Chronic illness care in Russia: a pilot project to improve asthma care in a "closed city"

Abstract

Context: In Russia, where health status has deteriorated since the late 1960s, asthma is a growing medical and public health problem.

Objective: To create a model for improving care and outcomes of patients with asthma through altering the culture of health care, physician behavior, and public policy in a Russian community.

Design: A 6-month, nonrandomized, before-and-after intervention evaluation.

Setting: Outpatients of Medical-Sanitary Unit No. 50, the central health authority in Sarov, Russia, a "closed" nuclear city.

Participants: A consecutive sample of 85 adult patients with severe-persistent or moderate-persistent asthma.

Interventions: A comprehensive asthma-care program that emphasized patient education and self-management with treatment based on internationally accepted guidelines modified for local resources.

Main outcome measures: Missed work or school, patients requiring emergency department visits, number of patients hospitalized, daytime symptoms, nighttime symptoms, rescue inhaler use, patient satisfaction, and FEV(1).

Results: After 6 months, significant reductions were observed in the proportion of patients missing work or school (1.2% vs 11.8%), emergency department visits (4.8% vs 15.7%), hospitalizations (0% vs 9.4%), daily symptoms (47.1% vs 65.9%), and nightly symptoms (14.1% vs 37.6%). Patient satisfaction with asthma control (81.2% vs 31.8%) and average level of FEV(1) (84.0% vs 72.4%) significantly increased from baseline.

Conclusions: The model for changing asthma management in this Russian community was effective in improving asthma outcomes and offers a reproducible paradigm approach for improving chronic illness care.