Exploring providers’ and patients’ perspectives on barriers to quality of care for chronic heart failure (CHF) in Uzbekistan and Georgia
In the framework of the project the qualitative study will be undertaken aiming at exploring barriers to quality of care for heart failure in two FSU states: Uzbekistan and Georgia. The project is funded by the Alliance for Health Policy and Systems Research (AHPSR).
Lead investigators are: Dr. Judith Green, London School of Hygiene and Tropical Medicine, Dr. Mohir Ahmedov, Tashkent Medical Academy, School of Public Health, Dr. George Gotsadze, Curatio International Foundation (CIF).

The study is a part of a project that explores transferability of qualitative principles (those for group and individual interviews) to low income former Soviet countries by conducting qualitative studies in Uzbekistan and Georgia. The aim of the larger project is to develop understanding of how qualitative methodologies can be developed for use in low/middle income countries, and how they can be developed for use in comparative health systems research. The proposed study therefore includes two countries in a comparative case study design. Each case study will use qualitative methods (individual interviews and group discussions) to explore a topic in quality of care that is of interest to both health care systems. The interviews will be used to explore physician and patient perspectives on barriers for quality care in the treatment of chronic heart failure in primary care settings.

The choice of topic for this project is based on a number of factors. First, the share of non-communicable conditions in the burden of diseases in developing countries is continuously increasing. According to WHO data, in 2001, non-communicable conditions accounted for 46% of the disease burden, the number that is expected to grow to 56% by 2020. [2]

Secondly, a significant shift in health policy making centering on quality care has taken place in the West over the last two decades. A noticeable translation of the policy shift in the developing country settings followed suit. The increasing interest in quality of care in developing countries is timely, as improved quality of care benefits patients by reducing medical errors and unnecessary care, increasing utilization of effective medications and procedures, as well as leading to significant system-wise improved efficiencies.
Heart failure (HF) is a major contributor to morbidity and health care costs, with an estimated population prevalence of 3-4%. Two threats to quality of care are the poor utilization of evidence based treatment protocols and inadequate patient adherence. To explore physician and patient perspectives on the barriers to quality of care for heart failure, researchers will first interview physicians from a purposively selected sample of urban and rural clinics to identify factors that impede compliance at the physician and patient level in Uzbekistan and Georgia. Prescription of ACE-inhibitors and beta-blockers will be used as markers of quality of care. The physicians (N = 10-15 in each country) will be interviewed to identify their current treatment approaches to patients with HF, their knowledge of existing guidelines, and their perspectives on what factors limit the use of ACE-inhibitors and beta-blockers in their practice. To explore patient level factors, CIF will invite 5-6 HF patients from each clinic (N= 4 groups in each country) to a group discussion to identify their perspectives on managing HF, treatment regimes, accessing health care for HF and their views on medications prescribed. All interviews and discussions will be audio recorded, transcribed and qualitatively analysed. The outputs from the project will be peer reviewed publications on barriers to quality of care for HF in the two countries and information for policy makers on potential areas for improvement. This study is part of a larger study on the transferability of qualitative methodology, and additional outputs will be: learning about the development of qualitative methods suitable for comparative health systems research and the development of web based materials to help training for health systems researchers.