a rheumatologist.

When a patient is referred to a rheumatologist by local therapists, general practitioners (family doctors) and doctors of other specialties, an extract from the patient’s medical documentation is provided, which must contain the diagnosis of the disease (condition), information about the patient’s health status, diagnosis and treatment carried out with application of the results of laboratory, instrumental and other types of research.

If it is impossible to provide medical care to a patient within the framework of primary health care and there are medical indications, the patient is sent to a medical organization that provides specialized medical care.

6. Specialized, including high-tech, medical care is provided by rheumatologists in medical organizations and their structural divisions.

7. If there are medical indications, the provision of medical care is carried out with the involvement of medical specialists in the specialties provided for by the Nomenclature of Specialties of Specialists with Higher and Postgraduate Medical and Pharmaceutical Education in the Healthcare Sphere of the Russian Federation, approved by order of the Ministry of Health and Social Development of the Russian Federation dated April 23, 2009 . N 210n (registered by the Ministry of Justice of the Russian Federation on June 5, 2009, registration N 14032), as amended by order of the Ministry of Health and Social Development of the Russian Federation dated February 9, 2011 N 94n (registered by the Ministry of Justice of the Russian Federation on March 16, 2011 ., registration N 20144).

8. If there are medical indications for therapy with genetically engineered biological drugs, patients are sent to therapy rooms with genetically engineered biological drugs.

9. The provision of specialized, with the exception of high-tech, medical care is carried out in federal state medical organizations under the jurisdiction of the Ministry of Health of the Russian Federation, if it is necessary to establish a final diagnosis due to the atypical course of the disease, the lack of effect from the therapy and (or) repeated courses of treatment with the probable effectiveness of other treatment methods, a high risk of surgical treatment due to the complicated course of the underlying disease or the presence of concomitant diseases, the need for additional examination in diagnostically difficult cases and (or) comprehensive preoperative preparation in patients with complicated forms of the disease, concomitant diseases, if necessary, repeated hospitalization on the recommendation of the specified federal state medical organizations in accordance with the Procedure for sending citizens of the Russian Federation to federal state institutions under the jurisdiction of the Ministry of Health and Social Development of the Russian Federation for the provision of specialized medical care, given in the annex to the Procedure for organizing the provision of specialized medical care, approved by order Ministry of Health and Social Development of the Russian Federation dated April 16, 2010 N 243n (registered by the Ministry of Justice of the Russian Federation on May 12, 2010, registration N 17175), as well as if the patient has medical indications in federal state medical organizations providing specialized medical care , in accordance with the Procedure for sending citizens by executive authorities of the constituent entities of the Russian Federation in the field of healthcare to the place of treatment in the presence of medical indications, approved by order of the Ministry of Health and Social Development of the Russian Federation dated October 5, 2005 N 617 (registered by the Ministry of Justice of the Russian Federation on October 27, 2005 city, registration N 7115).

10. If the patient has medical indications for the provision of high-tech medical care, referral to a medical organization providing high-tech medical care is carried out in accordance with the Procedure for referring citizens of the Russian Federation to provide high-tech medical care at the expense of budgetary allocations provided for in the federal budget to the Ministry of Health and Social Affairs development of the Russian Federation, through the use of a specialized information system, approved by order of the Ministry of Health of the Russian Federation of December 28, 2011 N 1689n (registered by the Ministry of Justice of the Russian Federation on February 8, 2012, registration N 23164).

11. Patients with rheumatic diseases, if there are medical indications, are sent for rehabilitation measures to specialized medical and sanatorium organizations.

12. Medical organizations, providing medical care to patients with the profile “rheumatology”, carry out their activities in accordance with Appendices No. 1 to this Procedure.