School of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan.
Health Policy Plan. 2013 Aug;28(5):458-66. doi: 10.1093/heapol/czs091. Epub 2012 Sep 16.
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.
乌兹别克斯坦拥有发达的初级保健系统，全民享有医疗服务，但在提高临床医疗质量方面面临挑战。本研究旨在通过关注一种常见疾病——慢性心力衰竭（CHF），来确定质量改进的障碍，因为针对这种疾病有循证的国际管理指南。为了确定与这些指南一致的 CHF 护理质量改进的挑战，我们采取了定性方法，详细采访了 15 名医生和 30 名患者，了解他们对 CHF 管理的经验。尽管最近对初级保健医生的培训有所改进，但他们获取最新信息的机会有限，并且过度依赖制药公司的信息。实施国际护理标准的主要障碍包括：医生（和患者）不愿意放弃无效的干预措施；临床上不必要的住院治疗的持久、系统激励；以及缺乏对循证卫生服务改进的结构性支持。患者普遍对药物治疗的依从性持积极态度，但在负担药物和住院治疗方面存在一些问题。未来应在评估其对慢性病护理过程和结果的影响的基础上，加强初级保健。
