Quality of Outpatient Care for Patients with Chronic Non-Communicable Diseases

BACKGROUND: The pressing task of the healthcare system is to provide high-quality medical care, including outpatient care, to patients with chronic non-communicable diseases. The progression of these diseases depends on the quality of medical care. Defects can complicate diagnosis, treatment, and prognosis.

AIM: The study aimed to evaluate the quality of primary healthcare for patients with chronic, non-communicable diseases.

METHODS: This was a cross-sectional study that included an analysis of a random sample of 288 outpatient medical records (n = 288). The study used quality criteria specified in the clinical guidelines on hypertension, type 2 diabetes mellitus, asthma, chronic obstructive pulmonary disease, and stable ischemic heart disease. The study also used parameters regulated by Order of the Ministry of Health of the Russian Federation dated March 15, 2022 No. 168н (168n) On Approval of the Procedure for Outpatient Follow-Up of Adults. This order regulates parameters such as the availability of data on complaints, smoking status, examinations, laboratory testing, investigations, diagnoses, and data on influenza and pneumococcal infection vaccinations.

RESULTS: Complaints were obtained in 6.6%–11.7% of patients. The smoking status was reported in 75.5%–90.2% of cases. A complete physical examination was performed on all patients with stable ischemic heart disease (100%) and none of the patients with type 2 diabetes mellitus (0%). Patients with hypertension had the fewest referrals for laboratory tests (4.9%), whereas patients with asthma had the most referrals (88.7%). Only 54.7% and 56.7% of patients with asthma or chronic obstructive pulmonary disease, respectively, were referred for complete investigations. The diagnoses corresponded to clinical guidelines in 75.9% of patients with diabetes mellitus and only in 10.0% of patients with chronic obstructive pulmonary disease. Vaccinations against influenza and pneumococcal infection were recommended for 21.5% and 14.9% of patients, respectively. An analysis of the quality of medical care for patients with chronic non-communicable diseases during outpatient follow-up revealed issues that could affect disease progression, as well as the identification of complications and suitable treatments.

CONCLUSION: The patient management did not fully comply with the clinical guidelines and Order of the Ministry of Health of the Russian Federation dated March 15, 2022 No. 168н (168n). Further research is needed to understand why outpatient follow-up is inadequate and how to improve it.