OBJECTIVE
To study the rates of cardiovascular diseases (CVD) diagnosis among the population who underwent clinical examination in territorial polyclinics and its connection with the frequency of outpatient visits, emergency medical calls and hospitalizations for CVD during the next 2 years of follow-up.
MATERIAL AND METHODS
The study included data obtained from 12 polyclinics in the Moscow region. The method of territorial multistage sampling was used. According to the data of reporting form No. 131 for 2016, each polyclinic was assessed in term of indicators reflecting the quality of clinical examination as a technology of medical prevention, primarily in relation to the revealing of CVD, including diseases characterized by high blood pressure, ischemic heart disease (IHD), cerebrovascular diseases (CVD). The frequency of all registered CVDs and newly diagnosed cases of diseases and the proportion of CVD patients who were placed under dispensary observation were assessed. In the cohort of the population that underwent medical examination in each polyclinic, according to the territorial fund of compulsory medical insurance for 2017 and 2018, the average annual frequency of outpatient visits, calls to ambulance or emergency medical care and hospitalizations for CVD was recorded, a statistical relationship was established between these indicators and the results of medical examination..
RESULTS
The population subject to medical examination in 2016 at 12 territorial polyclinics of the region was 151.130 people, 140.321 people underwent medical examination (coverage 92.8%). In total, CVDs were registered in 34 321 patients (243 cases per 1000 examined), including 20 870 patients — diseases characterized by high blood pressure (148.7 per 1000), 6778 — IHD (48.3 per 1000), 5880 — CVD (41.9 per 1000). There were significant differences between polyclinics for all analyzed indicators of clinical examination. It was found that the frequency of newly diagnosed cases of CVD is directly and reliably related to the completeness of the coverage of the population by the dispensary observation and is not related to the staffing of the district service of this polyclinic. Prospective observation showed that the frequency of outpatient visits for CVD was higher in polyclinics with a higher frequency of newly diagnosed IHD cases (r = 0.52, p <0.05). In polyclinics with a higher frequency of newly diagnosed cases of hypertension and coronary artery disease, the frequency of hospitalizations for coronary artery disease and emergency medical calls for CVD was significantly higher. In polyclinics with a higher coverage of dispensary observation of patients with CVD, and in particular patients with hypertension, there were significantly fewer cases of calls for emergency medical care for CVD.
CONCLUSION
The conducted statistical analysis showed that dispensary examination as a technology for medical prevention of CVD should be assessed not only from the point of view of the coverage of measures, but also from the point of view of the quality of the results of these measures, namely, the frequency of newly diagnosed cases of diseases and setting on dispensary observation. The development, testing and subsequent implementation of relevant indicators and an effective mechanism for internal quality control of medical prevention of CVD within the framework of clinical examination will contribute to strengthening the preventive focus of the entire primary health care.
