Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of Chronic Heart Failure management

Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of Chronic Heart Failure management

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...

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Bibliographic Details
Published in:Health policy and planning Vol. 28; no. 5; pp. 458 - 466
Main Authors: Ahmedov, Mohir, Green, Judith, Azimov, Ravshan, Avezova, Guloyim, Inakov, Sherzod, Mamatkulov, Bahrom
Format: Journal Article
Language:English
Published: England Oxford University Press 01-08-2013
Oxford Publishing Limited (England)
Subjects:
Chronic Disease
Chronic illnesses
Doctors
Drugs
Evidence-Based Medicine
Health administration
Health care access
Health services
Heart disease
Heart failure
Heart Failure - drug therapy
Hospital management
Hospital services
Hospitalization
Hospitals
Humans
Impact analysis
Interventions
Interviewing
Medical service
Medical treatment
Original articles
Patients
Pharmaceutical industry
Physician and patient
Physicians
Physicians, Primary Care
Primary care
Primary Health Care
Qualitative Research
Quality Improvement
Quality of care
Uzbekistan
Uzbekistan
Uzbekistan
primary care
Chronic heart failure
qualitative research
quality of care
evidence-based medicine
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Summary: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.
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ISSN:0268-1080
1460-2237
DOI:10.1093/heapol/czs091