Potential and limitations of secondary prevention of noncommunicable diseases: data from a survey of Russian outpatient physicians

Abstract

Aim. To identify potential and limitations of secondary prevention of noncommunicable diseases in outpatient clinics of various Russian cities.Material and methods. Outpatient physicians from 16 Russian cities took part in the cross-sectional study. A total of 545 general practitioners took part in the survey. The survey was carried out using a previously prepared questionnaire at the National Medical Research Center for Therapy and Preventive Medicine. It consisted of 11 blocks of questions, including sex and age characteristics, the prevalence of various diseases, adherence to therapy, preferential provision of medications, consultation assistance by hospital-based physicians and coverage of doctors and nursing staff. Answers were offered in several gradations to each question. Depending on the population, cities were divided into 4 following subgroups: population >2 million people (Moscow and St. Petersburg), population of 1-2 million people (Samara, Rostov-onDon, Krasnodar, Krasnoyarsk, Omsk), population of 0,4-1 million people (Vladivostok, Ulyanovsk, Penza, Kursk, Kirov, Tomsk) and population <400 thousand people (Nalchik, Saransk, Ivanovo).Results. In all Russian cities, among men visited a clinic, 37% were people in the age range of 50-60 years. Second place was taken by men aged 60-65 years (30%). Most often, patients present with chronic coronary artery disease (39%), followed by type 2 diabetes (22,6%). Patients present with symptoms of heart failure in 17,7% of cases. Cancer account for 11,5% in the structure of visits. A similar frequency was found for chronic obstructive pulmonary diseases (9,2%). Every third patient is partially adherent to drug correction; partial non-adherence is detected 2 times less, while complete nonadherence is <3%. On average, 67% of doctors from different cities declare 75% achievement of target levels of risk factors, while one in five declare 50% achievement of recommended indicators. In most cases, physicians report minor problems during hospitalization. Every fifth doctor reported no problems, while every tenth respondent noted difficulties in hospitalizing patients. In every second case, partial staffing is noted. Moreover, a comparable trend is observed among doctors and nursing staff. In megacities and small towns the situation is somewhat better compared to cities with a population of 0,4 to 2 million.Conclusion. To optimize the secondary prevention of noncommunicable diseases, a number of measures at the outpatient healthcare level should be taken. This includes educational work on adherence to drug and non-drug treatment correction, expanding coverage of preferential medication provision, improving interaction with hospitalbased doctors and coverage of doctors and nursing staff.