ABSTRACT
OBJECTIVE: Introduction: For primary health care patients with concomitant morbidity are usual phenomena. Combination of gastropathy with arterial hypertension is increasingly being studied. However, the assessing of the medical and economic effectiveness of treatment of patients with concomitant morbidity still methodologically challenging. The issue aggravated by different cushion programs aimed to alleviate financial burden to indigent population. These cover non-expensive drugs with probable hazard to concomitant morbidity. The aim: to evaluate the effectiveness of the gastropathy risk reduction program in patients with arterial hypertension (AH). PATIENTS AND METHODS: Materials and methods: data on 150 patients with AH collected by panel design with dynamic cohort traced up to 17 years. We have elaborated a program for the prevention of gastropathy in patients taking antihypertensive therapy. Program is based on regulations of the Ministry of Health of Ukraine, adapted clinical guidelines, and other official sources of information, since holistic prevention of gastropathy is not depicted in any source. Two main cohorts were distinguished: those in prevention program (PP) and patients with usual treatment. 6 built in cohorts (Groupâ0-â5) helped to diversify PP across groups of different severity. Event of interest was incidence or aggravation of gastropathy (gastroduodenitis mainly). We used Poisson model to study average treatment effect of PP on annual number of aggravations. RESULTS: Results: The main effect of program participation is significant in a model of fixed effects (ß = -0.269; p = 0.0156), and even more supportive in the mixed model (ß = -0.282; p = 0.0097). Other components with a variable "PP participation", namely participation in the program given the group, participation in the program given GP duration, participation in the program given compliance, appeared to be nonsignificant, that suggest absence of substantial selection bias due to non-randomness of allocation. The greatest risk reduction due to program participation was in patients of Group0, that is, in patients with hypertension who do not receive antihypertensive therapy. In groups â1-â5 with more aggressive hypertension treatment the effects of program participation are obvious but less pronounced. CONCLUSION: Conclusions: The elaborated program differentiates patients by groups and furthermore allows one to consider each patient characteristics, taking into account income, age, gender, progression of the disease, comorbidity, drugs the patient takes. The established program based on cooperation of patient, general practitioner, and gastroenterologist. We reduced selection bias due to possible randomness blemishes in allocation to the PP by control function method. The main effect of program participation is significant in a model of fixed effects (ß = -0.269; p = 0.0156), and even more supportive in the mixed model (ß = -0.282; p = 0.0097).
