Organizational and technological algorithm of primary specialized health care at cardiovascular diseases

Abstract

Aim. To develop an algorithm for primary specialized cardiovascular care with a priority of endovascular strategy.

Methods. The study was conducted in 2018–2019 based on the Central Clinical Hospital “Russian Railways-Medicine” and 14 polyclinics in the regions of the Russian Federation. The subject of the study is cardiovascular surgeons (n=2), possessing the skills of endovascular care. The object of the study was patients (n=1018) attended regional polyclinics of the Russian Federation. Patients were divided into two groups: group A consisting of 673 patients with clinically significant atherosclerosis of the coronary, brachiocephalic and peripheral arteries and abdominal aortic aneurysm; group B consisting of 345 patients with chronic lower limb ischemia that does not require surgical treatment. The average age of patients in group A was 69±6.1 years, in group B — 63±7.2 years. There were 467 men in group A (69.4%), and 339 in group B (98.3%). An organizational and technological algorithm was developed to improve the primary specialized cardiovascular care. The results were assessed by the presence of outcomes (heart attack, stroke, bleeding, death), the availability of endovascular care and patient survival follow up 12 and 24 months. A content analysis of scientific publications on the issue under study has been performed.

Results. An organizational and technological algorithm of primary specialized cardiovascular care has been deve­loped, including the activities of the cardiovascular surgeon, who has the skills of endovascular care and a nurse in an outpatient clinic. The implementation of the algorithm ensured continuity, 100% availability, safety and quality of cardiovascular care using endovascular technology. Outcomes are not registered in both groups. Both patient groups showed 100% one and two-year survival.

Conclusion. The developed algorithm of primary specialized cardiovascular care has provided high quality ­healthcare.

Keywords

primary specialized cardiovascular care / endovascular technology / cardiovascular diseases / algorithm

References

[1] Fede­ral Law No. 323-FZ of 21 November 2011 on Basics of Health Protection of the Citizens in the Russian Federation (amended to 29 December 2015). http://www.consultant.ru/document/cons_doc_LAW_121895/ (access date: 02.04.2020). (In Russ.)

[2] Федеральный закон от 21.11.2011 №323-ФЗ «Об основах охраны здоровья граждан в Российской Федерации». http://www.consultant.ru/document/cons_doc_LAW_121895/ (дата обращения: 02.04.2020).

[3] Order of the Government of the Russian Federation of December 28, 2012 No. 2580-r “On approval of the Strate­gy for the development of medical science in the Russian Federation for the period until 2025”. https://www.garant.ru/products/ipo/prime/doc/70192396/ (access date: 02.04.2020). (In Russ.)

[4] Распоряжение Правительства Российской Федерации от 28 декабря 2012 г. №2580-р «О Стратегии развития медицинской науки в Российской Федерации на период до 2025 года». https://www.garant.ru/products/ipo/prime/doc/70192396/ (дата обращения: 02.04.2020).

[5] Macinko J., Starfield B., Shi L. The contribution of primary care systems to health outcomes within organization for economic cooperation and development (OECD) countries, 1970–1998. Health Serv. Res. 2003; 38 (3): 831–865. DOI: 10.1111/1475-6773.00149.

[6] Atun R., WHO. What are advantages and disadvantages of restructuring health care system to be more focused on primary care services? Copenhagen: WHO Regional Office for Europe's Health Evidence Network (HEN). 2004. http://www.euro.who.int/__data/assets/pdf_file/0004/74704/E82997.pdf (access date: 03.04.2020).

[7] Starfield B. Is primary care essential? Lancet. 1994; 344 (8930): 1129–1133. DOI: 10.1016/S0140-6736(94)90634-3.

[8] Bokeria L.A., Alekyan B.G. Rentgenendovaskulyarnaya diagnostika i lechenie zabolevaniy serdtsa i sosudov v Rossiyskoy Federatsii. 2016 god. (Endovascular diagnosis and treatment of heart and vascular diseases in the Russian Fede­ration. 2016 year.) M.: NTSSSH im. A.N. Bakuleva RAMS. 2017; 179 p. (In Russ.)

[9] Бокерия Л.А., Алекян Б.Г. Рентгенэндоваскулярная диагностика и лечение заболеваний сердца и сосудов в Российской Федерации. 2016 год. М.: НЦССХ им. А.Н. Бакулева РАМН. 2017; 179 с.

[10] Pokrovsky A.V., Golovnyuk A.L. The state of vascular surgery in the Russian Federation in 2018. Angiologiya i sosudistaya khirurgiya. 2019; 25 (suppl. 2): 1–48. (In Russ.)

[11] Покровский А.В., Головнюк А.Л. Состояние сосудистой хирургии в Российской Федерации в 2018 году. Ангиол. и сосудист. хир. 2019; 25 (приложение 2): 1–48.

[12] Widimsky P., Fajadet J., Danchin N. “Stent for life” targeting PCI at all who will benefit the most. A joint pro­ject between EAPCI, EuroPCI, EUCOMED and the ESC Working Group on Acute Cardiac Care. Eurointervention. 2009; 4: 555–557. DOI: 10.4244/EIJV4I5A94.

[13] Grace S., Tan Y., Marcus L. et al. Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times. BMC Health Serv. Res. 2012; 12: 259. DOI: 10.1186/1472-6963-12-259.

[14] Leal J., Luengo-Fernández R., Gray A. et al. Economic burden of cardiovascular diseases in the enlarged European Union. Eur. Heart J. 2006; 27 (13): 1610–1619. DOI: 10.1093/eurheartj/ehi733.

[15] Kontsevaya A.V., Kalinina A.M., Koltunov I.E., Oga­nov R.G. Socio-economic damage by acute coronary syndrome in Russian Federation. Rational pharmacotherapy in cardiology. 2011; 7 (2): 158–166. (In Russ.)

[16] Концевая А.В., Калинина А.М., Колтунов И.Е., Оганов Р.Г. Социально-экономический ущерб от острого коронарного синдрома в Российской Федерации. Рационал. фармакотерап. в кардиол. 2011; 7 (2): 158–166.

[17] Belousova O.B., Okishev D.G. About the problem of opportune delivery of patients with cerebral aneurysms to specialized neurosurgical department of N.N. Burdenko Neurosurgical Institute. Voprosy nejrohirurgii. 2009; (1): 29–32. (In Russ.)

[18] Белоусова О.Б., Окишев Д.Г. О проблеме своевременной госпитализации больных с артериальными аневризмами в специализированное нейрохирургическое отделение (опыт НИИ нейрохирургии им. Н.Н. Бурденко РАМН). Вопр. нейрохир. им. Н.Н. Бурденко. 2009; (1): 29–32.

[19] Vinokurov A.V., Seme­nov V.Yu., Stupakov I.N. Labor functions of a cardiovascular surgeon as part of outpatient care for pathology of the cardiovascular system. Bulletin NTsSSH im. A.N. Bakuleva RAMN. Serdechno-sosudistye zabolevaniya. 2017; 18 (S6): 239. (In Russ.)

[20] Винокуров А.В., Семёнов В.Ю., Ступаков И.Н. Трудовые функции врача сердечно-сосудистого хирурга в рамках амбулаторно-поликлинической ­помощи при патологии сердечно-сосудистой системы. Бюлл. НЦССХ им. А.Н. Бакулева РАМН. Сердечно-сосудистые заболевания. 2017; 18 (S6): 239.

[21] Pogosyan V.A., Mikhaylova D.O. Analysis of satisfaction with the accessibility and quality of primary health care for patients with pathology of lower limb arteries. Kazan medical journal. 2020; (1): 73–79. (In Russ.) DOI: 10.17816/KMJ2020-73.

[22] Погосян В.А., Михайлова Д.О. Анализ удовлетворённости доступностью и качеством первичной медико-санитарной помощи пациентов с патологией артерий нижних конечностей. Казанский мед. ж. 2020; (1): 73–79. DOI: 10.17816/KMJ2020-73.

[23] Fuat A., Hungin A., Murphy J. Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. BMJ. 2003; 326: 196. DOI: 10.1136/bmj.326.7382.196.

[24] Ettelt S., Nolte E., Mays N. et al. Capacity planning in health care: a review of the international experience. Copenhagen: European Observatory on Health Systems and Policies. 2008; 62 р.

[25] Ettelt S., Nolte E., Mays N. et al. International Healthcare Comparisons Network. Основы политики. Медицинская помощь вне стационара. Получение общеврачебной и специализированной медицинской помощи в восьми странах. М.: Реал Тайм. 2009; 96 с.

[26] World Health Federation. Cardiovascular disease risk factors. world-health–federation.org/cardiovascular-health/cardiovasculardisease (access date: 04.04.2020).

[27] Order of the Ministry of Health of the Russian Federation No. 918 of 15 November 2012 “On approval of the Procedure for the provision of medical care to patients with cardiovascular diseases”. https://www.rosminzdrav.ru/documents/9130-prikaz-ministerstva-zdravoohraneniya-rossiyskoy-federatsii-ot-15-noyabrya-2012-g-918n-ob-utverzhdenii-poryadka-okazaniya-meditsinskoy-pomoschi-bolnym-s-serdechno-sosudistymi-zabolevaniyami (access date: 04.04.2020). (In Russ.)

[28] Приказ Министерства здравоохранения Российской Федерации от 15.11.2012 №918 «Об утверждении Порядка оказания медицинской помощи больным с сердечно-сосудистыми заболеваниями». https://www.rosminzdrav.ru/documents/9130-prikaz-ministerstva-zdravoohraneniya-rossiyskoy-federatsii-ot-15-noyabrya-2012-g-918n-ob-utverzhdenii-poryadka-okazaniya-meditsinskoy-pomoschi-bolnym-s-serdechno-sosudistymi-zabolevaniyami (дата обращения: 04.04.2020).

[29] Goloshchapov-Aksenov R.S., Pigolkin Yu.I., Kicha D.I. et al. Forensic medical criteria for the evaluation of the unfavourable outcomes of the roentgenoendovascular operations on the arteries of the lower extremities. Sudebno-meditsinskaya ekspertiza. 2018; 61 (3): 4–7. (In Russ.) DOI: 10.17116/sudmed20186134-7.

[30] Голощапов-Аксёнов Р.С., Пиголкин Ю.И., Кича Д.И. и др. Судебно-медицинские критерии оценки неблагоприятных исходов рентгенэндоваскулярных операций на артериях нижних конечностей. Суд.-мед. экспертиза. 2018; 61 (3): 4–7. DOI: 10.17116/sudmed20186134-7.

[31] Aaraas I., Fоrde O., Kristiansen I., Melbye H. Do general practitioner hospitals reduce the utilisation of ge­neral hospital beds? Evidence from Finnmark country in north Norway. J. Epidemiol. Commun. Health. 1998; 52 (4): 243–246. DOI: 10.1136/jech.52.4.243.

[32] Dale J., Lang H., Roberts J., Green J. Cost effectiveness of treating primary care patients in accident and emergency: a comparison between general practitioners, senior house officers, and registrars. BMJ. 1996; 312 (7042): 1340–1344. DOI: 10.1136/bmj.312.7042.1340.

[33] Ward P., Huddy J., Hargreaves S. et al. Primary care in London: an evaluation of general practitioners working in an inner city accident and emergency department. Accid. Emerg. Med. 1996; 13: 11–15. DOI: 10.1136/emj.13.1.11.

[34] Cleland J., Cohen-Solal A., Aguilar J. et al. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet. 2002; 360 (9346): 1631–1639. DOI: 10.1016/S0140-6736(02)11601-1.

[35] Hobbs F.D.R., Erhardt L. Acceptance of guideline recommendations and perceived implementation of coro­nary heart disease prevention among primary care physicians in five European countries: the Reassuring European Attitudes about Cardiovascular Treatment (REACT) survey. Fam. Pract. 2002; 19: 596–604. DOI: 10.1093/fampra/19.6.596.

[36] Carlsen B., Bringedal D. Attitudes to clinical guidelines — do GPs differ from other medical doctors? BMJ Q. Safe. 2011; 20: 158–162. DOI: 10.1136/bmjqs.2009.034249.

[37] Vlassov V., Reze A. Russian perspective: a note from the motherland of polyclinics. London J. Primary Care. 2008; 1: 33–34. DOI: 10.1080/17571472.2008.11493195.

[38] Iosseliani D. Organization of medical care to car­diac patients in Moscow. Am. Heart Hospital. J. 2007; 5 (1): 38–41. DOI: 10.1111/j.1541-9215.2007.06486.x.

[39] Wagner E. The role of patient care teams in chro­nic disease management. BMJ. 2000; 320 (7234): 569–572. DOI: 10.1136/bmj.320.7234.569.

[40] Dyachkova A.S. The history of formation and development of primary specialized me­dical care in Russia and abroad. Istoriya nauki i tekhniki. 2014; (6): 54–63. (In Russ.)

[41] Дьячкова A.C. История становления и развития первичной специализированной медико-санитарной помощи в России и за рубежом. История науки и техники. 2014; (6): 54–63.

[42] Dyachkova A.S. Three-­level system of rendering primary specialized medical care in Moscow as in-patient replacing technology. Vestnik Ros­siyskogo universiteta druzhby narodov. Seriya: Meditsina. 2014; (3): 88–92. (In Russ.)

[43] Дьячкова А.С. Трёхуровневая система оказания первичной специализированной медико-санитарной помощи в Москве как стационар-замещающая технология. Вестн. Рос. ун-та дружбы народов. Серия Медицина. 2014; (3): 88–92.

[44] McAlister F.A., Stewart S., Ferua S., ­McMurray J.J. Multidisciplinary strategies for the management of heart failure patients at high risk of admission: a systema­tic ­review of randomised trials. J. Am. Coll. Cardiol. 2004; 44 (4): 810–819. DOI: 10.1016/S0735-1097(04)01123-4.

[45] Weinberger M., Oddone E., Henderson W. Does increased access to primary care reduce hospital readmissions? veterans affairs cooperative study group on primary care and hospital readmission. N. Engl. J. Med. 1996; 334: 1441–1447. DOI: 10.1056/NEJM199605303342206.

[46] Goloshchapov-Akse­nov R.S., Frolov S.K., Gurin A.V. Study of the quality of life of patients of working age who had acute myocardial infarction. Bulletin NTsSSH im. A.N. Bakuleva RAMN. Serdechno-sosudistye zabolevaniya. 2018; 19 (S6): 256. (In Russ.)

[47] Голощапов-Аксёнов Р.С., Фролов С.К., Гурин А.В. Изучение качества жизни больных трудоспособного возраста, перенёсших острый инфаркт миокарда. Бюлл. НЦССХ им. А.Н. Бакулева РАМН. Сердечно-сосудистые заболевания. 2018; 19 (S6): 256.

RIGHTS & PERMISSIONS

Abramov A.Y., Goloshchapov-Aksenov R.S., Kicha D.I., Rukodayny O.V.