Comparative analysis of a survey of outand inpatient physicians on secondary prevention of noncommunicable diseases

Aim. To determining the potential of secondary prevention of noncommunicable diseases (NCDs) at the outpatient and inpatient stages by conducting a cross-sectional medical and social survey of a cohort of physicians from various Russian cities.

Material and methods. Physicians from outpatient clinics (16 cities, 545 physicians) and hospitals (13 cities, 151 physicians) took part in the cross-sectional study. The survey was carried out using an original questionnaire, in the development of which experts from the National Medical Research Center for Therapy and Preventive Medicine and public health professionals took part. The questionnaire consisted of 9 questions, including sex and age characteristics, frequency of various nosological units, medication adherence, subsidized drug provision, interaction with outpatient doctors, and staffing of doctors and midlevel personnel. Answers were offered for each question in several gradations. Depending on the population size, the cities were divided into 4 following subgroups: population >2 million people, 1-2 million people, 0,4-1 million people and <400 thousand people.

Results. According to the obtained results, in outpatients clinics and hospitals, coronary artery disease ranks first in terms of the frequency of adult population visits and accounts for ~40% of NCDs. Patients with a diagnosis of heart failure are 1,4 times more likely to visit hospitals compared to outpatient clinics. The frequency of detection of other chronic diseases in outpatient clinics and hospitals has a similar picture and in total amounts to 50% of visits for NCDs. Among hospitalized patients, persons of both sexes aged 65 years dominate, while at the outpatient level it is <2 times. Patients aged 60-64 years, regardless of sex, equally often seek outpatient and inpatient care. Subsidized provision of essential drugs in every second case is provided at a satisfactory level (50-75%). A comparable number of patients receive drugs up to 50% of cases. Every second patient is not adherent to drug and non-drug therapy to varying degrees, and the opinion of outand inpatient physicians is comparable. It should be noted that in outpatient clinics, the understaffing of doctors and paramedical personnel reaches 50%.

Conclusion. Given the dominant position of cardiovascular diseases among the causes of hospitalization and outpatient care due to older age groups, outpatient follow-up and care among high-risk individuals should be improved. Among the priorities of secondary prevention of NCDs, an important place is occupied by improving educational work to increase patient adherence to drug correction and achieving target levels of the main risk factors. Optimization of material and technical support, including drug provision of health facilities, as well as improving the staffing of doctors and nursing staff play a key role in managing secondary prevention in primary health care.

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