RESOURCE MAINTENANCE TREATMENT OF ARTERIAL HYPERTENSION IN OUTPATIENT CLINICS

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Due to the significant financial costs associated with the management of arterial hypertension (HTN), the optimization of health care resource distribution is required. Objective. To study the resource maintenance treatment of HTN in outpatient clinics. design and methods. The study included two stages. Firstly, we selected a sample of primary HTN patients based on the screening of primary medical records (n = 1766). Secondly, we performed a telephone survey 6 months after the inclusion (n = 1419). Results. Outpatients are characterized by a high frequency of visits to the doctor: 2,9 physician’s counseling, 2,6 cardiologist’s counseling, 0.21 cases of medical emergencies, 0.08 hospitalizations per 1 patient for 6 months on average. Significant use of health care resources was found in the following groups: patients aged 60 years and older, who periodically or regularly measure blood pressure (BP), regularly take antihypertensive therapy (AHT), those who have drug incentives, do not use fixed combinations, with uncontrolled BP, coronary heart disease (СHD), who take 3 or more antihypertensive drugs, who changed or withdrew the recommended AHT. Although achieving target BP is associated with a reduced likelihood of medical emergency calls and outpatient physician’s counseling, there was not difference in the number of hospitalizations between the groups with achieved target BP and the group with uncontrolled HTN. Total direct costs for 6 months composed 9 283,13 rubles per one study participant. Factors associated with a higher total direct costs included age 60 years or older, a high level of self-monitoring of BP, regular intake of AHT, the opportunity of drug incentives, the presence of СHD, uncontrolled HTN, multiple combination antihypertensive therapy (3 drugs and more), no use of fixed combinations, changes or withdrawal of recommended AHT. Conclusions. Our analysis of resource provision and cost-effectiveness of HTN treatment allowed to identify the groups of patients with inappropriate resource expenses. These data demonstrate the need for targeted interventions in order to reduce the economic burden of HTN.