Potential and limitations of secondary prevention of noncommunicable diseases: data from a survey of Russian outpatient physicians

Aim. To identify potential and limitations of secondary prevention of noncommunicable diseases in outpatient clinics of various Russian cities.

Material and methods. Outpatient physicians from 16 Russian cities took part in the cross-sectional study. A total of 545 general practitioners took part in the survey. The survey was carried out using a previously prepared questionnaire at the National Medical Research Center for Therapy and Preventive Medicine. It consisted of 11 blocks of questions, including sex and age characteristics, the prevalence of various diseases, adherence to therapy, preferential provision of medications, consultation assistance by hospital-based physicians and coverage of doctors and nursing staff. Answers were offered in several gradations to each question. Depending on the population, cities were divided into 4 following subgroups: population >2 million people (Moscow and St. Petersburg), population of 1-2 million people (Samara, Rostov-onDon, Krasnodar, Krasnoyarsk, Omsk), population of 0,4-1 million people (Vladivostok, Ulyanovsk, Penza, Kursk, Kirov, Tomsk) and population <400 thousand people (Nalchik, Saransk, Ivanovo).

Results. In all Russian cities, among men visited a clinic, 37% were people in the age range of 50-60 years. Second place was taken by men aged 60-65 years (30%). Most often, patients present with chronic coronary artery disease (39%), followed by type 2 diabetes (22,6%). Patients present with symptoms of heart failure in 17,7% of cases. Cancer account for 11,5% in the structure of visits. A similar frequency was found for chronic obstructive pulmonary diseases (9,2%). Every third patient is partially adherent to drug correction; partial non-adherence is detected 2 times less, while complete nonadherence is <3%. On average, 67% of doctors from different cities declare 75% achievement of target levels of risk factors, while one in five declare 50% achievement of recommended indicators. In most cases, physicians report minor problems during hospitalization. Every fifth doctor reported no problems, while every tenth respondent noted difficulties in hospitalizing patients. In every second case, partial staffing is noted. Moreover, a comparable trend is observed among doctors and nursing staff. In megacities and small towns the situation is somewhat better compared to cities with a population of 0,4 to 2 million.

Conclusion. To optimize the secondary prevention of noncommunicable diseases, a number of measures at the outpatient healthcare level should be taken. This includes educational work on adherence to drug and non-drug treatment correction, expanding coverage of preferential medication provision, improving interaction with hospitalbased doctors and coverage of doctors and nursing staff.

1. Huijts T, Stornes P, Eikemo TA, Bambra C; HiNews Consortium. Prevalence of physical and mental non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health. 2017;27(suppl_1):8-13. doi:10.1093/eurpub/ckw232.

2. Kalinina AM, Sokolov GE, Gornyy BE. Medical prophylaxis of chronic noncommunicable diseases in primary health care: attitude, opinion and practice of doctors (medical and sociological research). The Russian Journal of Preventive Medicine. 2020; 23(2):53-8. (In Russ.) doi:10.17116/profmed20202302153.

3. Drapkina OM, Kontsevaya AV, Kalinina AM, et al. 2022 Prevention of chronic non-communicable diseases in the Russian Federation. National guidelines. Cardiovascular Therapy and Prevention. 2022;21(4):3235. (In Russ.) doi:10.15829/1728-8800-2022-3235.

4. Loukianov MM, Andrenko EYu, Martsevich SYu, et al. Patients with Atrial Fibrillation in Clinical Practice: Comorbidity, Drug Treatment and Outcomes (Data from RECVASA Registries). Rational Pharmacotherapy in Cardiology. 2020;16(6):888-98. (In Russ.) doi:10.20996/1819-6446-2020-12-01.

5. Drozdova LYu, Ivanova ES, Egorov VA, et al. Quality assessment of the secondary prevention of chronic noncommunicable diseases during the public dispancery observation in regions of the Russian Federation. The Russian Journal of Preventive Medicine. 2020;23(6-2):21-25. (In Russ.) doi:10.17116/profmed20202306221.

6. Martsevich SYu, Kutishenko NP, Sichinava DP, et al. Prospective outpatient registry of myocardial infarction patients (profilemi): study design and first results. Cardiovascular Therapy and Prevention. 2018;17(1):81-6. (In Russ.) doi:10.15829/1728-8800-2018-1-81-86.

7. Boytsov SA, Loukianov MM, Yakushin SS, et al. Cardiovascular diseases registry (recvaza): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatientpolyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50. (In Russ.) doi:10.15829/1728-8800-2014-6-3-8.

8. Balanova YuA, Drapkina OM, Kutsenko VA, et al. Hypertension in the Russian population during the COVID-19 pandemic: sex differences in prevalence, treatment and its effectiveness. Data from the ESSE-RF3 study. Cardiovascular Therapy and Prevention. 2023;22(8S):3785. (In Russ.) doi:10.15829/1728-8800-2023-3785.

9. Rugol LV, Son IM, Menshikova LI. The impact of primary health care staffing on the effectiveness of its activities. Social aspects of public health. 2020;66(3):10. (In Russ.) doi:10.21045/2071-5021-2020-66-3-9.

10. Shepel RN, Senenko ASh, Kalashnikova MA. Staffing for primary health care for the adult population of the Russian Federation in 2014-2022. part 1: focus on doctors-therapists. Modern problems of health care and medical statistics. 2023;3:1148-59. (In Russ.) doi:10.24412/2312-2935-2023-3-1148-1159.

11. Starodubov VI, Kupeeva IA, Senenko ASh, et al. Models for organizing the provision of primary health care to the adult population with expansion of the areas of responsibility of nursing staff. Guidelines. Moscow: Publishing house of the Federal State Budgetary Institution "TsNIIOIZ" of the Ministry of Health of the Russian Federation. 2021. p. 68. (In Russ.) ISBN: 978-5-94116-065-5.