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


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


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


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


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


METHODS
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.
Hertzman
Phillip A
PA
Los Alamos Medical Center, Suite 130, West Rd, Los Alamos, NM 87544, USA. phertz1@aol.com
Kelly
H William
HW
Coultas
David
D
D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D010865:Pilot Projects; D012426:Russia; D012648:Self Care