Treatment standards in therapy. On the approval of the standard of emergency medical care for hypertension. Medical services for the diagnosis of disease, condition

Just a couple of weeks ago, the Faculty of Medical Law introduced its readers and subscribers to the list of the newly introduced standards of medical care in the article “The Ministry of Health approved new standards of medical care for the use of psychoactive substances” (published on July 13, 2016). And again, the Ministry of Health of Russia "released" a whole series of standards of medical care that regulate the rules for the provision of medical care for extremely serious diseases.

So, in July 2016, the following 20 new standards for emergency medical care were approved. Note that not all of the aforementioned standards are the first of their kind. So, earlier, for some diseases, standards have already been adopted, which have become invalid since the adoption of new standards of medical care.

So, in July 2016, the following standards of medical care were adopted, the scope of which had already been regulated earlier:

• Ambulance standard for bradycardia (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 453n) - comes into force on 02 August 2016. From that moment on, the Ambulance Standard for Bradyarrhythmias, approved by Order of the Ministry of Health of Russia dated 07.07.2013 No. 359n, became invalid.
• The ambulance standard for sudden cardiac death (approved by the Order of the Ministry of Health of Russia dated July 05, 2016 No. 454n) - comes into force on July 29, 2016. From that moment on, the Standard of Emergency Medical Care for Sudden Cardiac Death, approved by the Order of the Ministry of Health of Russia dated 20.12.2012 No. 1113n, became invalid.
• Ambulance standard for cardiogenic shock (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 455n) - comes into force on July 31, 2016. From that moment on, the Standard of Emergency Medical Care for Cardiogenic Shock, approved by the Order of the Ministry of Health of Russia dated 12.24.2012 No. 1432n, became invalid.
• Ambulance standard for acute coronary syndrome without ST segment elevation (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 456n) - comes into force on July 30, 2016. Since that date, the Standard for Emergency Medical Care for Acute Coronary Syndrome without ST segment elevation, approved by Order of the Ministry of Health of Russia dated 12.24.2012 No. 1387n, has become invalid.
• The ambulance standard for acute transmural myocardial infarction (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 457n) - comes into force on 06 August 2016. From that moment on, the Standard of Emergency Medicine for Acute Coronary Syndrome with ST segment elevation, approved by the Order of the Ministry of Health of Russia dated 12.24.2012 No. 1383n, became invalid.
• Ambulance Standard for Acute Respiratory Failure (approved by Order of the Ministry of Health of Russia dated July 05, 2016 No. 458n) - comes into force on August 06, 2016. From the same date, the Ambulance Standard for Acute Respiratory Failure, approved by the Order of the Ministry of Health of Russia dated 20.12.2012 No. 1080n, became invalid.
• Ambulance standard for pneumonia (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 459n) - comes into force on July 29, 2016. Since that date, the Standard of Emergency Medical Care for Pneumonia, approved by Order of the Ministry of Health of Russia dated 12.24.2012 No. 1437n, has ceased to be in force.
• The standard of ambulance for heart failure (approved by the Order of the Ministry of Health of Russia dated 05.07.2016 No. 460n) - comes into force on July 20, 2016. From that moment on, the Standard of Emergency Medical Care for Heart Failure, approved by the Order of the Ministry of Health of Russia dated 20.12.2012 No. 1283n, has ceased to be in force.
• The ambulance standard for fainting (syncope) and collapse (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 461n) - comes into force on 05 August 2016. From this date, the Standard for emergency medical care for fainting, approved by Order of the Ministry of Health of Russia dated 12.24.2012 No. 1398n, has ceased to be in force.
• The ambulance standard for tachycardia and tachyarrhythmias (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 464n) - comes into force on 05 August 2016. From the same date, the Standard for emergency medical care for tachyarrhythmias, approved by the Order of the Ministry of Health of Russia dated 20.12.2012 No. 1284n, has ceased to be valid.
• The ambulance standard for acute cerebrovascular accident (approved by the Order of the Ministry of Health of Russia dated 05.07.2016 No. 466n) - comes into force on July 29, 2016. Since that date, the Standard of Emergency Medical Care for Stroke, approved by the Order of the Ministry of Health of Russia dated 20.12.2012 No. 1282n, has ceased to be in force.
• The ambulance standard for seizures, epilepsy, status epilepticus (approved by the Order of the Ministry of Health of Russia dated 07/05/2016 No. 468n) - comes into force on 07/29/2016. from that date, he lost the Standard for emergency medical care for convulsions, approved by Order of the Ministry of Health of Russia dated 12/20/2012 No. 1082n.
• Ambulance standard for status asthmaticus (approved by Order of the Ministry of Health of Russia dated July 05, 2016 No. 469n) - comes into force on July 31, 2016. Since then, the Ambulance standard for status asthmaticus, approved by Order of the Ministry of Health of Russia dated 12/20/2012 No. 1087n ...
• Ambulance standard for hypertension (approved by the Order of the Ministry of Health of Russia dated 05.07.2016 No. 470n) - comes into force on July 31, 2016. From this date, the Standard for Emergency Medical Care for Diseases characterized by high blood pressure, approved by Order of the Ministry of Health of Russia dated 20.12.2012 No. 1513n, has ceased to be in force.
• The ambulance standard for doubtfulness, stupor, unspecified coma (approved by Order of the Ministry of Health of Russia dated July 05, 2016 No. 471n) - comes into force on July 29, 2016. Since that date, the Standard for Ambulance for Unspecified Coma, approved by Order of the Ministry of Health of Russia dated 20.12.2012 No. 1431n, has ceased to be in force.

The following standards are fundamentally new:

• Ambulance standard for meningitis (approved by Order of the Ministry of Health of Russia dated July 05, 2016 No. 462n) - comes into force on July 29, 2016.
• Ambulance standard for acute headache (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 463n) - comes into force on July 31, 2016.
• Ambulance standard for severe myasthenia gravis (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 465n) - comes into force on 05 August 2016.
• The ambulance standard for upper respiratory tract bleeding (pulmonary hemorrhage) (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 467n) - comes into force on July 31, 2016.
• The ambulance standard for inflammatory polyneuropathy (approved by the Order of the Ministry of Health of Russia dated 05.07.2016 No. 472n) - comes into force on 06 August 2016.

The Faculty of Medical Law reminds that the standards of medical care are developed in accordance with the nomenclature of medical services and include the average indicators of the frequency of provision and frequency of use:

• medical services;
• medicinal products registered in the Russian Federation (indicating average doses) in accordance with the instructions for use of the medicinal product and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization;
• medical devices implanted into the human body;
• blood components;
• types of health food, including specialized health food products;
• other based on the characteristics of the disease (condition).

At the same time, all standards for the provision of medical care differ from each other and reflect the specifics of a particular disease.

More detailed content of the above standards can be found on the website of the Faculty of Medical Law in the section "".

Dear colleagues!

In accordance with the Federal Law of December 25, 2018 No. 489-FZ "On Amendments to Article 40 of the Federal Law" On Compulsory Health Insurance in the Russian Federation "and the Federal Law" On the Fundamentals of Health Protection of Citizens in the Russian Federation "on clinical guidelines »A clinical practice guideline is now defined as a document containing scientific evidence-based structured information on prevention, diagnosis, treatment and rehabilitation.

This Federal Law defines a transition period until December 31, 2021, necessary for the revision and approval of clinical guidelines in accordance with the norms introduced by the draft law. The approved clinical guidelines will contain parameters that reflect the correct choice of diagnostic and treatment methods based on the principles of evidence-based medicine. The use of clinical guidelines will allow medical professionals to determine the tactics of managing a patient with a specific nosology at all stages of medical care.

Clinical guidelines will be used as the basis for the development of other documents regulating the process of providing medical care, including standards and procedures for the provision of medical care, as well as criteria for assessing the quality of medical care. Thus, at the end of the transition period, an integral system of quality management of medical care will be created, based on clinical guidelines, taking into account the best world practices.

The Ministry of Health of the Russian Federation has issued a number of orders regulating the work on the formation of clinical guidelines:

1. Order of the Ministry of Health of Russia dated February 28, 2019 No. 101n "On approval of the criteria for forming a list of diseases, conditions (groups of diseases, conditions) for which clinical guidelines are developed." Currently, this list is posted on the website of the Ministry of Health of the Russian Federation https://www.rosminzdrav.ru/poleznye-resursy/nauchno-prakticheskiy-sovet;
2. Order of the Ministry of Health of Russia dated February 28, 2019 No. 102n "On approval of the Regulations on the Scientific and Practical Council of the Ministry of Health of the Russian Federation";
3. Order of the Ministry of Health of Russia dated February 28, 2019 No. 103n "On the approval of the procedure and terms for the development of clinical guidelines, their revision, the standard form of clinical guidelines and requirements for their structure, composition and scientific validity of information included in clinical guidelines";
4. Order of the Ministry of Health of Russia dated February 28, 2019 No. 104n "On the approval of the procedure and terms for the approval and approval of clinical guidelines, criteria for the scientific and practical council's decision to approve, reject or send for revision of clinical guidelines or a decision to revise them."

According to the order of the Ministry of Health of Russia dated February 28, 2019 No. 103n “Medical professional non-profit organizations develop draft clinical guidelines and organize their public discussion, including with the participation of scientific organizations, educational institutions of higher education, medical organizations, medical professional non-profit organizations, their associations (unions ) specified in part 5 of article 76 of the Federal Law N 323-FZ, as well as by posting on the information and telecommunications network "Internet".

According to the order of the Ministry of Health of Russia No. 102n of February 28, 2019, after the development of clinical guidelines, they will be further considered by the Scientific and Practical Council of the Ministry of Health of Russia and approved, rejected or sent for revision in accordance with the terms and criteria regulated by the order of the Ministry of Health of Russia 104n.

With a positive decision of the scientific and practical council of the Ministry of Health of Russia, clinical guidelines are approved by professional non-profit organizations.

In connection with the above, we inform you about the beginning of the development of clinical guidelines for diseases, conditions (groups of diseases, conditions) included in the List by the medical professional non-profit organization Union of Pediatricians of Russia, according to which clinical guidelines should be developed / updated. ...

We also inform you that the formation of working groups will be carried out in cooperation with medical professional non-profit organizations in the relevant profiles and include, inter alia, specialists providing medical care to patients of the adult age category.

The Union of Pediatricians of Russia widely involves professional communities, as well as scientific, educational organizations and the public in the formation of clinical guidelines.

President of the Union of Pediatricians of Russia,
Chief freelance pediatric specialist in preventive medicine of the Ministry of Health of Russia,
acad. RAS L.S. Namazova-Baranova

Honorary President of the Union of Pediatricians of Russia,
Chief freelance specialist pediatrician of the Ministry of Health of Russia,
acad. RAS A.A. Baranov

• Vaccine prophylaxis of haemophilus influenzae type b in children
• Vaccine prophylaxis of diseases caused by human papillomavirus
• Vaccine prophylaxis of pneumococcal infection in children
• Vaccine prevention of rotavirus infection in children
• Deficiency of acyl-CoA dehydrogenase of very long carbon fatty acids in children
• Immunoprophylaxis of meningococcal infection in children

Order of the Ministry of Health and Social Development of the Russian Federation of April 16, 2012 N 366n
"On approval of the Procedure for the provision of pediatric care"

The procedure for the provision of pediatric care has been approved. It applies to all medical organizations.

Assistance is provided in the form of primary health care, emergency and specialized medical care. In this case, different conditions are possible.

The first is outside the medical organization (at the place where the ambulance team is called, as well as in the vehicle during medical evacuation).

The second is on an outpatient basis (in conditions that do not provide for round-the-clock medical supervision and treatment).

The third - in a day hospital (in conditions providing for observation and treatment during the day, but not around the clock).

Fourth - stationary (in conditions providing round-the-clock observation and treatment).

The rules for organizing the activities of the office of a pediatrician of a district, children's polyclinic (department), a consultative and diagnostic center for children, a pediatric department are given. For each of these structures, the recommended staffing standards for medical personnel and equipment standards have been determined.

In accordance with Article 37 of the Federal Law of November 21, 2011 No. 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, No. 48, Art. 6724; 2015, No. 10, Art. 1425 ) I order:

1. To approve the standard of emergency medical care for hypertension according to.

2. To declare invalid the order of the Ministry of Health of the Russian Federation of December 24, 2012 No. 1513n "On approval of the standard of emergency medical care for diseases characterized by high blood pressure" (registered by the Ministry of Justice of the Russian Federation on February 27, 2013, registration No. 27355).

The minister

IN AND. Skvortsova

Standard
ambulance for hypertension

Age category: adults Gender: any Phase: acute condition Stage: any Complications: regardless of complications Type of medical care: ambulance, including specialized emergency, medical care Conditions of medical care: outside the medical organization Form of medical care: emergency, urgent Average duration of treatment (number of days): 1
ICBH code
Nosological units
	I10	Essential (primary) hypertension
	I11	Hypertensive heart disease (hypertensive heart disease with predominantly heart disease)
	I12	Hypertensive (hypertensive) disease with predominant kidney damage
	I13	Hypertensive (hypertensive) disease with predominant damage to the heart and kidneys
	I15	Secondary hypertension
	I67.4	Hypertensive encephalopathy

1. Medical services for the diagnosis of disease, condition

1.1. Reception (examination, consultation) of a specialist doctor
Code medical services
B01.044.001	Examination by an ambulance doctor	0,5	1
B01.044.002	Examination by an ambulance paramedic	0,5	1
1.2. Laboratory research methods
1.3. Instrumental research methods
Code medical services	Name of the medical service	Average rendering frequency	Average rate of application rate
A05.10.004	Decoding, description and interpretation of electrocardiographic data	0,9	1
A05.10.006	Registration of an electrocardiogram	0,9	1
1.4. Other research methods

2. Medical services for the treatment of disease, condition and treatment monitoring

2.1. Reception (examination, consultation) and supervision of a specialist doctor
2.2. Observation and care of the patient by medical workers with secondary vocational education
2.3. Laboratory research methods
2.4. Instrumental research methods
2.5. Other research methods
2.6. Surgical, endoscopic, endovascular and other methods of treatment requiring anesthetic and / or resuscitation support
2.7. Methods of prevention, treatment and medical rehabilitation
Code medical services	Name of the medical service	Average rendering frequency	Average rate of application rate
A11.02.002	Intramuscular injection of drugs	0,1	1
A11.09.007	Inhalation of drugs and oxygen	0,3	1
A11.12.002	Catheterization of the cubital and other peripheral veins	0,5	1
A11.12.003	Intravenous drug administration	0,5	2
A23.30.042	Medical evacuation	0,5	1

3. The list of medicinal products for medical use registered on the territory of the Russian Federation, indicating the average daily and course doses

Code	Anatomical-therapeutic-chemical classification	Name of the medicinal product	Average rendering frequency	Units	SSD	SKD
В05СВ	Saline solutions		0,5
		Sodium chloride		ml	200	200
	Electrolyte solutions		0,1
		Magnesium sulfate		mg	2500	2500
	Organic nitrates		0,3
		Nitroglycerine		mg	10	10
С02АС	Agonists imidazoline receptors		0,6
		Clonidine		mg	0,1	0,1
		Moxonidine		mg	0,4	0,4
C02CA	Alpha blockers		0,1
		Urapidil		mg	50	50
C03CA	Sulfonamides		0,25
		Furosemide		mg	40	40
S07AV	Selective beta-blockers		0,05
		Esmolol		mg	10	10
C08CA	Dihydropyridine derivatives		0,05
		Nifedipine		mg	10	10
C09AA	ACE inhibitors		0,2
		Captopril		mg	50	50
N05BA	Benzodiazepine derivatives		0,2
		Diazepam		mg	20	20
V03AN	Medical gases		0,3
		Oxygen		l	120	120

* (1) - International Statistical Classification of Diseases and Related Health Problems, X revision

* (2) - Probability of providing medical services or prescribing medicinal products for medical use (medical devices) included in the standard of medical care, which can take values ​​from 0 to 1, where 1 means that this activity is carried out by 100% of patients who meet this models, and numbers less than 1 - the percentage of patients specified in the standard of care with appropriate medical indications.

* (3) - international non-proprietary or chemical name of the medicinal product, and in cases of their absence - the trade name of the medicinal product

* (4) - average daily dose

* (5) - average course dose

Notes:

1. Medicines for medical use registered on the territory of the Russian Federation are prescribed in accordance with the instructions for use of the medicinal product for medical use and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into account the method of administration and use medicinal product.

2. The prescription and use of medicinal products for medical use, medical devices and specialized medical food products that are not included in the standard of medical care are allowed in the presence of medical indications (individual intolerance, for health reasons) by decision of the medical commission (Part 5 of Article 37 of the Federal Law of November 21, 2011 No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, No. 48, Art. 6724; 2015, No. 10, Art. 1425)).

Document overview

A new standard of medical care has been approved, which defines the basic requirements for the diagnosis and treatment of patients with hypertension. The standard is recommended for use in the provision of emergency medical care (including specialized).

The ambulance standard for diseases characterized by high blood pressure is no longer valid.

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER

In accordance with Article 37 of the Federal Law of November 21, 2011 N 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, Article 6724; 2015, N 10, Article 1425)

I order:

1. To approve the standard of emergency medical care for hypertension according to the appendix.

2. To declare invalid the order of the Ministry of Health of the Russian Federation of December 24, 2012 N 1513n "On approval of the standard of emergency medical care for diseases characterized by high blood pressure" (registered by the Ministry of Justice of the Russian Federation on February 27, 2013, registration N 27355).

The minister
V. I. Skvortsova

Registered
at the Ministry of Justice
Russian Federation

registration N 42897

Application. Hypertension Ambulance Standard

Application
to order
Ministry of Health
Russian Federation
dated July 5, 2016 N 470н

Floor: any

Phase: acute condition

Stage: any

Complications: regardless of complications

Type of medical assistance: ambulance, including specialized ambulance, medical aid

Conditions for the provision of medical care: outside the medical organization

Medical assistance form: emergency, urgent

Average duration of treatment (number of days): 1

________________ * International Statistical Classification of Diseases and Related Health Problems, X revision.
Nosological units
		Essential (primary) hypertension
		Hypertensive heart disease (hypertensive heart disease with predominant heart disease)
		Hypertensive (hypertensive) disease with predominant kidney damage
		Hypertensive (hypertensive) disease with predominant damage to the heart and kidneys
		Secondary hypertension
		Hypertensive encephalopathy

1. Medical services for the diagnosis of disease, condition

1.1. Reception (examination, consultation) of a specialist doctor
Medical Service Code
________________ The probability of providing medical services or prescribing drugs for medical use (medical devices) included in the standard of medical care, which can take values ​​from 0 to 1, where 1 means that this event is carried out by 100% of patients corresponding to this model, and the numbers are less 1 - the percentage of patients specified in the standard of medical care with appropriate medical indications.
	Examination by an ambulance doctor
	Examination by an ambulance paramedic

1.3. Instrumental research methods
Medical Service Code	Name of the medical service	Average rendering frequency	Average rate of application
	Decoding, description and interpretation of electrocardiographic data
	Registration of electrocardiogram

2. Medical services for the treatment of disease, condition and treatment monitoring

2.7. Methods of prevention, treatment and medical rehabilitation
Medical Service Code	Name of the medical service	Average rendering frequency	Average rate of application
	Intramuscular injection of drugs
	Inhalation of drugs and oxygen
	Catheterization of the cubital and other peripheral veins
	Intravenous drug administration
	Medical evacuation

3. The list of medicinal products for medical use registered on the territory of the Russian Federation, indicating the average daily and course doses

	Anatomical therapeutic chemical classification	Name of the medicinal product **	The average frequency is provided laziness	Units
________________ ** International non-proprietary or chemical name of the medicinal product, and in cases of their absence - the trade name of the medicinal product. *** Average daily dose. **** Average course dose.
	Saline solutions
		Sodium chloride
	Electrolyte solutions
		Magnesium sulfate
	Organic nitrates
		Nitroglycerine
	Imidazoline receptor agonists
		Clonidine
		Moxonidine
	Alpha- adrenergic blockers
		Urapidil
	Sulfonamides
		Furosemide
	Selective beta adrenergic blockers
	Dihydropyridine derivatives
		Nifedipine
	ACE inhibitors
		Captopril
	Benzodiazepine derivatives
		Diazepam
	Medical gases
		Oxygen

Notes:

1. Medicines for medical use registered on the territory of the Russian Federation are prescribed in accordance with the instructions for use of the medicinal product for medical use and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into account the method of administration and use medicinal product.

2. The prescription and use of medicinal products for medical use, medical devices and specialized medical food products that are not included in the standard of medical care are allowed in the presence of medical indications (individual intolerance, for health reasons) by decision of the medical commission (Part 5 of Article 37 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, Article 6724; 2015, N 10, Article 1425)).

Electronic text of the document
prepared by JSC "Kodeks" and verified by:
Official Internet Portal
legal information
www.pravo.gov.ru, 20.07.2016,
N 0001201607200004