Резюме Цель -оценить качество лечения больных артериальной гипертензией (АГ) в поликлинике рабочего поселка Саратовской области с помощью информационно-аналитической системы регистра. Материал и методы -Ретроспективно изучены данные амбулаторных карт 88 пациентов с АГ (средний возраст 64,6±11,3 года; 40,5% мужчин), которые обратились за консультацией к участковому терапевту, врачу общей практики или кардиологу во время одного случайно выбранного приема. Для анализа качества лечения у больных АГ использовалась компьютерная информационно-аналитическая система (ИАС) Регистра пациентов с АГ, ишемической болезнью сердца (ИБС) и хронической сердечной недостаточностью (ХСН), которая оценивает исполнение клинических рекомендаций. Результаты -В группе исследования динамическое наблюдение проводилось согласно рекомендациям: все пациенты посетили поликлинику не менее 4 раз в течение последнего года. 42% больных АГ получали комбинированную антигипертензивную терапию. Однако около трети пациентов с неконтролируемым артериальным давлением (АД) продолжали оставаться на монотерапии. При сочетании АГ и ИБС антиагреганты были назначены в 82% случаев, статины -в 60% случаев, бета-блокаторы -в 80% случаев. При АГ в сочетании с ХСН были назначены ингибиторы ангиотензинпревращающего фермента или антагонисты рецепторов ангиотензина (иАПФ/АРА) в 87% случаев, при сочетании АГ и фибрилляции предсердий непрямые антикоагулянты были назначены в 62% случаев. Целевое АД достигнуто у 51% пациентов. Выводы -Применение ИАС Регистра АГ, ИБС и ХСН в первичном звене позволило объективно оценить исполнение клинических рекомендаций по лечению больных АГ. Установлено, что недостаточно часто назначается комбинированная антигипертензивная терапия, а также отдельные рекомендованные группы препаратов при наличии ассоциированных клинических состояний: статины при сочетании АГ и ИБС, антикоагулянты при фибрилляции предсердий. Целевое АД было достигнуто лишь у половины больных АГ.Ключевые слова: артериальная гипертензия, регистр, качество лечения, клинические рекомендации Abstract Aim -to evaluate the quality of treatment among hypertensive patients in workers settlement of Saratovskaya oblast using an research and information system of a registry.Material and Methods -Ambulatory cards of 88 patients with essential hypertension (aged 64.6±11.3 years, males -40.5%) who visited therapist, general practitioner or cardiologist during one randomly selected day were analyzed retrospectively. To assess the treatment quality we used computer research and informal system of hypertension (Htn), coronary artery disease (CAD) and chronic heart failure (CHF) registry. The registry controls a performance of hypertension guidelines in Htn patients.Results -Patients in the studied group were followed-up according to the guidelines. All patients visited polyclinic no less then four times during the previous year. 42% of patients were administered two or more antihypertensive drugs. However, about one third of hypertensives with uncontrolled blood pressure continued monothera...

РезюмеЦель -разработать опросник для оценки у пациентов с повышенным давлением осведомленности о заболевании, факторах риска, лечении и контроле артериального давления (АД), который позволяет принимать обоснованные решения по улучшению результатов медицинской помощи больным артериальной гипертензией (АГ) в первичном звене. Материал и методы -Проводился анализ литературы по базам E-library и PubMed для изучения опросников, применявшихся ранее у больных АГ в рамках клинических исследований. Отдельно изучались валидизированные опросники для оценки приверженности проводимой терапии, избыточного употребления алкоголя и алкогольной зависимости. Результаты литературного поиска были учтены при разработке собственного опросника, рассчитанного на применение в работе поликлиники. Результаты -Разработан опросник из 16 вопросов. Опросник позволяет оценить следующие аспекты: осведомленность о повышении АД, наличие аппарата и периодичность самоконтроля АД, применение антигипертензивных препаратов, приверженность медикаментозной терапии (шкала Мориски-Грина), частота обращений за первичной, специализированной, неотложной медицинской помощью в течение последних 12 месяцев, наличие модифицируемых факторов риска: курения, избыточного употребления алкоголя (опросник CAGE), заинтересованность в специализированной программе наблюдения. Проведена апробация опросника в поликлинике рабочего поселка Саратовской области. Согласились ответить на вопросы 80% респондентов. Заполнение занимало ≈ 5 минут. Вопросы были интуитивно понятны, не требовали разъяснений. Возможно применение в форме опроса врачом, медицинской сестрой, а также самостоятельно в форме анкетирования пациентов. Наиболее удобная форма использования -опрос медицинской сестрой. Выводы -Разработанный опросник позволяет с позиции пациента оценить основные аспекты лечения повышенного АД и выявить устранимые барьеры к достижению эффективного контроля АГ в условиях рутинной работы первичного звена.Ключевые слова: артериальная гипертензия, контроль артериального давления, первичное звено, опросник для пациентов Abstract Aim -to develop a questionnaire for evaluation awareness of hypertension, risk factors, treatment and blood pressure (BP) control in patients with raised BP which allows justified decision making on improvement the results of medical care delivered to patients with hypertension in primary care. Material and Methods -Literature review with using E-library and PubMed databases was conducted to search questionnaires previously developed in clinical studies for patients with hypertension. Validated questionnaires for assessment adherence to treatment, excessive use of alcohol and alcohol abuse were reviewed separately. The results of literature review were considered in development of a new questionnaire designed for using in polyclinic. Results -Questionnaire containing 16 questions was developed. The questionnaire allows evaluation the following aspects: awareness of BP elevation, having a tonometer at home and frequency of BP self-measurement, taking antihypertensive...

Background:Primary care units in rural areas of the Russian Federation experience difficulties in long-term follow-up of chronic cardiovascular diseases, such as hypertension. Identification of outpatient clinical traits affecting the goal blood pressure (BP) may optimize the choice of treatment pathways.Objective:To identify the patient-related factors affecting the achievement of the goal BP in the course of hypertension treatment at a rural polyclinic.Methods:We analyzed the data on 182 patients with essential hypertension (64.6 ± 11.3 yo; 48.5% men), who were treated in polyclinic settings of a rural settlement in the Saratov Region of the Russian Federation. Outpatient medical records were used as a source of clinical data. Repeat patients with hypertension diagnosis specified in their medical records, visiting a therapeutist or cardiologist on two randomly selected workdays, were enrolled in our study. The first appointment took place during 1-31 July, 2015 (n = 88), while the second visit occurred on 1- 31 July, 2016 (n = 94). Eleven district therapeutists, two general practitioners and the only cardiologist of the polyclinic participated in the study. Discriminant function analysis was used to identify factors affecting the achievement of the goal blood pressure in the patients. Basic demographic and anamnesis data, risk factors, medical treatment type and lifestyle modification measures, if any, which exhibited statistical significance in univariate analysis (p<0.05), were selected for multi-factor discriminant analysis.Results:The goal BP was achieved in 93 patients (51%). The patients with the goal BP differed from those with uncontrolled hypertension in various ways. They were less often women (53.8% vs. 69.7%, p = 0.028), more frequently had prior myocardial infarction (22.6% vs. 10.1%, p = 0.024), more rarely suffered from other forms of stable CAD (55.9% vs. 73%, p = 0.016), as well as took fewer thiazide-like diuretics (9.7% vs 21.3%, p = 0.03). It is worth noting that fewer antihypertensive medications were prescribed to the patients with the goal BP as opposed to those with poor BP control (1.63 ± 0.12 vs. 1.98 ± 0.11, p = 0.018).Resulting discriminant model exhibited high predictive power. The ratio of odds for the model was 5.4 (95% CI: 2.7-10.7), р<0.001. The single factor correlating significantly with the achievement of the goal BP was preceding myocardial infarction (OR 2.6, 95% CI: 1.1 - 6.6, р=0.032), while prescription of two or more antihypertension drugs was associated with poor BP control (OR 0.4, 95% CI: 0.2 - 0.7, р=0.003).Conclusion:In the hypertensive patients with a history of myocardial infarction versus those without it, treated at a rural polyclinic, BP was more likely to be controlled. Administration of multiple antihypertensive drugs was associated with poor BP control.

The aim of the research. To reveal the clinical characteristics influencing to the achievement of target BP in patients with AH, observed in the polyclinic of the working village of the Saratov region. Material and methods. The data of outpatient cards of 182 patients with essential hypertension (mean age 64.6 ± 11.3 years, 48.5%-men) were studied, they asked for medical care in the polyclinic of the working village of the Saratov region in the period from 01.07.2015 to 31.07 .2015-the first stage (n = 88) and from 01.07.2016 to 31.07.2016-the second stage (n = 94). There were included all consecutive patients, visited a district doctor, general practitioner or cardiologist during one randomly chosen reception at the first and second stages. To identify the factors associated with achieving the target blood pressure, we used discriminant analysis. Results. In the study group (n = 182), BP corresponded to the target level in 93 patients with AH (51%). Patients with targeted BP were rarely females (53.8% vs. 69.7, p = 0.028), more likely to have a history of myocardial infarction (22.6% vs. 10.1%, p = 0.024), less likely to have other forms of stable ischemic heart disease (55.9% vs. 73%, p = 0.016), received fewer antihypertensive drugs: 1.63 ± 0.12 versus 1.98 ± 0.11 (p = 0.018). The constructed discriminant model had a high predictive value (OR 5.4 (95% CI 2.7-10.7), p <0.001) and took into account two most significant factors: previous myocardial infarction in the anamnesis (OR 2.6 (95% CI) 1,1-6,6), p = 0,032) and the number of prescribed antihypertensive drugs ≥ 2 (OW 0.4 (95% CI 0.2-0.7), p = 0.003). Conclusion. In patients, underwent myocardial infarction and received less than two antihypertensive drugs, the probability of achieving the target blood pressure is 5.4 times higher than in the absence of these factors.

Aim: to compare the results of examination conducted among oil and gas refinery employees, obtained during yearly periodic medical examination with the results obtained during cardioscreening. Material and Methods – 47 employees (64% - men, mean age 52 ± 8 yrs) of large oil and gas refinery were examined by cardiologist in 2018. Six months before the cardioscreening all employees underwent yearly periodic medical examination. The data of anamnesis, laboratory and instrumental findings (blood glucose, lipids, ECG) of examinees were analyzed. Revealed risk factors, the levels of risk SCORE, diagnosis and recommendations made during periodic medical examination and during cardioscreening were compared. Results – In the studied group dyslipidemia was observed in 39 employees (83%). Elevated blood glucose was revealed in 30 examinees (64%). Left ventricle hypertrophy on ECG was determined in 6 patients (13%). Hypertension was diagnosed in 35 subjects (75%) by cardiologist vs 26 subjects (55%) by therapeutist, diabetes mellitus was diagnosed in 8 (15%) vs 4 (8,5%) subjects by cardiologist and therapeutist correspondingly, smoking – in 20 (43%) and 16 (34%) of employees correspondingly (p < 0,001). Mean systolic BP was 152±20 mm Hg during cardioscreening versus 133±24 mm Hg during periodic medical examination (p < 0,001). High and very high risk SCORE have had 26 subjects (55%) according the data of cardiologist and 15 subjects (32%) according the data of therapeutist (p < 0,001). Conclusion – In the companies with abusive working conditions it is necessary to distinguish high and very high cardiovascular risk groups by means of cardioscreening.

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Background: Information on treatment obtained from hypertensive patients could add the data of medical records and reveal the problems addressed to hypertensives’ attitudes and behavior. Objective: To evaluate patients’ knowledge on hypertension and treatment behavior at a rural polyclinic with the help of structured questionnaire. Methods: We interviewed 83 patients with essential hypertension (64.6±9.6 yo; 30% - men) who referred to a polyclinic of a rural settlement in the Saratov region of the Russia. Consecutive patients with hypertension diagnosis specified in their medical records, visiting a therapeutist or cardiologist on one randomly selected workday, were enrolled in our study. The appointment took place during 1-31 July 2015. Eleven district therapeutists, two general practitioners and the only cardiologist of the polyclinic participated in the study. Structured questionnaire for patients with elevated Blood Pressure (BP) proposed by S.N. Gerasimov et al. (2015) was used for interviewing. The questionnaire included 16 questions addressed to the following issues: Awareness of hypertension and risk factors, BP self-monitoring, non-pharmacological and pharmacological treatment, adherence to antihypertensive therapy, referrals to medical care. Results: Ninety percent of respondents have known previously about BP elevation. Ninety four percent of patients had a tonometer at home. Eighty four percent of hypertensives measured their BP no rare than once a week, and fifty four percent did it every day. Eighty eight percent of study participants took antihypertensive drugs regularly. Only 36% of patients could be classified as adherent to therapy according to the Morisky-Green scale. Ninety two percent of respondents received one or more advices on lifestyle modification. Eighty two percent underwent diet counseling. Two-third of participants were advised to reduce their weight. About half of hypertensives were asked by the doctor to increase their physical activity. One-third of patients received smoking cessation advice, and the same part of enrollees received advice on alcohol consumption. The majority of patients (62.7%) were interested in organization of special follow-up program. Conclusion: With the help of structured questionnaire we revealed high frequency of BP self-measurement among visitors of rural polyclinic in Saratov region whereas the adherence to antihypertensive medication was low. We observed good level of knowledge on non-pharmacologic treatment interventions and revealed patients’ interest in special follow-up program. Such program should be addressed to the increase of patients’ adherence to treatment.