Boitsov S A, Vylegzhanin S V
National Research Center for Preventive Medicine, Ministry of Health of Russia, Moscow.
Ministry of Health of the Russian Federation, Moscow.
Ter Arkh. 2015;87(1):4-9. doi: 10.17116/terarkh20158714-9.
High-risk and secondary prevention strategies for noncommunicable diseases in primary health care are mainly implemented by local therapists. The large-scale clinical examination of an adult population (a high-risk strategy), which has been launched in the country since 2013 to solve the problems of detecting people with noncommunicable diseases and their risk factors and making a prevention counseling, is simultaneously a mechanism for the formation of a full therapeutic area passport to identify follow-up groups (a secondary prevention strategy). Currently, there is an obviously insufficient follow-up of inadequate quality. The reasons for this situation are a lack of regular training of local doctors in follow-up in addition to staff shortages. Medical teachers and professional communities working on the basis of common guidelines must be attracted to solve this problem. The actual introduction of a local therapist's efficient performance measures, the setting up of special structures in charge of primary care prevention in the health authorities, and the active involvement of medical prevention and health centers (for people at high risk in the absence of proven non-communicable diseases) in this process will be able to enhance the efficiency of a follow-up. Information technologies, including a tele-follow-up, are an important reserve in implementing the high-risk and secondary prevention strategies.
初级卫生保健中针对非传染性疾病的高危和二级预防策略主要由当地治疗师实施。自2013年起在该国开展的针对成年人群的大规模临床检查（高危策略），旨在解决非传染性疾病患者及其危险因素的检测问题并提供预防咨询，同时也是形成完整治疗区域护照以确定后续群体的一种机制（二级预防策略）。目前，存在明显的质量不高的随访情况。造成这种情况的原因除了人员短缺外，还包括当地医生缺乏随访方面的定期培训。必须吸引依据共同准则开展工作的医学教师和专业团体来解决这一问题。实际引入当地治疗师的高效绩效衡量标准、在卫生当局设立负责初级保健预防的特殊机构，以及让医疗预防和健康中心（针对无已证实非传染性疾病的高危人群）积极参与这一过程，将能够提高随访效率。包括远程随访在内的信息技术是实施高危和二级预防策略的一项重要储备。
