THE MODEL OF A PRIMARY MEDICAL CARE SPECIALIST FOR CARDIOVASCULAR DISEASES; [МОДЕЛЬ ВРАЧА-СПЕЦИАЛИСТА НА ЭТАПЕ ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИ ПРИ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЯХ]

To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and Aim evaluate the clinical and managerial effectiveness of its implementation. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary Methods care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p<(0.05. ThedevelopedmodelofaPHCspecialistincludedcomponentsofpatientorientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons Results to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p<(0.05) and ambulance calls from 9% to 0.13% (p<(0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p<(0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p<(0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure. The developed model of a PHC specialist in cardiovascular diseases is an effective Conclusion component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up. © 2022 NII KPSSZ. All rights reserved.