Abstract
Background/Aim: The prevention of cardiovascular risk factors and cardiovascular disease management contributes to the cardiovascular mortality reduction. The effects of these activities have been measured by quality indicators. The aim of this study was to determine the effects of family medicine team training workshop and implementation of clinical guidelines on the cardiovascular risk factors and diseases management in primary health care in the Republic of Srpska/Bosnia and Herzegovina. Methods: The "CardioVascular Risk Assessment and Management" study included a sample of 373 teams from 41 primary health care centres trained to provide adequate services and to compare the quality of cardiovascular risk management before and after the training workshop and implementation of clinical guidelines. The comparison was based on nine project defined performance indicators related to hypertension, type 2 diabetes mellitus, hyperlipidaemia, tobacco smoking and obesity. Results: Significant improvements were observed in six indicators after the training workshop and implementation of guidelines. Target values for blood pressure and HbA1c were achieved in over 80 % of patients (82.12 ± 15.81 vs 84.49 ± 12.71 and 84.49 ± 12.71 vs 85.49 ± 24.55; before and after the training workshop, respectively), while the target values for LDL cholesterol were achieved in 54.98 % ± 20.33 before and 57.64 % ± 16.66 after the training workshop. The number of teams that had less than 20 % of recorded data significantly decreased after the training workshop and guidelines implementation, and adequate recording of all indicators was improved. Conclusion: The training workshop of family medicine teams and implementation of clinical guidelines resulted in significant quality improvement of cardiovascular diseases management in primary health care.
Highlights
Chronic non-communicable diseases account for 74 % of deaths worldwide, of which 31 % has been caused by cardiovascular diseases (CVD).[1, 2]In the Republic of Srpska (RS), Bosnia and Herzegovina (B&H), the CVDs cause 47.3 % of total mortality.[3]
The cardiovascular risk factors mentioned in this study have been listed by the American Society for Preventive Cardiology as ten essential things to be known about CVD risk factors, emphasising the key activities for health professionals at primary health care level who are facing the fact that many patients have multiple cardiovascular risk factors.[10]
The results of this study showed a decreasing number of hypertensive patients with irregular blood pressure (BP) level after CardioVascular Risk Assessment and Management” (CVRAM) training workshop
Summary
Chronic non-communicable diseases account for 74 % of deaths worldwide, of which 31 % has been caused by cardiovascular diseases (CVD).[1, 2]In the Republic of Srpska (RS), Bosnia and Herzegovina (B&H), the CVDs cause 47.3 % of total mortality.[3]. The main pillar of PHC in the RS is family medicine team (FMT). FMTs can be organised as freestanding FMT (independent legal entity; public or private), group practice or FMT within a PHC Centre (PHCC) as its internal organisational unit. FMTs are primary “gateway” for citizens/patients or entry points into the health system. FMT works in family medicine ambulance which is a PHC setting integrated into and operate within PHCC. PHCC (Dom Zdravlja) - is a public health institution that organises its work according to FM model on municipality level. The total number of PHCC in is 54 corresponding to the number of municipalities in the RS. First contact with health system or an entry point for citizens is operated through FMT. The FMT’s are locally organised and its number and composition, as well as the corresponding municipality population, remain rather stable over the long period of time
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