The first results of a multi-year feasibility study on improving the management of cardiovascular disease risk in the Republic of Moldova, published in the European Journal of Public Health, are promising.
The results include better detection of cardiovascular risk factors, such as smoking and specific markers in diabetic patients; better identification of patients with hypertension or diabetes; and improved control in the treatment of hypertension.
“These results are timely as too many Moldovans die prematurely from cardiovascular disease,” said Mr. Igor Pokenevych, the WHO representative in Moldova. “Noncommunicable disease risk factors in the Republic of Moldova, particularly smoking and alcohol use, are among the highest in the WHO European Region. This work is essential for building an evidence-based health care system that meets the needs of the people of Moldova.”
Study: first of its kind in the WHO European Region
The scope of the study included an initial training, simplified clinical protocols, and follow-up support for primary health care workers using adapted WHO guidelines and tools, followed by a subsequent assessment of impact on the management of their patients. It is the first of its kind to be conducted in the WHO European Region.
183 frontline health workers from across the country, including family physicians and nurses, were trained on a range of routine activities such as task sharing, organization of patient flow, and implementation of simple interventions using the WHO Package of Essential NCD Interventions (PEN) for Primary Health Care in Low-Resource Settings. The study then compared the health of their patients to similar patients from other regions. Nearly 5000 patient records, reviewed over a 12-month period, showed a significant improvement in the prevention and management of cardiovascular disease risk factors.
"We initially didn’t pay attention to the additional factors that could influence the cardiovascular risks, such as smoking or physical inactivity,” said one doctor who participated in the study. “After the training, we were informed and are now more careful to measure the cardiovascular risk.”
“These findings are exciting because they demonstrate the feasibility of using routine paper-based clinical records for studies of effectiveness, implementation, and long-term monitoring and evaluation, relevant for countries with limited resources,” said co-author Professor Ghenadie Curocichin. “This work will have a lasting impact as it has helped to develop local research capacity, including involving doctors-in-training in health systems research,” he said.
If these positive health effects persist, they could translate to long-term impact and reductions in premature death from heart disease. Analysis of long-term impact is currently underway. “We will continue to scientifically evaluate the effects of this work and we look forward to observing its longer-term impact,” said Dr Jill Farrington, Coordinator, Noncommunicable diseases in the WHO Regional Office for Europe. “We were able to demonstrate that simple primary health care interventions could lead to improvements in risk factor control after only 12 months and are expanding this work across the European Region.”
Funded jointly by the Swiss Agency for Development and the WHO Regional Office for Europe, the study is part of the Office’s ongoing efforts to support implementation research and to control cardiovascular risk factors in Europe. The findings are already being shared throughout the Region to maximize their impact on health outcomes.