The “Comorbid Patient” Scale as a General practitioner’s tool to increase treatment adherence in patients living in rural areas

Aim. To develop a visual aid “Comorbid patient Scale” and evaluate its effectiveness through dynamic follow-up of patients with chronic non-communicable diseases (NCDs) in outpatient practice.

Materials and methods. The prevalence of risk factors and NCDs were analyzed in the course of a retrospective study of 1444 patients in rural areas. A visual aid “Comorbid Patient Scale” developed on obtained data has been evaluated in a 3-month prospective comparative study of 93 patients with NCDs, randomized to group 1, in which the Scale was used (n = 47), and a control group (group 2, n = 46).

Results. Group 1 showed a statistically significant increase in adherence to treatment after using the Scale for 3 months: 81% vs 57% at baseline (p < 0.05); in group 2 similar indicators were: 61% vs 54% (the difference is not significant). In group 1, the proportion of smoking patients (39% vs 15% (p < 0.05)) and the number of patients with hypercholesterolemia (23% vs 0% (p < 0.05)) significantly decreased; the number of patients with well-controlled arterial hypertension increased from 47% to 87% (p < 0.05). A similar dynamics was observed in group 2, however, the difference was not statistically significant. At baseline and 3 months later, the share of patients without exacerbation of diseases of the musculoskeletal system and respiratory tract diseases was the same across the groups.

Conclusion. The use of “Comorbid patient Scale” compared to standard patient management increases patient adherence to treatment by 17%, reduces the share of smoking patients by 21%, with hypercholesterolemia by 14%, with the achievement of target blood pressure indicators by 26%.

1. 1 Oganov R.G., Simanenkov V.I., Bakulin I.G., et al. Komorbidnaya patologiya v klinicheskoi praktike. Algoritmy diagnostiki i lecheniya. Kardiovaskulyarnaya terapiya i profilaktika. [Comorbidities in clinical practice. Algorithms for diagnostics and treatment]. Cardiovascular Therapy and Prevention. 2019; 18(1): 5–66 (In Russian). https://doi.org/10.15829/1728-8800-2019-1-5-66

2. 2 Gubanova G.V., Belyaeva Yu.N, Shemetova G.N. Komorbidnyy patsient: etapy formirovaniya, faktory riska i taktika vedeniya [Comorbid patient: stages of formation, factors and management tactics]. Sovremennye problem nauki i obrazovaniya. 2015; 6. URL: http://science-education.ru/ru/article/view?id=23986 (In Russian)

3. 3 de Groot V., Beckerman H., Lankhorst G.J., Bouter L.M. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol. 2003 Mar; 56(3): 221–9. https://doi.org/10.1016/s0895-4356(02)00585-1 PMID: 12725876

4. 4 Chrysant S.G. A new paradigm in the treatment of the cardiovascular disease continuum: focus on prevention. Hippokratia. 2011 Jan; 15(1): 7–11. PMID: 21607028

5. 5 Puzyrev V.P. Geneticheskie osnovy komorbidnosti u cheloveka [Genetic bases of human comorbidity]. Genetika. 2015. 4 (51): 491–502 (In Russian).

6. 6 Fortin M., Soubhi H., Hudon C., et al. Multimorbidity’s many challenges. BMJ. 2007 May 19; 334(7602): 1016–7. https://doi.org/10.1136/bmj.39201.463819.2C PMID: 17510108

7. 7 Korreia L. L., Lebedev T. YU., Efremova O. A., et al. Problema polimorbidnosti pri sochetanii khronicheskoi obstruktivnoi bolezni legkikh i nekotorykh serdechno-sosudistykh zabolevanii. [The problem of polymorbidity in the combination of chronic obstructive pulmonary disease and some cardiovascular diseases]. Nauchnye vedomosty. Seriya Meditsina. Farmatsiya. 2013; 4(147): 12–5 (In Russian).

8. 8 Blanco J.A., Toste I.S., Alvarez R.F. Age, comorbidity, treatment decision and prognosis in lung cancer. Age Ageing. 2008 Nov; 37(6): 715–8. https://doi.org/10.1093/ageing/afn226 PMID: 19004964

9. 9 Skotnikov A.S., Dochova O.M., Shulgina E.S. Sistemnoe vospalenie i oslozhneniya “sosudistoI” komorbidnosti u bol’nykh KHOBL [Systemic inflammation and complications of ”vascular» comorbidity in patients with COPD]. Archiv vnutrenney meditsiny. 2015; (5): 49–54 (In Russian). https://doi.org/10.20514/2226-6704-2015-0-5-17

10. 10 Bragina E.Yu., Freidin M.B. Molekulyarno-geneticheskie issledovaniya komorbidnosti [Molecular genetic studies of comorbidity]. Byulleten sibirskoy meditsiny, 2015; 6 (14): 94–108 (In Russian).

11. 11 Piepoli M.F., Hoes A.W., Agewall S., et al. European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016 Aug 1; 37(29): 2315– 81. https://doi.org/10.1093/eurheartj/ehw106 PMID: 27222591

12. 12 Zigmond A.S, Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun; 67(6): 361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x PMID: 6880820

13. 13 Akhmedzhanov N.M., Nebieridze D.V., Safaryan A.S. Korrektsiya giperkholesterinemii v pervichnoi i vtorichnoi profilaktike serdechno-sosudistykh zabolevanii: osobennosti i spornye voprosy. [Correction of Hypercholesterolemia in Primary and Secondary Prevention of Cardiovascular Diseases: Features and Controversial Issues]. Rational Pharmacotherapy in Cardiology. 2018; 14(6): 917–21 (In Russian). https://doi.org/10.20996/1819-6446-2018-14-6-917-921

14. 14 Erina A.M., Rotar O.P., Solntsev V.N., et al. Ehpidemiologiya arterial’noi gipertenzii v Rossiiskoi Federatsii — vazhnost’ vybora kriteriev diagnostiki. [Epidemiology of Arterial Hypertension in Russian Federation — Importance of Choice of Criteria of Diagnosis]. Kardiologiia. 2019; 59(6): 5–11 (In Russian). https:// doi.org/10.18087/cardio.2019.6.2595

15. 15 Balanova Yu.A., Shalnova S.A., Imaeva A.E., et al. Rasprostranennost’ arterial’noi gipertonii, okhvat lecheniem i ego ehffektivnost’ v Rossiiskoi Federatsii (dannye nablyudatel’nogo issledovaniya EHSSE-RF-2). [Prevalence, awareness, treatment and control of hypertension in russian federation (data of observational ESSERF-2 study)] Rational Pharmacotherapy in Cardiology. 2019; 15(4): 450–66 (In Russian). https://doi.org/10.20996/1819-6446-2019-15-4-450-466

16. 16 Oleynikova T.A., Pozhidaeva D.N., Oreshko A.Yu. Monitoring zabolevaemosti patologiyami kostno-myshechnoi sistemy i soedinitel’noi tkani v Rossiiskoi Federatsii. [Prevalence survey of musculoskeletal and connective tissue disorders in the Russian Federation]. Farmakoekonomika. Modern Pharmacoeconomic and Pharmacoepidemiology. 2019; 12(1): 5–13 (In Russian). https://doi.org/10.17749/2070-4909.2019.12.1.5-13

17. 17 Karpov Yu.A., Sorokin E.V. Vliyanie kombinirovannoi gipotenzivnoi terapii na risk serdechno-sosudistykh oslozhnenii i sosudistyi vozrast: rezul’taty mnogotsentrovogo otkrytogo issledovaniya [The effect of the combined antihypertensive therapy for the risk of cardiovascular complications and vascular age: results of the multicenter open research]. Advant’age. Atmosfera. Novosti kardiologii. 2015; 3: 18–26 (In Russian).