Ministry of Health of the Republic of Uzbekistan 
Tashkent Medical Academy 

                                                                                                                      "Approved"
   Pro-Rector
prof. Sh.A.Boymurodov 

                                                                                                «-------»--------- 2017. 

Department: "Public health organizations and health management"
Subject: Public health organization and management of health care.
Subject:
.
Social Security, an organization expert permanent disability. VTEK. Organization and problems of rehabilitation.

Educational - methodical development
(For teachers and students of 3 rd year medical - pedagogical, medical faculty)

Tashkent 2017

Compiled by:

Rustamov H.E. - MD Professor: "Public health organizations and health management"
Hvan A.A. - Assistent: "Public health organizations and health management"

Reviewers:

Head. Department of "Public health organizations and health care management" Tash.PMI, prof. Iskandarov Sh.T.
Professor, Department of General and Radiation Hygiene "TMA
Tajibayeva NS

The role of physicians in the examination permanent disability
The order of examination of persistent disability in health facilities
The basic rules and procedure for issuing directions to VTEK
VTEK, its main function
Types and Structure VTEK
Cause of disability.
Disability group
Types of rehabilitation.

Questions for controlling the initial level of knowledge of students:
The role of physicians in the examination permanent disability
The order of examination of persistent disability in health facilities
The basic rules and procedure for issuing directions to VTEK
VTEK, its main function
Types and Structure VTEK
Cause of disability.
Disability group
Types of rehabilitation.

The content of lessons
Subject lessons: Social Security, the organization of expertise permanent disability. VTEK. Organization and problems of rehabilitation.

1st place for lessons, equipment:
-Chair
-Handout

2. The duration of the study subjects: 2 hours
3. Session Purpose:

    Acquaint students with the basics of organizing examination of disability, the provisions on the procedure of establishing the disability group.
Upon completion of training a student must:
An understanding of the system sotsialnog8o insurance.
Aware of the problem and the types of VTEK
Know the reasons of disability and the types of rehabilitation.
Have an understanding of the basic rules and procedure for referral to VTEK
Be able to issue form "Directions for the VTEK" on the proposed situation.
Able to identify a group of disability on the proposed situation

4. Motivation: The general practitioner should know the criteria for health, types of disability, be able to properly assess the patient's condition and conduct examination of disability.
5. Interdisciplinary and intodisciplinary links:
Teaching Health Organization is based on the student's knowledge bases of social hygiene, physiology, valeology, a court of law, medicine and philosophy.

6. CONTENTS THEMES 
Theoretical part

Medical examination of disability as one of the objectives of health care aimed at:
Preventing the development of the disease process;
Creating an enabling environment for the patient during treatment and recovery;
Perhaps a more complete rehabilitation patient. Examination of disability is determined by three criteria: health, social and legal.
Disability means a full or partial disability occur as a result of organic lesions of body systems due to illness or injury.
There are two types of permanent disability: full and partial.
Total disability - is a condition when a person due to illness can not and should not perform any work and in need of special treatment.
Partial disability occurs when the sick can not carry out his professional work in full, but without damage to health can perform other work or their previous under easier conditions.

The functions of GPs on the examination of temporary disability.

1.Determination and reasons for persistent disability;
2. Registration Form, Directions for VTEK "graphs № 0 - 88u
3. Presentation of the patient to the consultation and approval, Directions for VTEK "at WCC.
4. Making the necessary documentation.

Functions of the head. Outpatient and head. Department

1. Oversight of diagnostic and treatment process;
2. Control over the timely referral to VTEK;
3. Participation in the WCC
4. Analysis of the causes of primary disability.

Functions of the deputy chief physician of clinical expert work or the head of health facilities
1.The management and performance analysis for quality control examination of temporary disability;
2. Analysis of clinical and expert mistakes;
3. Interaction with VTEK expert in solving problems;
4. Consideration of claims and demands of insurance companies and patients' complaints;

Functions of the WCC.

1. Expert evaluation of the quality and effectiveness of diagnostic and treatment process;
2. Referrals to VTEK;
3. Recommendations for a transfer to another job for medical reasons;
The main institutions are working in all areas related to establishing the fact of disability and rehabilitation is VTEK medical labor expert committee.

The following types of VTEK:
- Commission general;
- Commission specialist profile (tuberculosis, mental disorders, diseases and defects of vision, circulatory diseases, etc.);
- Commission a mixed profile;
Depending on the service area VTEK happens:
- primary (regional, inter-urban);
- higher (republican, regional, central city or cities - Tashkent).

Primary VTEK their structure and function
Commission general consists of 3 doctors experts (physician, surgeon, neurologist), one of whom is appointed chairman VTEK, and representatives of departments of social insurance and social security.
In the special commission composed of two expert physician specialist, and the third - the general profile. One of the medical specialists appointed by the president VTEK.
Chairman VTEK organizes its work, providing a quality examination and is personally responsible for the activities of the commission.
The main functions of the primary VTEK are:
- establishment of the state of disability, long-term or permanent loss, group, cause and time of - - - occurrence of disability and the degree of disability (per cent);
- definition of measures of social labor rehabilitation, advice on employment of disabled people.
 
Higher VTEK their structure and function

Higher VTEK formed out of 4 doctors, a representative of the Social Security and a representative trade union organization. One of the doctors is the chairman. Specialty 4-th doctor is determined taking into account regional peculiarities of the structure of morbidity and disability. If necessary, instead of the 4 th doctor can be administered by psychologists, sociologists and other specialists, as well as specialist rehabilitation psychologist, a specialist in functional diagnosis; expert guidance, an engineer or technician of technical means of rehabilitation; lawyer.

Higher VTEK carry out:

- organizational guidance and control
of district, inter-urban VTEK;
- if necessary pereosvidetelstvuyut persons appealed the decision VTEK;
- conducts examination in difficult cases of persons in the direction of regional, district and urban VTEK;
- take measures to enhance the skills of workers VTEK.

The order of examination of citizens in the institutions of VTE.

Survey of citizens in the institutions of VTE carried by place of residence or place of treatment by referral hospitals.
The facility fills a special document - "Request for VTEK (r № 088/u-97).
These expert survey and solutions VTEK shall be recorded in "Survey VTEK", which are signed by the entire Commission and stamped VTEK.
VTEK sends an appropriate health institution "Notice LPU conclude VTEK.
If the patient has declared an invalid, he is issued a certificate of the required forms and gives the conclusion of need in social protection measures. Group disability and the date of its establishment marked a piece of disability. If the patient is not considered disabled, he is issued a certificate of arbitrary shape. Extract from an act of examination of persons recognized as disabled, is sent to the bodies of pension schemes in the 3-day period from the date of determination of disability. If inspected disagrees with the decision of the primary VTEK it within a month and is applying his act, a statement sent to the supreme VTEK. Higher VTEK decision is final.
Documents certifying permanent disability:
Help the disabled;
Survey VTEK.

Criteria for the installation of disability

VTEK in determining disability guided instruction on the definition of disability groups, approved by the Ministry of Health of Uzbekistan, State Committee for Labor and Social Affairs and the Committee of Trade Unions.

     Group I - established patients who have a permanent total disability and in need of constant assistance, care or supervision. These are the same, and those individuals that can be adapted to certain types of work in especially created and individual conditions (blind, paralysis of limbs, etc.).

      II group - patients with established expressed violations of the organism, who became permanent or long-term total disability, but who do not need constant care. As well as those who have functional disorders are not as heavy, but all kinds of work for long periods are contraindicated because of possible worsening of the disease under the influence of employment.
      Group III - is set for a significant reduction in disability when:
for health reasons need to translate the work of other professions, lower education;
require substantial changes in working conditions throughout the profession leading to a significant reduction in industrial activity.

Causes of disability:

1. Systemic disease or trauma.
2. Occupational disease or industrial injury (trauma).
3. Disabled since childhood.
4. Disabled before the onset of labor.
 5. Injury, concussion, injury resulting in the performance of military duty or defense of the fatherland.

Social protection of disabled persons.

All persons with disabilities in need of social protection.
Social Protection disabled - the system of state-guaranteed economic, social and legal measures to ensure conditions for people with disabilities overcome the limitations of life and aimed at the creation of an equal footing with other citizens opportunities to participate in society.
Legal documents relating to the social protection of disabled persons. R. Ouse Constitution, the Law on social protection of disabled persons, laws and regulations.
State Rehabilitation Service - a collection of public authorities, local government, various agencies engaged in activities for medical, vocational and social rehabilitation. Rehabilitation of Disabled Persons - a system of medical, psychological, educational, social and economic activities to the fullest possible compensation for Disability. The aim of rehabilitation - the restoration of the social status of disabled person, his attainment of financial independence and social adaptation. Rehabilitation of Persons with Disabilities include:
medical rehabilitation, which consists of regenerative therapy, reconstructive surgery and prosthetics;
vocational rehabilitation - a vocational guidance, vocational and industrial adaptation and employment;
social rehabilitation - a socio-ENVIRONMENTAL orientation and social adaption.
In Uzbekistan the state and developed individual programs of rehabilitation of invalids. municipal health care facilities, private practice with licenses and certificates of advanced training in examination of temporary disability;
tuberculosis sanatoriums, clinics, Research Institute of Prosthetics, VTE;
Rehabilitation Centers in prosthetics musculoskeletal;
- Hospital orthopedic organizations.

62Praktical part of the end of the topic is taught, students folder with the documentation and the options model of situational tasks for the examination of permanent disability.
The actions of students on steps
The group is divided into groups (students receive an equal score subgroups according to the quality, timeliness and accuracy of trained job.)
Select a task to solve by drawing lots.
Study independently the problem of all parts of the VET and excerpts from the instructions on the order of VTEK.
Solve situational problems, and fill models "aimed at VTEK" in a notebook.
Algorithm to determine the actions of GPs to work with this patient.
Report the results of a group

6.3 Analytical part students should undertake a comparative analysis of the results of practical work on all proposed case studies

6.4 used in the lesson, the new educational technology
The methodology of the business game, "Working in small groups." Done on a business game, "Working in small groups." The group is divided into groups by drawing on April 3 in each student, conducted a situational analysis of the problem and fill models "aimed at VTEK" in a notebook. Determine the sequence of actions of GPs to work with this patient. After that, group leaders report to the situation developed, and students from other groups with the teacher evaluate the correctness, adequacy and correctness of the identified activities. Scores are given the correct wording, logical answer, and the number of errors during parsing of the situation and solving the problem

Progress:
1.All students draw divided into subgroups of 3 - 4 students.
2.Kazhdaya subgroup sits at a separate table and gets the job in a sealed envelope.
3.Na clean sheet in a notebook written date, participants and setting.
4.Zasekaetsya time (25 min.) For the performance of work and filling out forms, the answer should be complete and accurate.
5.Obschenie with other subgroups are prohibited.
6.Lider group read out the answer, which is estimated teacher for correctness, completeness and accuracy of execution.
7.Vsem member of a small group put the same points:
 Maximum - 100% 86-100% - "5" 71-85% - "4", 55-70% - "3", 40-54% - "2."
8.Protokoly work in the notebooks are signed by each student teacher.
 9. The scoring on the sheet of the protocol are taken into account when calculating the current total occupation by the simple average in the amount of the assessment for the theoretical part.

7.Formy of knowledge and skills.
Oral interview
Parsing making common tasks

8. Criteria for assessment of the current level of control
Levels	Rating count	Points Criteria evaluations
	
Excellent
86 - 100%	96 - 100	Answers originality, rationale, meet all program requirements, use additional information from the Internet, magazines, etc. He takes an active part in discussion topics, solving situational problems with the analysis and explanation.	
	91 -95	correct answers with interesting examples. Takes an active part in discussion topics, addressing situational tasks, with analysis and explanation.	
	86 -90	correct answers with interesting examples within the lecture and practical courses. Takes an active part in discussion topics, addressing situational tasks, with elements of analysis.
	
Well 
71 - 85.9%	81 - 85.9	correct answers in accordance with the scope of the program, not more. Decision situational tasks with an explanation, there may be minor errors.	
	76 - 80	answers within the textbook or lecture notes, perhaps glitches in the wording. Less active in the discussion of topics addressing the situational problems may be small errors.	
	71 - 75.9	responses within the textbook, perhaps minor inaccuracies, errors or difficulties in the wording. Passive, when discussing the topic, to solve situational problems of possible errors and errors of up to 20%.	
Satisfactory
55 - 70,9%	65 -70.9	Replies average from inaccuracies or errors. Passive, when discussing the topic, to solve situational problems of possible errors and errors of up to 30%. But does accurately notes in notebooks.	
	55 - 64.9	Weak knowledge of the theoretical question, the answers are not complete, with bugs. Passive, when discussing the topic, to solve situational problems and possible responses to errors and errors of up to 40%. Is not accurately notes in notebooks.	
Does not satisfy
Satisfactory
40 - 55%	50 -54.9	answers are not right, listens attentively to explanations of the teacher and student responses. Problem solved mene than 50%, no laptop leads neatly.	
	40 - 49.9	is not responding, not attentive, did not participate in the discussion of issues and solving situational problems.	

9. Chronological map of classes

№	Stages classes	Form of	Time	
1	Roll call and introduction of a teacher (study subjects)		5 minutes	
2	Discussion topics initial assessment of students' knowledge 	Poll	15 minutes	
3	Carrying out online game "Work in small groups" 	Business Game	5min	
4	independent work of students on the assignments obtained 
	Independent Work	35 minutes	
5	Report on the results of independent work 	Checking
Results	20 minutes	
6	Reciprocal analysis of the results of independent work by students under the guidance of teacher evaluation on 100 point system method of calculating the average of the oral response, a business game, independent work. 	Information teacher	10minut	

Test questions
What purpose they serve the social security system in Uzbekistan.
What types of disability you know.
What are the main principles of the examination of disability.
Describe the organization of work and tasks VTEK.
Name the group, the causes and possible disability.
Name the problem and the types of rehabilitation.
Describe the activities of rehabilitation centers.
What documentation is used in health care facilities during the examination of disability.

11. Exercises for independent work

12.Razdatochny material
Criteria for the installation of disability
Causes of disability:
Types of VTE
Problem.

13. Recommended Reading:
 Main:
Serenko AF, Ermakov VV Social Care and Health Organization, "Moscow. 1984.
Lisitsyn YP Hooves NY Guidelines for practical training in social hygiene ", Moscow. 1984.
More:
Lisitsyn YP et al. "Social Hygiene and Public Health Organization" in 2 volumes, Volume 2, Moscow. 1989.
2.Lisitsin Yu.P. Polunin H. MV <Public Health and Health Care>> Moscow. 2002.

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