Outpatient Care

Outpatient Care encompasses all forms of medical assistance provided on an outpatient basis or in the form of home care. In a narrower sense, outpatient care includes the following forms of therapeutic care: outpatient care provided by venereal and tuberculosis dispensaries and stations, venereal and eye teams, consultations; first aid provided by corresponding stations at enterprises, emergency care, home care, etc. All these forms of outpatient care, especially outpatient care, home care, and first aid, are closely united by a single system of outpatient care in terms of the continuity of observations and in regard to establishing a unified plan for serving the population. In cities and factory-industrial centers, outpatient care serves as the core unit for uniting local medical-sanitary institutions (see Ambulatory Care). Individual forms of outpatient care here are usually differentiated and provided by specialized personnel. In rural areas, outpatient care, both ambulatory and mobile, is usually provided by the general medical personnel of the area, constituting a significant and very important part of their work. Outpatient care helps bring various forms of medical assistance closer to the population. With a rational organization of outpatient care, the need for expensive inpatient care is reduced, and patients are given the opportunity to receive treatment without interrupting their work. Outpatient care agencies serve as support points in all work on the dispensarization (see) of the population and in the dissemination of sanitary-hygienic knowledge among the vast population covered by outpatient care. Outpatient care also includes patronage (see). Like all medical care, outpatient care is built on the principles of free service, accessibility, qualification, and specialization of individual forms of care for working people, with preferential service for insured persons in provincial cities and factory-industrial centers. In the decade following the October Revolution, outpatient care has developed significantly and continues to develop steadily. Thus, according to the data in D. N. Zhbankov's 'Collection on Urban Medical-Sanitary Affairs,' in 1914, within the territory of the present RSFSR, home care existed only in 16 cities, and the number of home care physicians was limited to one or two in the vast majority of cities. In 1926, there were already 457 home care stations in the RSFSR, mostly served by several physicians. Before the revolution, there were almost no state dental outpatient clinics, but in 1926, there were already 2,160 state dental chairs in the RSFSR, etc. The growth of outpatient care is characterized by the data presented in the table (see art. 169). In addition, the size of institutions has been expanded, additional (evening) receptions have been introduced, and specialized care has been strengthened. The same growth is observed in all union republics and especially in the deprived outskirts. First aid stations at enterprises ..... Home care stations....... Emergency care stations ....... Outpatient clinics . . . Dental chairs ...... Eye teams . . Physiotherapy institutions. X-ray cabinets ...... Pr- 19 24 g. 1925 g. 1928 g. growth over 2 years in % 62 4 .061 33 5.330 46 5.674 68 6.4 57 106 21,1 1.535 39 4 4 2.160 73 40,7 80 before the revolution. Specialized outpatient care institutions of a completely new type have emerged - neuropsychiatric dispensaries, narcological dispensaries and stations, offices and polyclinics for combating occupational diseases. For more details, see individual forms of outpatient care.

D. Gorfin.

Outpatient psychiatric care appeared in an organized form from the second half of the 19th century in the form of patronage (see). The actual development, with the setting of broad tasks and increasingly complex organizational forms, belongs already to the 20th century, especially to the period after the world war of 1914-18. This process covered almost all cultural countries and was caused by various reasons: the universal increase in mental morbidity of the population, and especially - the appearance of a huge number of borderline forms, the high cost of constructing new psychiatric hospitals, the development of scientific and practical psychiatry, and the expansion of the psychohygienic movement. In the USSR, the general preventive orientation of the entire health care system (see Dispensarization) plays a significant role, as well as the extreme shortage of psychiatric beds. Despite the difference in starting points and external conditions in different countries, a common line is found in the construction and development of psychiatric outpatient care. The central place is occupied by the outpatient clinic, which serves mentally ill patients discharged from psychiatric hospitals (Germany, England), those on leave (U.S.A.), and those living freely among the population (part of Germany, France, USSR). The circle of patients cannot be limited to mentally ill patients in the narrow sense of the word and expands naturally toward borderline forms.

The care consists not only in therapeutic advice and procedures; it also seeks to improve the social position of the patient, influencing him and his surrounding environment (material assistance, protection of the patient's rights, finding work, improving housing conditions, placing the patient under patronage, psychos sanitary education of surrounding persons, etc.). Subsequently, psychotechnical service, care for homeless and mentally retarded children, care for criminals released from prison, etc., are also added to this. An obligatory part of the work is the accounting of mentally ill patients; to this are added special examinations of individuals and entire population groups. The outpatient clinic is organizationally connected with the psychiatric hospital: it carries out, on assignment from the hospital, examinations of the social environment of a particular patient both to determine the origin of the illness and to decide on the possibility of discharge from the hospital; it takes discharged patients under its observation; it often serves as an apparatus for selecting mentally ill patients for inpatient treatment. The expansion of the work requires the participation of specially selected and trained personnel and leads to the creation of, in connection with psychiatric outpatient care, institutes of sisters and brothers of social assistance, as well as to the involvement of society and the state (government agencies, representatives of departments and public organizations, private charitable societies). Being a new stage in the development of the system of non-restraint with respect to mentally ill patients, psychiatric outpatient care inevitably develops into a broad psychohygienic movement. In the USSR, psychiatric outpatient care exists in very few places; its broader development began only in the last 2-3 years. In Moscow, since 1919, there has been an institute of district psychiatrists who provide various assistance to mentally ill patients living among the population, the scope of which, however, is limited by lack of funds. Along with therapeutic activities, district psychiatrists also participate in preventive work; in addition to auxiliary service personnel, they rely in their work on members of district psychohygienic commissions, selected from the health sections of district and Moscow councils. District psychiatrists are in charge of admitting patients to psychiatric hospitals; from the hospitals they receive discharged patients for observation. In Leningrad, since 1927, the institute of district psychiatrists has also been introduced, whose activity cannot yet be considered defined. In various large cities, neuropsychiatric dispensaries have been opened. Most of them are connected with a psychiatric hospital, some conduct scientific research work. At present, there are 15 dispensaries (in Moscow, Leningrad, Voronezh, Vyatka, Kharkov, Rostov-on-Don, etc.); 10 more dispensaries are planned to be opened. In Moscow and Tiflis, there are neuropsychiatric outpatient clinics. In counties, there is almost no psychiatric outpatient care. Only in the Moscow province, out of 17 counties, 12 have physicians-psychoneuropathologists; in other regions and provinces of the USSR, county specialists are an even greater rarity, despite the clearly expressed need for neuropsychiatric assistance; the reason for this lies in the shortage of physicians and local funds. Psychiatric patronage has not been used to a sufficient degree in the USSR; it exists in a few places (Moscow, Orel, Tver) and so far shows a weak tendency to grow. A rational organization of psychiatric outpatient care under the conditions of Soviet health care appears as follows: for a provincial city - an outpatient clinic of the dispensary type, located in the closest interaction with the provincial psychiatric hospital, equipped with social assistance personnel and relying on the support of local public organizations. For the largest cities (capitals, etc.) - a network of district dispensaries, connected with each other and with psychiatric hospitals, as well as with public organizations. For counties - a neuropsychiatric outpatient clinic, whose physician also provides assistance by traveling to the places. Observation of mentally ill patients in the county is carried out with the assistance of area hospitals. Referral to the provincial psychiatric hospital is made through the outpatient clinic. At its disposal should be a certain number of beds in the local general hospital for quickly passing cases and for patients awaiting transfer to the provincial psychiatric hospital.