Improving the management of Hypertension in Kazakhstan: implications for improving clinical practice, patient behaviours and health outcomes

Abstract

This paper presents findings from the assessment of a strategy aimed at improving case-finding and management of hypertension patients. Study findings suggest that providers’ orientation to clinical guidelines, public information on hypertension risks, promotion of yearly blood pressure screening, and universal access to an outpatient drug benefit package, improve case-finding and management. In addition, training of providers at pilot sites resulted in a substantial and significant difference in patient care and health outcomes. Provider training and tools, especially focused on effective patient counselling, made a significant contribution to increased case-finding, patient adherence to prescribed drugs, reducing salt, and increasing regular exercise. However, further refinements are required to achieve the expected adherence of patients to medication and lifestyle advice. In the pilot area, we compared two samples of patients before and after the initiation of the intervention. We found an increase in the proportion of patients with blood pressure <140/90 mmHg, and a significant decrease in the proportion of patients with blood pressure ≥160/100 mmHg. The strategy involved the joint efforts of the Research Institute of Cardiology and Internal Diseases, Karaganda Drug Information Centre, Karaganda Oblast Health Department, Kazakhstan Association of Family Physicians, Almaty Postgraduate Institute for Physicians, and USAID ZdravPlus Project in Central Asia.

Keywords:

• Hypertension
• cardiovascular disease
• quality improvement
• clinical practice guideline
• Kazakhstan
• Central Asia

Acknowledgements

We would like to express our appreciation to the United States Agency of International Development (USAID); Sheila O'Dougherty (Regional Project Director, ZdravPlus Project); Liza Myglina (Kazakhstan Country Manager/Regional Programme Manager, ZdravPlus Project); Karaganda Oblast Health Department for supporting all activities done within the project; Drug Information Centre in Karaganda, Dr. Bahytgul Emekbaeva and Dr. Alexander Gulyaev for participating in all stages of the project; Director of the Cardiology Institute, Dr.Alikhan Dzhusipov, and his staff for collaboration in project implementation; Kazakhstan Association of Family Physicians and its Karaganda branch (Dr. Lyudmila Makazhanova and Dr. Baurzhan Omarkulov); and doctors from Karaganda PHC facilities for active participation in all activities described; Oleg Storozhenko (Regional EBM/CPG Director, ZdravPlus Project) for help and comments given during project planning and implementation; the Health Information System team of Karaganda oblast, for data collection and presentation; Hilda Kuter, for editing and giving recommendations in writing the article; Timur Balabaev, for help in providing statistical analyses; and all patients with hypertension who participated in the surveys. We thank the staff of the family medicine departments of Almaty Postgraduate Institute for Physicians and Karaganda State Medical Academy for providing clinical training and support.