Статья

Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of Chronic Heart Failure management

Mohir AhmedovSchool of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan. [email protected]John GreenSchool of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan, 2Department of Health Services, University of California, Los Angeles, USA and 3Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UKRavshan AzimovSchool of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan, 2Department of Health Services, University of California, Los Angeles, USA and 3Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UKGuloyim AvezovaSchool of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan, 2Department of Health Services, University of California, Los Angeles, USA and 3Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UKSherzod InakovSchool of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan, 2Department of Health Services, University of California, Los Angeles, USA and 3Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UKBahrom MamatkulovSchool of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan, 2Department of Health Services, University of California, Los Angeles, USA and 3Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

Health Policy and Planningjournal2012en

ABI

Аннотация

Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.

Темы

Heart Failure Treatment and Management Health Systems, Economic Evaluations, Quality of Life Chronic Disease Management Strategies

Идентификаторы

DOI: 10.1093/heapol/czs091

Цитирования и источники

Цитирований: 2 Использованных источников: 43

Показатели — AkademScholar · Скоро