THE WAY OF ASSESSING THE ADHERENCE TO MODERN DRUG THERAPY CLINICAL GUIDELINES AIMED AT REDUCING THE RISK OF RECURRENT STROKE (ACCORDING TO THE LIS-2 REGISTER)

Abstract

Aim. To develop a method for the assessment of quality of medical prevention of recurrent stroke and its’ testing using the results of the LIS-2 register (Lyubertsy study of mortality in patients after stroke).Material and methods. The scale evaluation of the quality of therapy for the prevention of recurrent stroke developed in accordance with the modern clinical practice guidelines, as well as the recurrent stroke prevention index (RSPI) for this assessment were elaborated. The analysis of the therapy was performed in patients after stroke in LIS-2 registers (n=219). The assessment of the quality of treatment was performed using RSPI, the influence of the index results on the in-hospital mortality was studied.Results. Two groups of patients [with RSPI=0 (n=137) and RSPI>0 (n=82)] were formed on the basis of the results evaluation via RSPI. Significant differences between groups were not found. At the same time higher in-hospital mortality (p=0.014; χ2 Pearson) was detected in patients with RSPI=0; relative risk of in-hospital death (after adjustment for sex and age) was 2.04 [1.07-3.91] (p=0.031). Analysis of the length of survival and duration of hospital stay was performed in both groups using the Kaplan-Meier method. In-hospital mortality was significantly higher in patients with RSPI=0, which was confirmed by the log-rank test (p=0.032).Conclusion. The results of the quality of medical care assessment in accordance with the developed method are significantly related to the outcomes during the stay in a hospital. The developed method, based on current clinical recommendations, can serve as an example of the implementation of evidence-based medicine in actual practice.

Keywords

• сlinical practice guidelines
• quality of care
• register
• stroke
• secondary prevention
• pharmacotherapy