Recommendations for pediatrics. Clinical guidelines for pediatrics. How to organize palliative care for children

Clinical guidelines in pediatrics were developed by a group of experienced pediatric specialists on behalf of the Minister of Health of the Russian Federation. We recommend that you familiarize yourself with the current version of the document for application national recommendations in the daily activities of a pediatrician

We recommend that you familiarize yourself with the current version of the document to apply national recommendations in the daily activities of a pediatrician.

Download the clinical guidelines compliance checklist.

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From the article you will learn

Based on them, under the leadership of the Russian Ministry of Health, criteria for assessing the quality of medical care for specific groups of conditions and diseases of minor patients are being developed.

Main changes for medical officers in 2019

Look at the algorithm for implementing clinical recommendations that have been in effect since 2019. It was developed by experts from the magazine "Deputy Chief Physician". Click on sections and follow the instructions.

Are the 2019 federal clinical guidelines for pediatrics mandatory? medical institutions? In accordance with the Federal Law “On Health Protection,” attending physicians, when providing care to patients, are guided by medical standards, procedures and clinical recommendations.

Referring a child for palliative care: ways to make medical decisions

Order of the Ministry of Health of Russia dated April 14, 2015 No. 193n approved the Procedure for the provision of palliative care medical care children. The decision to refer a child for palliative care should be made by medical commission medical organizations.

At the same time, the Procedure does not detail the methodology for selecting patients. childhood for referral to palliative care.

Stratification of patients into certain clinical groups necessary for proper planning scope and nature of palliative care:

Category 1 - life threatening diseases in which radical treatment may be feasible, but often fails to produce results (e.g. malignant neoplasms, irreversible/malignant cardiac, hepatic and renal failure);
Category 2 - conditions in which premature death is inevitable, but prolonged intensive treatment can increase the life expectancy of the child and allow him to maintain his activity (cystic pulmonary hypoplasia/polycystic pulmonary disease)...

How to organize palliative care for children

Render palliative care Children can receive visiting patronage services, palliative care departments, and children's hospices. Look at convenient tables with indicators and practical developments in the field of children's palliative care in the Chief Physician System.

Vaccinal prevention of hemophilus influenzae type b infection in children
Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
Immunoprophylaxis of respiratory syncytial virus infection in children
Acute obstructive laryngitis (croup) and epiglottitis in children
Consequences of perinatal damage to the central nervous system with atonic-astatic syndrome
Consequences of perinatal damage to the central nervous system with hydrocephalic and hypertension syndromes
Consequences of perinatal damage to the central nervous system with hyperexcitability syndrome

Dear colleagues!

In accordance with the Federal Law of December 25, 2018 No. 489-FZ “On Amendments to Article 40 Federal Law“On compulsory health insurance in Russian Federation"and the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" on the Issues of Clinical Recommendations" clinical recommendations are currently defined as a document containing a scientific evidence 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 recommendations in accordance with the standards introduced by the bill. Approved clinical recommendations will contain parameters reflecting the correct choice of diagnostic methods and treatment based on the principles evidence-based medicine. The use of clinical recommendations will allow medical workers determine tactics for managing a patient with a specific nosology at all stages of medical care.

Clinical recommendations will be used as the basis for the development of other documents regulating the process of providing medical care, including standards and procedures for providing medical care, as well as criteria for assessing the quality of medical care. Thus, at the end of the transition period, a comprehensive quality management system for medical care will be created, based on clinical recommendations that take into account the best global practices.

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

Order of the Ministry of Health of Russia dated February 28, 2019 No. 101n “On approval of criteria for the formation of a list of diseases, conditions (groups of diseases, conditions) for which clinical recommendations are developed.” Currently this list posted on the website of the Ministry of Health of the Russian Federation https://www.rosminzdrav.ru/poleznye-resursy/nauchno-prakticheskiy-sovet;
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”;
Order of the Ministry of Health of Russia dated February 28, 2019 No. 103n “On approval of the procedure and timing for the development of clinical recommendations, their revision, standard form clinical recommendations and requirements for their structure, composition and scientific validity of information included in clinical recommendations";
Order of the Ministry of Health of Russia dated February 28, 2019 No. 104n “On approval of the procedure and timing for the approval and approval of clinical recommendations, criteria for the scientific and practical council to make a decision on approval, rejection or referral for revision of clinical recommendations or a decision on their revision.”

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 recommendations and organize their public discussion, including with the participation of scientific organizations and educational organizations higher education, medical organizations, medical professional non-profit organizations, their associations (unions), specified in Part 5 of Article 76 of Federal Law N 323-FZ, as well as through posting on the Internet information and telecommunications network.

According to Order of the Ministry of Health of Russia No. 102n dated February 28, 2019, after development, clinical recommendations 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 deadlines and criteria regulated by Order of the Ministry of Health of Russia 104n.

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

In connection with the above, we inform you that the medical professional non-profit organization Union of Pediatricians of Russia has begun developing clinical recommendations for diseases, conditions (groups of diseases, conditions) included in the List for which clinical recommendations 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 will include, among other things, 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.

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

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

Vaccinal prevention of hemophilus influenzae type b infection in children
Vaccinal prevention of diseases caused by human papillomavirus
Vaccinal prevention of pneumococcal infection in children
Vaccinal prevention of rotavirus infection in children
Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
Immunoprophylaxis of meningococcal infection in children

Clinical guidelines for pediatrics were developed by a group of experienced pediatric specialists on behalf of the Minister of Health of the Russian Federation. We recommend that you familiarize yourself with the current version of the document to apply national recommendations in the daily activities of a pediatrician

We recommend that you familiarize yourself with the current version of the document to apply national recommendations in the daily activities of a pediatrician.

Download the clinical guidelines compliance checklist.

↯ More articles in the magazine

From the article you will learn

Main changes for medical officers in 2019

Look at the algorithm for implementing clinical recommendations that have been in effect since 2019. It was developed by experts from the magazine "Deputy Chief Physician". Click on sections and follow the instructions.

Are the 2019 federal clinical guidelines for pediatrics mandatory for use by medical institutions? In accordance with the Federal Law “On Health Protection,” attending physicians, when providing care to patients, are guided by medical standards, procedures and clinical recommendations.

Referring a child for palliative care: ways to make medical decisions

Order of the Ministry of Health of Russia dated April 14, 2015 No. 193n approved the Procedure for providing palliative medical care to children. The decision to refer a child for palliative care should be made by the medical commission of the medical organization.

At the same time, the Procedure does not detail the methodology for selecting pediatric patients for referral to palliative care.

Stratification of patients into certain clinical groups is necessary for proper planning of the scope and nature of palliative care:

Category 1 - life-threatening diseases for which radical treatment may be feasible but often fails (eg, malignancy, irreversible/malignant cardiac, hepatic and renal failure);
Category 2 - conditions in which premature death is inevitable, but long-term intensive treatment can increase the child's life expectancy and maintain his activity (cystic pulmonary hypoplasia/polycystic pulmonary disease)...

How to organize palliative care for children

Visiting patronage services, palliative care departments, and children's hospices can provide palliative care to children. Look at convenient tables with indicators and practical developments in the field of children's palliative care in the Chief Physician System.

Vaccinal prevention of hemophilus influenzae type b infection in children
Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
Immunoprophylaxis of respiratory syncytial virus infection in children
Acute obstructive laryngitis (croup) and epiglottitis in children
Consequences of perinatal damage to the central nervous system with atonic-astatic syndrome
Consequences of perinatal damage to the central nervous system with hydrocephalic and hypertension syndromes
Consequences of perinatal damage to the central nervous system with hyperexcitability syndrome