Organizational context of quality assessment of follow-up care for patients with stable coronary heart disease by primary care general practitioners

Abstract

The high prevalence of coronary heart disease (CHD) in the Russian population warrants the importance of the quality of medical care for such patients during the follow-up care in accordance with established criteria. Objective. To evaluate the quality of the follow-up care of patients with stable CHD performed by primary care general practitioners in health care facilities in the constituent entities of the Russian Federation. Material and methods. During field visit of the experts of the National Medical Research Center for Therapy and Preventive Medicine in 38 constituent entities of the Russian Federation, outpatient records of randomly selected patients with CHD during visits of outpatient departments of primary health care facilities were analyzed. Data were collected and analyzed using a unified developed algorithm (checklist) for assessing the availability and quality of follow-up care in accordance with the requirements of the procedure for follow-up care for adults, approved by Order of the Ministry of Health of the Russian Federation dated March 29, 2019 No. 173n, and the Ministry of Health guidelines “Stable Coronary Heart Disease” (2020). Results. Data from 751 outpatient records of patients with stable CHD were included in the analysis. The mean age of the patients was 65.2±11.1 years (65.2±11.1 years in females and 65.2±11.1 years in males). The proportion of female patients was 47.8%. The follow-up care by primary care general practitioners was performed well-timed in 66.0% of cases (496 patients). The proportions of males and females were comparable, 50.6% and 49.4%, respectively. In 20.1% of cases (153 patients), the minimum recommended frequency of visits (examinations, consultations) by the primary care general practitioners was not observed. More than half of the irregularly followed-up patients (56%) were males. In 12.5% of patients at the last follow-up visit, blood pressure (BP) did not reach the target values specified in the clinical guidelines, and in 5.4% of patients followed up for more than a year, BP was above 180/90 mm Hg;this group consisted of male patients. It should be noted that in 88% of patients’ outpatient records there was no information about LDL cholesterol levels, and among patients with reported LDL cholesterol levels the target values were achieved only in 57.7% of cases. Conclusions. The results of the analysis showed inadequate quality of follow-up care for patients with stable coronary heart disease. The data collection was carried out during the evolving COVID-19 pandemic, which may have affected the results, so the situation is still being monitored. The systemic methodical defects of the follow-up care for patients with stable coronary heart disease revealed in this analysis, as well as the suggestions made, can be the basis for the organization of routine internal quality control of medical care in outpatient settings for chronically ill patients. (English) [ABSTRACT FROM AUTHOR] Ð’N‹N