Possibilities of Using the National Electronic Data Syetstem in Assessing the Control of Arterial Hypertension at The Primary Health Care Level in the Kyrgyz Republic Using the Example of a Single Family Medicine Center

Aim. To determine the capabilities of the National Electronic System for collecting quantitative data necessary to assess the quality of management and effectiveness of arterial hypertension (AH) control at the primary health care (PHC) level and to develop indicators and possibilities of their use for a standardized report on the quality of AH management and control at the PHC level in the Kyrgyz Republic.

Material and methods. Data from electronic outpatient records were processed for all registered patients of a pilot family medicine center (FMC) that was selected randomly. The registered patient group consisted of 91,226 people older than 18 years, including 37,740 men and 53,486 women. The data obtained during contact with a patient was entered by the family doctor into the electronic outpatient record and automatically forwarded to the center that collected and aggregated the data. To monitor AH control, 11 indicators were developed and evaluated. The indicators were divided into 3 groups: indicators for identifying AH, indicators for the quality of AH patient management, and indicators for the effectiveness of AH control.

Results. In total, 26,206 patients (7,933 men and 18,273 women) visited the FMC during a year, and blood pressure (BP) was measured in 71.4% of them. In 2022, 5,072 patients (5.6% of the registered group) visited the FMC for AH, including 1,539 men and 3,533 women (4.1 and 6.6% of the registered patient group, respectively; p<0.001). The proportion of patients with AH who, according to the clinical protocol, had their BP measured 2 times a year or more, was 81.4% and was slightly higher for women than for men (82.3% and 79.1%, respectively; p<0.01). 38.7% of AH patients received antihypertensive drugs. Lipid-lowering therapy was prescribed to 23.5% of AH patients. The proportion of AH patients taking acetylsalicylic acid was higher, 36.3% for the whole group, including 34.1% for men and 37.2% for women (p<0.05). The efficacy of AH treatment was 62.8%.

Conclusion. Any monitoring system has limitations for the amount of useful data that can be obtained ensuring their proper quality. Taking this into account, two major indicators are suggested to use for evaluating the effectiveness of AH control at the PHC level: 1) the number of AH patients who have achieved the BP goal; 2) the number of AH patients who visited a medical institution (health care facility) during a calendar year relative to the number of registered patients (AH detectability).

1. World Health Organisation. World health statistics 2019: monitoring health for the SDGs, sustainable development goals. [Internet] Available at: https://www.who.int/publications-detail-redirect/9789241565707

2. World Health Organisation. WHO reveals leading causes of death and disability worldwide: 2000-2019. [Internet] Available at: https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019

3. Laslett LJ, Alagona P, Clark BA, Drozda JP, Saldivar F, Wilson SR et al. The Worldwide Environment of Cardiovascular Disease: Prevalence, Diagnosis, Therapy, and Policy: a report from the American Сollege of Сardiology. Journal of the American College of Cardiology. 2012;60(25):S1–49. DOI: 10.1016/j.jacc.2012.11.002

4. World Health Organization. Primary health care: making our commitments happen: realizing the potential of primary health care: lessons learned from the COVID-19 pandemic and implications for future directions in the WHO European Region. 2022. [Internet] Available at: https://iris.who.int/handle/10665/353576

5. National Statistical Committee of the Kyrgyz Republic. ‘Kyrgyzstan’ brief statistical handbook - Publications Archive - Statistics of the Kyrgyz Republic. [Internet] Available at: https://www.stat.kg/en/publications/kratkij-statisticheskij-spravochnik-kyrgyzstan/

6. World Health Organization. Prevention and control of noncommunicable diseases in Kyrgyzstan: the case for investment. 2017. [Internet] Available at: https://apps.who.int/iris/handle/10665/351407

7. Kaliev M, Djakipova R, Kydyralieva R, Altymysheva A, Knyazeva V, Ryskulova S. “STEPS” research on episurveillance of risk factors of noncommunicable diseases in the Kyrgyz Republic. Bishkek: Ministry of Health. 2015.

8. Cabinet of Ministers of the Kyrgyz Republic. Resolution of the Government of the Kyrgyz Republic dated December 20, 2018 №600. About the Program of the Government of the Kyrgyz Republic for the protection of public health and development of the healthcare system for 2019-2030 “A healthy person is a prosperous country”. Av. at: https://www.gov.kg/ru/npa/s/222.

9. World Health Organization. Global health risks : mortality and burden of disease attributable to selected major risks. 2009. [Internet] Available at: https://www.who.int/publications-detail-redirect/9789241563871

10. World Heart Federation. What is cardiovascular disease? [Internet] Available at: http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/

11. World Health Organization. The top 10 causes of death. [Internet] Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

12. Lackland DT, Weber MA. Global Burden of Cardiovascular Disease and Stroke: Hypertension at the Core. Canadian Journal of Cardiology. 2015;31(5):569–71. DOI: 10.1016/j.cjca.2015.01.009

13. Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF et al. Hypertension. Nature Reviews Disease Primers. 2018;4(1):18014. DOI: 10.1038/nrdp.2018.14

14. Polupanov A.G., Kontsevaya A.V., Khalmatov A.N., Altymysheva A.T., Suvorova E.I., Romanova T.A. et al. Ethnic features of arterial hypertension prevalence in small town and countryside residents of the Kyrgyz Republic: results of the international study INTEREPID. Cardiovascular Therapy and Prevention. 2013;12(6):4–8. DOI: 10.15829/1728-8800-2013-6-4-8

15. Batyraliev T.A., Makhmutkhodzhaev S.A., Kydyralieva R.B., Altymysheva A.T., Dzhakipova R.S., Zhorupbekova K.S. et al. Prevalence of Risk Factors of Non-Communicable Disease in Kyrgyzstan: Assessment using WHO STEPS Approach. Kardiologiia. 2016;56(11):86–90. DOI: 10.18565/cardio.2016.11.86-90

16. National Statistical Committee of the Kyrgyz Republic. Brief statistical reference book «Kyrgyzstan» 2017-2019. Av. at: https://www.stat.kg/ru/publications/kratkij-statisticheskij-spravochnik-kyrgyzstan/.2020.

17. A healthy heart for every Kyrgyzstani by 2010. Av. at: https://cbd.minjust.gov.kg/6052?cl=ru-ru.

18. Program of prevention and control of noncommunicable diseases in the Kyrgyz Republic for 2013-2020. Av. at: https://cbd.minjust.gov.kg/94880. 2013.

19. National Health Reform Program of the Kyrgyz Republic ‘Manas taalimi’ for 2006-2010. Av. at: https://cbd.minjust.gov.kg/57155.

20. Ministry of Health and Social Development of the Kyrgyz Republic. Order No. 1070 of 09/8/2022 ‘On Amendments and Additions to the “Outpatient Visits Record Card” (Registration form No. 039/y) and the “Nursing Specialist Work Record Form” (Registration Form No. 039-5/y)’. Av. at: https://med.kg/uploads/aee5d41c-e1ae-429b-bc16-98a66cc7a549-prikaz_1070_08092022.pdf.

21. Laatikainen T, Inglin L, Chonmurunov I, Stambekov B, Altymycheva A, Farrington JL. National electronic primary health care database in monitoring performance of primary care in Kyrgyzstan. Primary Health Care Research & Development. 2022;23:e6. DOI: 10.1017/S1463423622000019

22. World Health Organisation. HEARTS: Technical package for cardiovascular disease management in primary health care: Systems for monitoring. 2018. [Internet] Available at: https://www.who.int/publications-detail-redirect/WHO-NMH-NVI-18-5

23. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I. et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):149–218. DOI: 10.15829/1560-4071-2020-3-3786

24. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Russian Journal of Cardiology. 23(12):143–228. DOI: 10.15829/1560-4071-2018-12-143-228