The experience of the decision-making algorithm of primary healthcare for the elderly patients with cardiovascular diseases

Abstract

Highlights. The basis for improving the quality of medical care is the arrangement of algorithms for clinical processes. The choice of a clinical and organizational solution for cardiovascular diseases in groups of older age patients at the stage of primary healthcare is a complex medical and economic task that requires maintaining the balance of efficiency, safety and quality of life in the "patient – risks – survival – economic efficiency" system. The development of an algorithm for making clinical and organizational decisions concerning cardiovascular diseases in elderly patients to improve the effectiveness of primary healthcare is an urgent health issue.Aim. To develop and evaluate the effectiveness of the algorithm for making clinical and organizational decisions at the primary healthcare stage for elder patients with cardiovascular diseases.Methods. The bases for the study were conducted in 2016–2020 at the Vascular Surgery Department of Peoples Friendship University of Russia and the Central Clinical Hospital “RZD-Medicine”. The object of the study was the patients with cardiovascular diseases (n = 422), mean age 76.11±7.2 years old. The subject of the study was cardiovascular surgeons (n = 4) experienced in surgical and endovascular technology. The algorithm was based on the content analysis of scientific publications (n = 27), clinical practice, the organizational and technological algorithm of PHC (primary healthcare) developed by Abramov A.Yu. and the colleagues in 2020 and the recommendations for the care of the elderly people with polymorbidity developed by the American Geriatric Society (2012). The medical, social and clinical effectiveness as well as the economic results of inpatient treatment were evaluated. The periods before and after the implementation of the algorithm in 2016–2017 and 2018–2020 were compared. Content analysis, analytical, statistical, mathematical, comparative, and expert research methods were applied.Results. The developed PHC (primary healthcare) algorithm contributed to the high level of accessibility of endovascular care (100%). Cardiovascular surgeons positively assessed the possibility of providing surgical care in 100% of cases and patient adherence to surgical treatment (99.5%). In 2016–2017 and 2018–2020 the surgical activity of the vascular surgery department significantly increased from 7 to 98.9%, the average bed-day decreased from 9.5 to 6.8 days and the postoperative bed-day from 7.2 to 4.12 days, the frequency of repeated hospitalizations in the hospital decreased during the year from 3.1±0.2 to 1.6±0.4 times, the incidence of primary acute myocardial infarction from 12 to 0% and relapses of critical ischemia of the lower extremities from 36 to 2%. The average cost of direct medical costs for the treatment of one patient during the year in the main and control groups did not differ significantly, 4 086$ (USA) и 3 887$ (USA), respectively.Conclusion. The PHC development and experience algorithm indicates the increase in the medical, social and clinical effectiveness of medical care for cardiovascular diseases in patients of older age groups and helps to reduce the direct costs of inpatient care.