Антон Киселев » Публикация

Аннотация The necessity of improvement of medical care quality to patients with hypertension set conditions for the development of an alternative approach to evaluation of the effectiveness of medical care to such patients aimed to reveal deviations of medical care procedures from guidelines of National Recommendations on Hypertension. The most common statistical indices used currently and designated for the quality of care to patients with hypertension assessment are not founded on evidence-based data of Recommendations. Aim. To compare the results of estimation of quality indicators founded on evidence-based data on arterial hypertension presented in National Recommendations with the results of estimation of comparable statistical indices used commonly in clinical practice. Material and methods. The results of two-year management of 458 patients with hypertension of I-III grades aged 55±19 in four polyclinics of Saratov were studied. The main statistical and clinicodemographic characteristics of the hypertensive patients (the first method) and quality indicators developed (the second method) were estimated. Results. Under comparing the first and the second methods the following values of assessing characteristics were obtained. The percentage of patients with established arterial hypertension was 89.6% и 32.7% respectively. The percentage of patients with hypertension, who had one or more risk factors, was 42.3% и 67.8% respectively. The percentage of patients with the evidence of target organs damage or/and associated clinical condition was 48.2% и 59.9% respectively. The percentage of patients with secondary hypertension was 1.2% и 3% respectively. The percentage of patients in whom blood pressure (BP) achieved its target level was 26.2% и 9.4% respectively. The percentage of patients in whom a target BP level has been sustained was 2.1% и 1.7% respectively. Furthermore, the set of developed quality indicators included the following characteristics: assessment of personal 5-year risk of fatal cardiovascular events, BP level assessment before starting of medical treatment, registration of patients with hypertension who had one or more modified risk factors and received documented advice on lifestyle change measures at least once a year, assessment of medication principles compliance and regularity of hypertensive patients observation. At present, there are no analogues to such care quality characteristics among up-to-date statistical indices. Conclusions. 1. The results of cardiologic situation assessment obtained with the help of quality indicators differ substantially from the results obtained with the help of the main statistical characteristics. 2. Quality indicators of medical care have more applied value then the main currently used statistical characteristics because they are founded on evidence-based data of National Recommendations on Hypertension and point out directly those problems of the treatment-and-diagnostic process which need to be improved for raising the quality of medical care.