Background: An assessment of the level of adherence of patients diagnosed with hypertension to therapy has not been conducted in Central Asia yet. It includes the lack the information on the impact of digital technologies on hypertension management. Objective: The study aimed at the evaluation of the effect of using a mobile application on adherence to therapy in patients with diagnosed arterial hypertension. Methods: A multi-centre randomized controlled study was conducted on 517 patients with diagnosed arterial hypertension (in the out-patient clinic, Almaty, Kazakhstan). Patients were randomly assigned to intervention (IG) and control (CG) groups. IG patients used a mobile application, which allowed creating an individual schedule for taking medications, including visual and audio notifications. The assessment of adherence to antihypertensive treatment was carried out using the Lebanese Medication Adherence Scale-14 (LMAS-14), consisting of 14 items. Data were collected before therapy (T1), 3 months (T2), 6 months (T3) and 12 months (T4) followed the first dose. Adherence was assessed on 101 patients in the CG group and 165 respondents in the IG group. Results: In the period T1 in both groups CG and IG, a moderate adherence to treatment was recorded with indices equal to 35.9 ± 1.2 and 35.9 ± 1.3, respectively (p ≤ 0.05). A decrease in adherence in the CG group was determined after 3 months (35.9 ± 1.2) (p ≤ 0.05) and six months later (36.5 ± 3.2) in comparison with relatively high adherence among respondents in the IG group in periods T2 (39.5 ± 1.2) and T3 (40.5 ± 1.2) (p ≤ 0.001). After 12 months (T4) on the adherence scale in patients who used the mobile application “MyTherapy” (IG), despite a slight decrease in scores, the results were relatively higher (40.3 ± 1.3) compared with the CG group (33.6 ± 1.9) (p ≤ 0.001). Conclusion: The analysis of adherence of patients with primary health care in Almaty (Kazakhstan) with chronic arterial hypertension showed the effectiveness of using the ‘MyTherapy’ mobile application in increasing patient adherence. The obtained data on the positive effect of the use of digital technologies require further research to assess the possibility of wider implementation in healthcare.

IntroductionConsidering the World Health Organization (WHO) Astana Declaration, in order to provide universal healthcare coverage, Kazakhstan through ongoing healthcare reform committed to the promotion of a people-centered Primary Healthcare (PHC) system. Since the implemented top-down policies showed low buy-in from community members and put more constraints on PHC facilities and teams, the Kazakh National Medical University, the Medeo district mayor's office and the WHO European Centre for PHC supported the initiative of a local non-governmental organization “Community health committee” and Outpatient clinic of Almaty State hospital #5, for creation of an integrated plan to develop people-centered PHC through better coverage and engagement of patients with non-communicable disease and enhancing the health literacy of the population above 65 years.MethodsWe used a community-based participatory approach. The process consisted of: forming a steering committee with at least one member from each stakeholder group; two interactive workshops where the community worked jointly with PHC professionals in defining priority health needs and proposing actions to address selected priorities; and, after, joint development by all stakeholders of an action plan for empowerment of the community, and for assessment and review of the scope of practice of PHC teams.ResultsThe interactive workshops identified priority health needs such as low health literacy, low responsibility for health, low engagement of the elderly in prevention and self-management of non-communicable diseases. The main findings of semi-structured interviews were that there are no planning approaches (neither shared planning by a PHC team, or individually by PHC professionals) for addressing defined priority needs of the community, families and/or patients, and that the role of a PHC team in community empowerment is very limited.ConclusionsUsing results of the review on PHC teams’ scope of practice, we will develop, discuss and agree with the national and local stakeholders’ proposal of a conceptual model of PHC service delivery. Further, we will implement and evaluate the results of implementation.

Considering Astana declaration on Primary healthcare (PHC) and universal healthcare coverage UN member countries agreed on committing for PHC development. Kazakhstan prepared legal basis for that during ongoing healthcare system reform. Meanwhile, there is no clear mechanism for integration of sectors to address person and community centeredness for health, which has emerged into a need of rethinking engagement between outpatient clinics and their communities. Local NGO “Community health committee” has led the bottom-up initiative in collaboration with Kazakh National Medical University, Outpatient clinic of Almaty State hospital #5, Medeo district mayor’s office and WHO European Center for PHC for creation of an integrated plan to strengthen diseases prevention and health promotion at the district. Project aims to strengthen people centeredness of PHC at Medeo district, through equal integration of all stakeholders into every step of decision-making using community based participatory research framework. Project includes development of teamwork in PHC teams’ through multi-professional training, development of nurses’ competencies for more autonomous work in community, community capacity building and empowerment. After gaining support from all stakeholders, we organized two interactive seminars with community members and PHC teams in order to assess district health needs and build an action plan. Ownership of community members in decision on priority health problem provided community buy-in, high level of engagement and enthusiasm in designing and implementation of the project activities. Voice from empowered community on priority health needs were accounted by local policymakers and led for creation of action plan on identified needs to be implemented in 2019 -2020. One of the main limits of the community engagement is gaining trust and sustainability of the group, we are mitigating it through involvement of academia as an “umbrella”. Key messages Project will create a model for equal partnership in disease prevention and health promotion in Kazakhstan. Engaging all key stakeholders based on equal partnership creates sustainable outcomes for health and solidarity.

В данной статье представлен научно-литературный обзор факторов, влияющих на возникновение жалоб потребителей медицинских услуг и их управление. Приведена информация о том, в каком объеме поступают медицинские жалобы, в национальную лигу потребителей. В статье приведены в качестве примера жалобы потребителей медицинских услуг не только в Казахстане, но и зарубежом. This article presents a scientific and literary review of the factors that influence the occurrence of complaints of consumers of medical services and their management. Information is provided on the extent to which medical complaints are received by the national league of Consumers. The article provides an example of complaints from consumers of medical services not only in Kazakhstan, but also abroad.

В данной статье представлен научно-литературный обзор планирования кадрового потенциала среднего медицинского персонала в организации первичной медико-санитарной помощи. This article presents a scholarly and literary review of nursing workforce planning in a primary care organization.