A computer-assisted staged system of a follow-up of factory workers with CHD and diabetes mellitus was developed. It included automated screening by questionnaire, ECG and biochemical screening, physical examination, investigation of the basic carbohydrate-lipid indices, more detailed examination in out- or inpatients settings using up-to-date diagnostic methods (bicycle ergometry, monitoring after Holter, etc.), identification of groups for a follow-up, and therapeutic and sanitary measures. A total of 27750 persons were investigated. The most important group was that including persons with risk factors: vegetovascular dystonia developing into CHD (6%) or essential hypertension (20%). Sanitary measures by unified methods caused a decrease in temporary disability with the economic effect of 197,000 rubles.
Although universal health care aims for equity in service delivery, socioeconomic status still affects death rates from ischemic heart disease and stroke as well as access to revascularization procedures. We investigated whether psychiatric status is associated with a similar pattern of increased mortality but reduced access to procedures. We measured the associations between mental illness, death, hospital admissions and specialized or revascularization procedures for circulatory disease (including ischemic heart disease and stroke) for all patients in contact with psychiatric services and primary care across Nova Scotia.
We carried out a population-based record-linkage analysis of related data from 1995 through 2001 using an inception cohort to calculate rate ratios compared with the general public for each outcome (n = 215,889). Data came from Nova Scotia's Mental Health Outpatient Information System, physician billings, hospital discharge abstracts and vital statistics. We estimated patients' income levels from the median incomes of their residential neighbourhoods, as determined in Canada's 1996 census.
The rate ratio for death of psychiatric patients was significantly increased (1.34), even after adjusting for potential confounders, including income and comorbidity (95% confidence interval [CI] 1.29-1.40), which was reflected in the adjusted rate ratio for first admissions (1.70, 95% CI 1.67-1.72). Their chances of receiving a procedure, however, did not match this increased risk. In some cases, psychiatric patients were significantly less likely to undergo specialized or revascularization procedures, especially those who had ever been psychiatric inpatients. In the latter case, adjusted rate ratios for cardiac catheterization, percutaneous transluminal coronary angioplasty and coronary artery bypass grafts were 0.41, 0.22 and 0.34, respectively, in spite of psychiatric inpatients' increased risk of death.
Psychiatric status affects survival with and access to some procedures for circulatory disease, even in a universal health care system that is free at the point of delivery. Understanding how these disparities come about and how to reduce them should be a priority for future research.
General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration.
A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n=109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present.
In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment.
In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles.
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The results are provided of an in-depth study of the organization, quality and effectiveness of medical care provided at home to persons who referred to medical institutions for cardialgias. It has been shown that the real number of circulatory diseases while considering the complaints such as "pains in the heart area" is considerably less than the number of calls for outpatient home care. The influence is established of the amount and quality of home health care delivery on the effectiveness of outpatient care as a whole in cases of circulatory disease aggravation and of the possibility to reduce the duration of disability in the aggravation cases (and consequently the economic losses) at the expense of improving the medical care quality just at home. The improvement of the organization and quality of home health care is an important reserve for the perfection of outpatient care at large.
The experience gained in the study of outpatient consultative cardiac care in a big city such as Leningrad permits one to single out the following stages in the delivery of these services: a polyclinic-based cardiologist--a cardiologist in the consultative-diagnostic polyclinic and (or) an out-patient department at the Research Institute of Cardiology (follow-up centre)--urban specialized centres of consultative care. The main issues requiring improvement in this system are: the necessity of efficient regulation of indications for consultative care at all stages, determination of functional responsibilities of consulting physicians, their role in the system of dispensarization, the drafting of optimum documentation and criteria of performance.