OBJECTIVE
To determine the possibilities and limitations of secondary prevention of chronic non-communicable diseases in a hospital setting by conducting a sociomedical survey of doctors.
MATERIALS AND METHODS
A cross-sectional study involved hospital doctors (151 specialists of therapeutic profile) from 13 cities of the Russian Federation. The survey was carried out on a previously prepared in «NMRC for Therapy and Preventive Medicine» questionnaire, which consisted of 9 blocks of questions including gender-age features, frequency of various nosological entities, adherence to therapy, preferential provision of medicines, interaction with out-patient doctors and staff coverage by doctors and nurses. Answers in several gradations were proposed to each question. The cities are divided into 4 subgroups depending on the population size: population over 2 million people (Moscow and Saint-Petersburg), 1—2 million people population (Rostov-on-Don, Krasnodar, Krasnoyarsk, Omsk), 400 thous.—1 million people population (Ulyanovsk, Penza, Kursk, Kirov, Tomsk) and population less than 400 thous. people (Nalchik, Ivanovo).
RESULTS
The analysis of the questionnaire survey results allowed us to highlight the most important stages in the organization of secondary prevention in hospital setting, namely age and nature of patients’ diseases, level of material and technical support of medical organization, including medicinal, staff coverage by doctors and nurses. One in two men admitted to the hospital was aged 65 years or older, about 30% of hospitalized men were in the 60—65 years age range, men in three age ranges (30—39, 40—49, 50—59 years) amounted to less than 20%. The largest proportion of hospitalized patients were women in the 60—64 and >65 years age ranges. On average, one in three patients is hospitalized for chronic forms of ischemic heart disease, chronic heart failure has a comparable frequency. The third place is occupied by type 2 diabetes mellitus, that means one in five patients enters a hospital with various complications of diabetes. The incidence of chronic obstructive pulmonary disease and cancer is comparable and does not exceed 10%. In every second case, doctors claim that a medicine provision during inpatient treatment is 50—75%, 100% of medicine provision is implemented only in 12% of cases. Insufficient provision of medicine is observed in about 40% of cases in doctors’ opinion. In 65% of cases doctors report that 75% of the target levels of major risk factors can be reached, while 12% of doctors report achieving the highest level. In every fifth case, a 50% of target level of the major risk factors is achieved and a 25% level is identified in less than 5% of cases. In every second case, 100% staff coverage with doctors is noted; 75% staff coverage is revealed in 26.5% of cases, 50% staff coverage — in 23%. The situation is similar in terms of the staff coverage with nurses.
CONCLUSION
The effectiveness of secondary prevention of chronic non-communicable diseases in primary health care facilities depends on many indicators. The quality of secondary prevention is influenced by the level of material and technical support of medical facilities, including medicine provision. Education on improvement of patients’ adherence to pharmacological correction and achievement of target levels of major risk factors are priority directions for secondary prevention of chronic non-communicable diseases. The provision of medical and nursing staff is also an important issue in the organization of secondary prevention in a hospital setting.
