rfhealthЗдравоохранение Российской ФедерацииHealth care of the Russian Federation0044-197X2412-0723Federal Scientific Center of Hygiene named after F.F. Erisman10.47470/0044-197X-2024-68-5-349-355gnqsqprfhealth-1671Research ArticleОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯHEALTH CARE ORGANIZATIONМультидисциплинарные модели оказания первичной медико-санитарной помощи пациентам с хроническими неинфекционными заболеваниямиMultidisciplinary models of primary health care for patients with chronic non-communicable diseaseshttps://orcid.org/0000-0003-3565-2124СтаршининАндрей ВикторовичStarshininAndrey V.

Канд. мед. наук, зам. руководителя Департамента здравоохранения города Москвы, 127006, Москва, Россия

e-mail: starshininAV@mos.ru

MD, PhD, Deputy Head, Department of Health of the City of Moscow, Moscow, 127006, Russian Federation

e-mail: starshininAV@mos.ru

starshininAV@mos.ruhttps://orcid.org/0000-0002-0925-5822КамынинаНаталья НиколаевнаKamyninaNatalya N.

Доктор мед. наук, доцент, зам. директора ГБУ города Москвы «НИИ организации здравоохранения и медицинского менеджмента ДЗМ», 115088, Москва, Россия

e-mail: kamyninaNN@zdrav.mos.ru

DSc (Medicine), Associate Professor, Deputy Director, Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, 115088, Russian Federation

e-mail: kamyninaNN@zdrav.mos.ru

kamyninaNN@zdrav.mos.ruhttps://orcid.org/0000-0002-7620-0207БурковскаяЮлия ВалерьевнаBurkovskayaYulia V.

Науч. сотр., ГБУ города Москвы «НИИ организации здравоохранения и медицинского менеджмента ДЗМ», 115088, Москва, Россия

e-mail: burkovskayaYV@zdrav.mos.ru

Researcher, Research Institute for Healthcare Organization and Medical Management, Moscow, 115088, Russian Federation

e-mail: burkovskayaYV@zdrav.mos.ru

burkovskayaYV@zdrav.mos.ruhttps://orcid.org/0009-0008-5581-3814ТимофееваАлена СергеевнаTimofeevaAlyona S.

Мл. науч. сотр., ГБУ города Москвы «НИИ организации здравоохранения и медицинского менеджмента ДЗМ», 115088, Москва, Россия

e-mail: timofeevaAS2@zdrav.mos.ru

Junior researcher, Research Institute for Healthcare Organization and Medical Management, Moscow, 115088, Russian Federation

e-mail: timofeevaAS2@zdrav.mos.ru

timofeevaAS2@zdrav.mos.ruДепартамент здравоохранения города МосквыDepartment of Health of the city of MoscowГБУ города Москвы «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department202404112024685349355Copyright © Старшинин А.В., Камынина Н.Н., Бурковская Ю.В., Тимофеева А.С., 20242024Старшинин А.В., Камынина Н.Н., Бурковская Ю.В., Тимофеева А.С.Starshinin A.V., Kamynina N.N., Burkovskaya Y.V., 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.rfhealth.ru/jour/article/view/1671Введение

Введение. Хронические неинфекционные заболевания (ХНИЗ) требуют множества стратегий с разных точек зрения и на различных уровнях, включая индивидуальный и страновой. Комплексный пациентоориентированный и проактивный подходы играют важную роль при оказании мультидисциплинарными командами медицинской помощи пациентам с установленным ХНИЗ.

Целью исследования является анализ московского опыта в части организации мультидисциплинарных команд по ведению пациентов, страдающих ХНИЗ, на примере артериальной гипертензии в рамках пилотного проекта в амбулатории Троицкого и Новомосковского административных округов (ТиНАО).

Материалы и методы

Материалы и методы. Исследование проводилось в два этапа: на первом осуществлялся литературный обзор, на втором — разрабатывались и обсуждались стадии запуска пилотного проекта по организации мультидисциплинарных команд для ведения пациентов, страдающих ХНИЗ, на примере артериальной гипертензии в амбулатории ТиНАО.

Результаты

Результаты. В ходе исследования проанализированы подходы к применению мультидисциплинарных команд в мире. На основании проанализированных действующих нормативных документов в зарубежную модель внесли коррективы для её возможной адаптации в московские поликлиники, сделав упор на проактивное диспансерное динамическое наблюдение.

Ограничения исследований

Ограничения исследований. Результаты проведённого исследования основаны на оперативных данных г. Москвы и могут быть применимы только для формирования управленческих решений на территории Москвы.

Заключение

Заключение. По результатам апробации пилотного проекта констатировано увеличение уровня охвата прикреплённого населения медицинской помощью, доступности узких специалистов и обеспеченности равными возможностями получения медицинской помощи для москвичей.

Соблюдение этических стандартов. Данный вид исследования не требует прохождения экспертизы локальным этическим комитетом.

Участие авторов

Участие авторов: Старшинин А.В. — научное руководство; Камынина Н.Н. — концепция и дизайн исследования, формулировка и развитие основных тезисов статьи, редактирование; Бурковская Ю.В. — сбор и обработка материала, статистическая обработка данных; Тимофеева А.С. — сбор и обработка материала, написание текста, составление списка литературы. Все авторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Финансирование

Финансирование. Исследование не имело спонсорской поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 14

Поступила 14.05.2024 / Принята к печати 03.10.2024 / Опубликована 06.11.2024

Introduction

Introduction. Chronic non-communicable diseases (CNCD) requires a variety of strategies from different perspectives and at different levels, including individual and country-specific. Comprehensive patient-oriented and proactive approaches play an important role in the provision of multidisciplinary teams of medical care to patients with established CNCD.

The purpose of this study is to present the Moscow experience in managing multidisciplinary teams for the treatment of CND patients, using the example of arterial hypertension in the framework of a pilot project in the outpatient clinics of the Troitsk and Novomoskovsky administrative districts (TiNAO; were attached to the territory of Moscow in 2012).

Materials and methods

Materials and methods. The study was conducted in two stages: at the first, a literature review was carried out, at the second, the stages of launching a pilot project on the management of multidisciplinary teams for the treatment patients with CNCD, using the example of arterial hypertension in the outpatient clinic of TinAO, were developed and discussed.

Results

Results. The research analyzes approaches to the use of multidisciplinary teams in the world. Based on the analyzed current regulatory documents, adjustments were made to the foreign model for its possible adaptation to Moscow polyclinics, focusing on proactive dispensary dynamic monitoring.

Research limitations

Research limitations. The results of the conducted research are based on operational data from Moscow and can be applied only to the formation of management decisions in Moscow.

Conclusion

Conclusion. According to the results of the pilot project testing, an increase in the level of coverage of the attached population with medical care, accessibility of narrow specialists and provision of equal opportunities for obtaining medical care for Muscovites was noted.

Compliance with ethical standards. This type of research does not require an examination by the local ethics committee.

Contribution of the authors: Starshinin A.V. — scientific guidance;Kamynina N.N. — concept and design of research, formulation and development of the main theses of the article, editing;Burkovskaya Yu.V. — collection and processing of material, statistical data processing;Timofeeva A.S. — collection and processing of material, writing the text, compiling a list of references.All authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The authors declare that there is no conflict of interest.

Received

Received: May 14, 2024 / Accepted: October 3, 2024 / Published: November 6, 2024

мультидисциплинарные командыпервичная медико-санитарная помощьхронические неинфекционные заболеванияартериальная гипертензияmultidisciplinary teamsprimary health carechronic non-communicable diseaseshypertensionReferencesGassner L., Zechmeister-Koss I., Reinsperger I. National strategies for preventing and managing non-communicable diseases in selected countries. Front. Public Health. 2022; 10: 838051. https://doi.org/10.3389/fpubh.2022.838051Gassner L., Zechmeister-Koss I., Reinsperger I. National strategies for preventing and managing non-communicable diseases in selected countries. Front. Public Health. 2022; 10: 838051. https://doi.org/10.3389/fpubh.2022.838051Budreviciute A., Damiati S., Sabir D.K., Onder K., Schuller-Goetzburg P., Plakys G., et al. Management and prevention strategies for Non-communicable Diseases (NCDs) and their risk factors. Front. Public Health. 2020; 8: 574111. https://doi.org/10.3389/fpubh.2020.574111Budreviciute A., Damiati S., Sabir D.K., Onder K., Schuller-Goetzburg P., Plakys G., et al. Management and prevention strategies for Non-communicable Diseases (NCDs) and their risk factors. Front. Public Health. 2020; 8: 574111. https://doi.org/10.3389/fpubh.2020.574111Prynn J.E., Kuper H. Perspectives on disability and non-communicable diseases in low- and middle-income countries, with a focus on stroke and dementia. Int. J. Environ. Res. Public Health. 2019; 16(18): 3488. https://doi.org/10.3390/ijerph16183488Prynn J.E., Kuper H. Perspectives on disability and non-communicable diseases in low- and middle-income countries, with a focus on stroke and dementia. Int. J. Environ. Res. Public Health. 2019; 16(18): 3488. https://doi.org/10.3390/ijerph16183488Ларина В.Н., Глибко К.В., Аракелов С.Э., Касаева Д.А. Мультиморбидность и факторы риска хронических заболеваний у медицинских работников многопрофильной городской клинической больницы. Международный журнал сердца и сосудистых заболеваний. 2020; 8(25): 26–37. https://elibrary.ru/pktmksLarina V.N., Glibko K.V., Arakelov S.E., Kasaeva D.A. Multimorbidity and risk factors of chronic diseases in healthcare workers of a general city clinical hospital. Mezhdunarodnyi zhurnal serdtsa i sosudistykh zabolevanii. 2020; 8(25): 26–37. https://elibrary.ru/pktmks (in Russian)Stafford G., Villén N., Roso-Llorach A., Troncoso-Mariño A., Monteagudo M., Violán C. Combined multimorbidity and polypharmacy patterns in the elderly: a cross-sectional study in primary health care. Int. J. Environ. Res. Public Health. 2021; 18(17): 9216. https://doi.org/10.3390/ijerph18179216Stafford G., Villén N., Roso-Llorach A., Troncoso-Mariño A., Monteagudo M., Violán C. Combined multimorbidity and polypharmacy patterns in the elderly: a cross-sectional study in primary health care. Int. J. Environ. Res. Public Health. 2021; 18(17): 9216. https://doi.org/10.3390/ijerph18179216Gerry C.J., Kaneva M. Adapting to the challenges of chronic non-communicable diseases: evidence from Russia. Appl. Res. Qual. Life. 2021; (16): 1537–53. https://doi.org/10.3390/ijerph1817921Gerry C.J., Kaneva M. Adapting to the challenges of chronic non-communicable diseases: evidence from Russia. Appl. Res. Qual. Life. 2021; (16): 1537–53. https://doi.org/10.3390/ijerph1817921WHO. Noncommunicable diseases progress monitor 2022. Geneva; 2022. Available at: https://who.int/publications/i/item/9789240047761WHO. Noncommunicable diseases progress monitor 2022. Geneva; 2022. Available at: https://who.int/publications/i/item/9789240047761Nunes Oliveira C., Galvão Oliveira M., Wildes Amorim W., Nicolaevna Kochergin C., Mistro S., de Medeiros D.S., et al. Physicians’ and nurses’ perspective on chronic disease care practices in Primary Health Care in Brazil: a qualitative study. BMC Health Serv. Res. 2022; 22(1): 673. https://doi.org/10.1186/s12913-022-08078-zNunes Oliveira C., Galvão Oliveira M., Wildes Amorim W., Nicolaevna Kochergin C., Mistro S., de Medeiros D.S., et al. Physicians’ and nurses’ perspective on chronic disease care practices in Primary Health Care in Brazil: a qualitative study. BMC Health Serv. Res. 2022; 22(1): 673. https://doi.org/10.1186/s12913-022-08078-zLeon N., Xu H. Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence. BMC Health Serv. Res. 2023; 23(1): 169. https://doi.org/10.1186/s12913-023-09151-xLeon N., Xu H. Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence. BMC Health Serv. Res. 2023; 23(1): 169. https://doi.org/10.1186/s12913-023-09151-xOECD. Realizing the full potential of primary care. OECD Health policy studies. Paris; 2020: 208. https://doi.org/10.1787/a92adee4-enOECD. Realizing the full potential of primary care. OECD Health policy studies. Paris; 2020: 208. https://doi.org/10.1787/a92adee4-enKhader Y., Al Nsour M., Abu Khudair S., Saad R., Tarawneh M.R., Lami F. Strengthening primary healthcare in Jordan for achieving universal health coverage: a need for family health team approach. Healthcare (Basel). 2023; 11(22): 2993. https://doi.org/10.3390/healthcare11222993Khader Y., Al Nsour M., Abu Khudair S., Saad R., Tarawneh M.R., Lami F. Strengthening primary healthcare in Jordan for achieving universal health coverage: a need for family health team approach. Healthcare (Basel). 2023; 11(22): 2993. https://doi.org/10.3390/healthcare11222993Иванова А.Ю., Долгалев И.В. Формирование риска смертности в зависимости от поведенческих факторов (курение, потребление алкоголя) по результатам 27-летнего проспективного исследования. Кардиоваскулярная терапия и профилактика. 2017; 16(5): 40–5. https://doi.org/10.15829/1728-8800-2017-5-40-45 https://elibrary.ru/zrovjnIvanova A.Yu., Dolgalev I.V. Composition of death risk according to behavioral factors (smoking, alcohol consumption) by the results of 27-year prospective study. Kardiovaskulyarnaya terapiya i profilaktika. 2017; 16(5): 40–5. https://doi.org/10.15829/1728-8800-2017-5-40-45 https://elibrary.ru/zrovjn (in Russian)Akselrod S., Collins T.E., Hoe C., Seyer J., Tulenko K., Ortenzi F., et al. Building an interdisciplinary workforce for prevention and control of non-communicable diseases: the role of e-learning. BMJ. 2023; 381: e071071. https://doi.org/10.1136/bmj-2022-071071Akselrod S., Collins T.E., Hoe C., Seyer J., Tulenko K., Ortenzi F., et al. Building an interdisciplinary workforce for prevention and control of non-communicable diseases: the role of e-learning. BMJ. 2023; 381: e071071. https://doi.org/10.1136/bmj-2022-071071Matthys E., Remmen R., Van Bogaert P. An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care? BMC Fam. Pract. 2017; 18(1): 110. https://doi.org/10.1186/s12875-017-0698-xMatthys E., Remmen R., Van Bogaert P. An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care? BMC Fam. Pract. 2017; 18(1): 110. https://doi.org/10.1186/s12875-017-0698-xHu P.L., Tan C.Y., Nguyen N.H.L., Wu R.R., Bahadin J., Nadkarni N.V., et al. Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases. Singapore Med. J. 2023; 64(7): 423–9. https://doi.org/10.11622/smedj.2022067Hu P.L., Tan C.Y., Nguyen N.H.L., Wu R.R., Bahadin J., Nadkarni N.V., et al. Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases. Singapore Med. J. 2023; 64(7): 423–9. https://doi.org/10.11622/smedj.2022067Dorans K.S., Mills K.T., Liu Y., He J. Trends in prevalence and control of hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline. J. Am. Heart Assoc. 2018; 7(11): e008888. https://doi.org/10.1161/JAHA.118.008888Dorans K.S., Mills K.T., Liu Y., He J. Trends in prevalence and control of hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline. J. Am. Heart Assoc. 2018; 7(11): e008888. https://doi.org/10.1161/JAHA.118.008888Akindele M.O., Useh U. Multimorbidity of chronic diseases of lifestyle among South African adults. Pan. Afr. Med. J. 2021; 38: 332. https://doi.org/10.11604/pamj.2021.38.332.15109Akindele M.O., Useh U. Multimorbidity of chronic diseases of lifestyle among South African adults. Pan. Afr. Med. J. 2021; 38: 332. https://doi.org/10.11604/pamj.2021.38.332.15109Multiple Chronic Conditions: A Strategic Framework Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Available at: https://www.hhs.gov/sites/default/files/ash/initiatives/mcc/mcc_framework.pdfMultiple Chronic Conditions: A Strategic Framework Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Available at: https://www.hhs.gov/sites/default/files/ash/initiatives/mcc/mcc_framework.pdfOverwyk K.J., Dehmer S.P., Roy K., Maciosek M.V., Hong Y., Baker-Goering M.M., et al. Modeling the health and budgetary impacts of a team-based hypertension care intervention that includes pharmacists. Med. Care. 2019; 57(11): 882–9. https://doi.org/10.1097/MLR.0000000000001213Overwyk K.J., Dehmer S.P., Roy K., Maciosek M.V., Hong Y., Baker-Goering M.M., et al. Modeling the health and budgetary impacts of a team-based hypertension care intervention that includes pharmacists. Med. Care. 2019; 57(11): 882–9. https://doi.org/10.1097/MLR.0000000000001213Li H., Radhakrishnan J. A pharmacist-physician collaborative care model in chronic kidney disease. J. Clin. Hypertens. (Greenwich). 2021; 23(11): 2026–9. https://doi.org/10.1111/jch.14372Li H., Radhakrishnan J. A pharmacist-physician collaborative care model in chronic kidney disease. J. Clin. Hypertens. (Greenwich). 2021; 23(11): 2026–9. https://doi.org/10.1111/jch.14372Peckens S., Adelman M.M., Ashcraft A.M., Xiang J., Sheppard B., King D.E. Improving Chronic Obstructive Pulmonary Disease (COPD) symptoms using a team-based approach. J. Am. Board Fam. Med. 2020; 33(6): 978–85. https://doi.org/10.3122/jabfm.2020.06.200176Peckens S., Adelman M.M., Ashcraft A.M., Xiang J., Sheppard B., King D.E. Improving Chronic Obstructive Pulmonary Disease (COPD) symptoms using a team-based approach. J. Am. Board Fam. Med. 2020; 33(6): 978–85. https://doi.org/10.3122/jabfm.2020.06.200176Старшинин А.В. Амбулаторная помощь: новая парадигма развития. Московская медицина. 2023; 1(53): 24–33.Starshinin A.V. Outpatient care: a new paradigm of development. Moskovskaya meditsina. 2023; 1(53): 24–33. (in Russian)Старшинин А.В. Ценности столичного здравоохранения: доверие, командный подход, профессионализм. Московская медицина. 2023; 4(56): 4–19.Starshinin A.V. Values of metropolitan healthcare: trust, team approach, professionalism. Moskovskaya meditsina. 2023; 4(56): 4–19. (in Russian)Старшинин А.В., Андрусов В.Э., Пахуридзе М.Д., Скворцова Е.В. Аспекты развития телемедицинских технологий в Москве. Здоровье мегаполиса. 2023; 4(2): 73–81. https://doi.org/10.47619/2713-2617.zm.2023.v.4i2;73-81 https://elibrary.ru/qtpaftStarshinin A.V., Andrusov V.E., Pakhuridze M.D., Skvortsova E.V. Aspects of development of telemedicine technologies in Moscow. Zdorov’e megapolisa. 2023; 4(2): 73–81. https://doi.org/10.47619/2713-2617.zm.2023.v.4i2;73-81 https://elibrary.ru/qtpaft (in Russian)Безымянный А.С., Прохоренко Е.В., Тяжельников А.А., Старшинин А.В. Летняя городская программа павильонов здоровья как инновационный подход к общественному здоровью. Московская медицина. 2021; (2): 86–96. https://elibrary.ru/ayaahnBezymyannyi A.S., Prokhorenko E.V., Tyazhelnikov A.A., Starshinin A.V. The summer city program of health pavilions as an innovative approach to public health. Moskovskaya meditsina. 2021; (2): 86–96. https://elibrary.ru/ayaahn (in Russian)Команда первых: создание флагманских центров больниц в Москве. М.; 2023. https://elibrary.ru/mttuszThe team of the first: the creation of flagship hospital centers in Moscow. Moscow; 2023. https://elibrary.ru/mttusz (in Russian)

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