natszdravНациональное здравоохранениеNational Health Care (Russia)2713-069X2713-0703Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)10.47093/2713-069X.2023.4.4.14-22natszdrav-312Research ArticleОБЩЕСТВЕННОЕ ЗДОРОВЬЕPUBLIC HEALTHМодели работы с пациентами старше трудоспособного возраста, страдающими хроническими неинфекционными заболеваниями: обзор зарубежных и российских практикModels of work with patients older than working age suffering from chronic non-infectious diseases: overview of foreign and Russian practiceshttps://orcid.org/0000-0002-0925-5822КамынинаН. Н.KamyninaN. N.

Камынина Наталья Николаевна – д-р мед. наук, канд. пед. наук, доцент, заместитель директора по научной работе

ул. Шарикоподшипниковская, д. 9, г. Москва, 11508

Natalia N. Kamynina – Dr. of Sci. (Medicine), Cand. of Sci. (Pedagogy), Assistant Professor, Acting Head (Scientific work)

Sharikopodshipnikovskaya str., 9, Moscow, 115088

https://orcid.org/0009-0008-5581-3814ТимофееваА. С.TimofeevaA. S.

Тимофеева Алена Сергеевна – младший научный сотрудник

ул. Шарикоподшипниковская, д. 9, г. Москва, 11508

Alena S. Timofeeva – junior research employee

Sharikopodshipnikovskaya str., 9, Moscow, 115088

TimofeevaAS2@zdrav.mos.ruГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»РоссияResearch Institute for Healthcare Organization and Medical Management of Moscow Healthcare DepartmentRussian Federation202302042024441422Copyright © Камынина Н.Н., Тимофеева А.С., 20242024Камынина Н.Н., Тимофеева А.С.Kamynina N.N., Timofeeva A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.natszdrav.ru/jour/article/view/312

Проведен анализ российских и зарубежных практик по применению моделей ведения пациентов, страдающих хроническими неинфекционными заболеваниями (ХНИЗ). Рассмотрены особенности разных моделей ведения пациентов старше трудоспособного возраста с ХНИЗ и отражены результаты их использования в первичном звене здравоохранения. Модели лечения хронических заболеваний и их адаптации рассмотрены с точки зрения примеров проактивных подходов к лечению. Представлены особенности разработанных моделей ведения пациентов старше трудоспособного возраста с ХНИЗ, проживающих в сельских территориях зарубежных стран. Рассмотрены особенности динамического наблюдения пациентов с ХНИЗ в медицинских организациях. Проанализирован опыт стран по применению ведения пациентов, страдающих ХНИЗ, на первичном уровне в странах с низким и средним уровнем доходов. Продемонстрирована неотъемлемая роль комплексного пациентоориентированного подхода при оказании медицинской помощи пациентам с установленным ХНИЗ. Определены перспективы развития моделей ведения пациентов с ХНИЗ.

The analysis of Russian and foreign practices on the application of models for the management of patients suffering from chronic non-communicable diseases (CNID) had been carried out. Examines the features of different models of management of patients older than working age with CNID and reflects the results of their use in primary health care. The models of treatment of chronic diseases and their adaptation were considered from the point of view of examples of proactive approaches to treatment. The features of the developed models of management of patients older than working age with CNID living in rural areas of foreign countries were presented. The features of dynamic follow-up of patients with CNID in medical organizations were considered. The experience of countries in the application of management of patients suffering from CNID at the primary level in low- and middle-income countries were analyzed. The integral role of an integrated patient-oriented approach in providing medical care to patients with established CNID had been demonstrated. The prospects for the development of models for the management of patients with CNID had been determined

первичная медико-санитарная помощьмножественные хронические заболеваниякоморбидностьмодель лечения хронических заболеванийпроактивностьпациент старше трудоспособного возрастамедицинская помощьprimary health caremultiple chronic diseasescomorbiditymodel of treatment of chronic diseasesproactivitypatient older than working agemedical careReferencesStafford G., Villén N., Roso-Llora A., et al. Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care. International journal of environmental research and public health. 2021; 18(17): 9216. https://doi.org/10.3390/ijerph18179216Stafford G., Villén N., Roso-Llora A., et al. Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care. International journal of environmental research and public health. 2021; 18(17): 9216. https://doi.org/10.3390/ijerph18179216Butterworth J.E., Hays R., McDonagh S.T.J., et al. Involving older people with multimorbidity in decision-making about their primary healthcare: A Cochrane systematic review of interventions (abridged). Patient education and counseling. 2020; 103(10): 2078–2094. https://doi.org/10.1016/j.pec.2020.04.008Butterworth J.E., Hays R., McDonagh S.T.J., et al. Involving older people with multimorbidity in decision-making about their primary healthcare: A Cochrane systematic review of interventions (abridged). Patient education and counseling. 2020; 103(10): 2078–2094. https://doi.org/10.1016/j.pec.2020.04.008Rawaf S. A proactive general practice: Integrating public health into primary care. London journal of primary care. 2018; 10(2), 17–18. https://doi.org/10.1080/17571472.2018.1445946Rawaf S. A proactive general practice: Integrating public health into primary care. London journal of primary care. 2018; 10(2), 17–18. https://doi.org/10.1080/17571472.2018.1445946Boehmer K.R., Abu Dabrh A.M., Gionfriddo M.R., et al. Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis. PLOS ONE. 2018; 13(2): e0190852. https://doi.org/10.1371/journal.pone.0190852Boehmer K.R., Abu Dabrh A.M., Gionfriddo M.R., et al. Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis. PLOS ONE. 2018; 13(2): e0190852. https://doi.org/10.1371/journal.pone.0190852Cottrell E., Yardley S. Lived experiences of multimorbidity: An interpretative meta-synthesis of patients, general practitioners and trainees perceptions. Chronic Illness. 2015; 11(4): 279–303. https://doi.org/10.1177/1742395315574764Cottrell E., Yardley S. Lived experiences of multimorbidity: An interpretative meta-synthesis of patients, general practitioners and trainees perceptions. Chronic Illness. 2015; 11(4): 279–303. https://doi.org/10.1177/1742395315574764Vainieri M., Quercioli C., Maccari M., et al. Reported experience of patients with single or multiple chronic diseases: empirical evidence from Italy. BMC health services research. 2018; 18(1): 659. https://doi.org/10.1186/s12913-018-3431-0Vainieri M., Quercioli C., Maccari M., et al. Reported experience of patients with single or multiple chronic diseases: empirical evidence from Italy. BMC health services research. 2018; 18(1): 659. https://doi.org/10.1186/s12913-018-3431-0Silva L.B., Soares S.M., Silva P.A.B., et al. Assessment of the quality of primary care for the elderly according to the Chronic Care Model. Rev Lat Am Enfermagem. 2018; 26: e2987. https://doi:10.1590/1518-8345.2331.2987Silva L.B., Soares S.M., Silva P.A.B., et al. Assessment of the quality of primary care for the elderly according to the Chronic Care Model. Rev Lat Am Enfermagem. 2018; 26: e2987. https://doi:10.1590/1518-8345.2331.2987Schwab G.L., Moysés S.T., Kusma S.Z., et al. Perception of innovations in Chronic Diseases. Conditions. Saúde em Debate. 2014; 38: 307–318. https://doi:10.5935/0103-1104.2014S023Schwab G.L., Moysés S.T., Kusma S.Z., et al. Perception of innovations in Chronic Diseases. Conditions. Saúde em Debate. 2014; 38: 307–318. https://doi:10.5935/0103-1104.2014S023Dowou R.K., Amu H., Saah F.I., et al. Management of chronic non-communicable diseases in Ghana: a qualitative study of patients coping strategies and the role of caregivers. BMC Health Serv Res. 2023; 23: 371. https://doi.org/10.1186/s12913-023-09398-4Dowou R.K., Amu H., Saah F.I., et al. Management of chronic non-communicable diseases in Ghana: a qualitative study of patients coping strategies and the role of caregivers. BMC Health Serv Res. 2023; 23: 371. https://doi.org/10.1186/s12913-023-09398-4Osei E., Amu H., Appiah-Kubi P., et al. Prevalence and predictors of selected risk factors of non-communicable diseases in Ghana: evidence from a sub-national survey. J Glob Health Sci. 2021; 3(2): e13. https://doi.org/10.35500/jghs.2021.3.e13Osei E., Amu H., Appiah-Kubi P., et al. Prevalence and predictors of selected risk factors of non-communicable diseases in Ghana: evidence from a sub-national survey. J Glob Health Sci. 2021; 3(2): e13. https://doi.org/10.35500/jghs.2021.3.e13Feng Z., Glinskaya E., Chen H., et al. Long-term care system for older adults in China: policy landscape, challenges, and future prospects. The Lancet. 2020; 396(10259): 1362–1372. https://doi.org/10.1016/S0140-6736(20)32136-XFeng Z., Glinskaya E., Chen H., et al. Long-term care system for older adults in China: policy landscape, challenges, and future prospects. The Lancet. 2020; 396(10259): 1362–1372. https://doi.org/10.1016/S0140-6736(20)32136-XZhou M., Wang H., Xinying Zeng X., et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2019; 394(10204): 1145–1158. https://doi.org/10.1016/S0140-6736(19)30427-1Zhou M., Wang H., Xinying Zeng X., et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2019; 394(10204): 1145–1158. https://doi.org/10.1016/S0140-6736(19)30427-1Liu Q., Liu J., Sui S. Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS. International Journal of Environmental Research and Public Health. 2020; 17(20): 7683. https://doi.org/10.3390/ijerph17207683Liu Q., Liu J., Sui S. Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS. International Journal of Environmental Research and Public Health. 2020; 17(20): 7683. https://doi.org/10.3390/ijerph17207683Xie F., Jiang X., Yuan F., et al. Impact of the New Cooperative Medical Scheme on the rural residents’ hospitalization medical expenses: A five-year survey study for the Jiangxi Province in China. Int. J. Environ. Res. Public Health. 2018; 15(7): 1368. https://doi.org/10.3390/ijerph15071368Xie F., Jiang X., Yuan F., et al. Impact of the New Cooperative Medical Scheme on the rural residents’ hospitalization medical expenses: A five-year survey study for the Jiangxi Province in China. Int. J. Environ. Res. Public Health. 2018; 15(7): 1368. https://doi.org/10.3390/ijerph15071368Lall D., Engel N., Devadasan N., et al. Models of care for chronic conditions in low/middle- income countries: a ‘best fit’ framework synthesis. BMJ global health. 2018; 3(6): e001077. https://doi.org/10.1136/bmjgh-2018-001077Lall D., Engel N., Devadasan N., et al. Models of care for chronic conditions in low/middle- income countries: a ‘best fit’ framework synthesis. BMJ global health. 2018; 3(6): e001077. https://doi.org/10.1136/bmjgh-2018-001077Craig P., Dieppe P., Macintyre S., et al. Developing and evaluating complex interventions: following considerable development in the field since 2006, MRC and NIHR have jointly commissioned an update of this guidance to be published in 2019. BMJ. 2019; 50(5): 587–592. https://doi.org/10.1136/bmj.a1655Craig P., Dieppe P., Macintyre S., et al. Developing and evaluating complex interventions: following considerable development in the field since 2006, MRC and NIHR have jointly commissioned an update of this guidance to be published in 2019. BMJ. 2019; 50(5): 587–592. https://doi.org/10.1136/bmj.a1655Lall D., Engel N., Srinivasan P.N., et al. Improving primary care for diabetes and hypertension: findings from implementation research in rural South India. BMJ Open. 2020; 10(12): e040271. https://doi:10.1136/bmjopen-2020-040271Lall D., Engel N., Srinivasan P.N., et al. Improving primary care for diabetes and hypertension: findings from implementation research in rural South India. BMJ Open. 2020; 10(12): e040271. https://doi:10.1136/bmjopen-2020-040271Pearson-Stuttard J., Ezzati M., Gregg E.W. Multimorbidity – a defining challenge for health systems. The Lancet Public Health. 2019; 4(12): e599–e600. https://doi.org/10.1016/S2468-2667(19)30222-1Pearson-Stuttard J., Ezzati M., Gregg E.W. Multimorbidity – a defining challenge for health systems. The Lancet Public Health. 2019; 4(12): e599–e600. https://doi.org/10.1016/S2468-2667(19)30222-1Martinez M., Sapag J.C., Zamorano P., et al. Contribution of a multimorbidity personcentered care strategy to the Comprehensive Family and Community Healthcare Model in Chile. Revista Medica De Chile. 2022; 150(6): 782–787.Martinez M., Sapag J.C., Zamorano P., et al. Contribution of a multimorbidity personcentered care strategy to the Comprehensive Family and Community Healthcare Model in Chile. Revista Medica De Chile. 2022; 150(6): 782–787.Margozzini P., Passi Á. Encuesta Nacional de Salud ENS. 2016–2017: un aporte a la planificación sanitaria y políticas públicas en Chile. ARS Med Rev Ciencias Médicas. 2018; 43(1): 30.Margozzini P., Passi Á. Encuesta Nacional de Salud ENS. 2016–2017: un aporte a la planificación sanitaria y políticas públicas en Chile. ARS Med Rev Ciencias Médicas. 2018; 43(1): 30.Varela T., Zamorano P., Muñoz P., et al. Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile. BMC Health Serv Res. 2023; 23(1): 439. https://doi.org/10.1186/s12913-023-09412-9Varela T., Zamorano P., Muñoz P., et al. Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile. BMC Health Serv Res. 2023; 23(1): 439. https://doi.org/10.1186/s12913-023-09412-9Aksenova E.I. A doctor’s assistant is a key resource of the proactive dispensary monitoring program. Moscow Medicine. 2022; 5(51): 64–71 (In Russian).Aksenova E.I. A doctor’s assistant is a key resource of the proactive dispensary monitoring program. Moscow Medicine. 2022; 5(51): 64–71 (In Russian).Znachkova E.A., Grishina N.K., Serdiukovskii S.M., et al. The medical care provision to people older than 60 years with multiple chronic diseases in Moscow. Problems of Social Hygiene, Public Health and History of Medicine. 2017; 25(3): 163–167 (In Russian). https://doi.org/10.18821/0869-866X-2017-25-3-163-167Znachkova E.A., Grishina N.K., Serdiukovskii S.M., et al. The medical care provision to people older than 60 years with multiple chronic diseases in Moscow. Problems of Social Hygiene, Public Health and History of Medicine. 2017; 25(3): 163–167 (In Russian). https://doi.org/10.18821/0869-866X-2017-25-3-163-167Schenker M., Harth da Costa D. Advances and challenges of health care of the elderly population with chronic diseases in Primary Health Care. Ciênc. saúde colet. 2019; 24(4): 1369–1380. URL: https://doi.org/10.1590/1413-81232018244.01222019Schenker M., Harth da Costa D. Advances and challenges of health care of the elderly population with chronic diseases in Primary Health Care. Ciênc. saúde colet. 2019; 24(4): 1369–1380. URL: https://doi.org/10.1590/1413-81232018244.01222019Brettel J.H., Manuwald U., Hornstein H., et al. Chronic-Care-Management Programs for Multimorbid Patients with Diabetes in Europe: A Scoping Review with the Aim to Identify the Best Practice. Journal of diabetes research. 2021; 6657718. https://doi.org/10.1155/2021/6657718Brettel J.H., Manuwald U., Hornstein H., et al. Chronic-Care-Management Programs for Multimorbid Patients with Diabetes in Europe: A Scoping Review with the Aim to Identify the Best Practice. Journal of diabetes research. 2021; 6657718. https://doi.org/10.1155/2021/6657718Vainieri M., Quercioli C., Maccari M., et al. Reported experience of patients with single or multiple chronic diseases: empirical evidence from Italy. BMC health services research. 2018; 18: 659. https://doi.org/10.1186/s12913-018-3431-0Vainieri M., Quercioli C., Maccari M., et al. Reported experience of patients with single or multiple chronic diseases: empirical evidence from Italy. BMC health services research. 2018; 18: 659. https://doi.org/10.1186/s12913-018-3431-0

The authors declare that there are no conflicts of interest present.