ADHERENCE TO PHARMACOTHERAPY STANDARDS FOR CHRONIC CARDIOVASCULAR AND RESPIRATORY DISEASES AMONG PRIMARY CARE...

Guideline-based pharmacotherapy for chronic cardiovascular diseases and chronic respiratory diseases is a key determinant of outcomes in primary care; however, adherence may vary across territories due to organizational factors and access to essential medicines.

To assess compliance with international clinical guidelines in the management of patients with chronic cardiovascular and respiratory diseases in primary care facilities of the Samarkand region and to compare prescribing patterns across urban, district, and rural settings.

This cross-sectional analytical study included 3,049 patients aged 40-75 years who had been followed for >=6 months. Actual diagnostic and therapeutic prescriptions were compared with ESC/ESH (2023) and ESH (2023) recommendations for hypertension, ESC guidance for chronic coronary syndromes, the ESC Focused Update on heart failure (2023), GINA (2023), and GOLD (2024). Between-setting differences were evaluated using Pearson's chi-square test in SPSS 13.0; p<0.05 was considered statistically significant.

Urban facilities more frequently prescribed combination antihypertensive therapy and standard secondary prevention regimens for ischemic heart disease, whereas district and rural facilities showed more frequent deviations from recommended treatment patterns, particularly for chronic heart failure, bronchial asthma, and chronic obstructive pulmonary disease, where symptomatic and outdated approaches were more common. Because multivariable adjustment was not performed, the observed differences should be interpreted as territorial associations rather than evidence of an independent effect of facility type.

Primary care in the Samarkand region demonstrates pronounced territorial variation in adherence to clinical guidelines, with the most critical reduction in compliance observed for chronic heart failure and for asthma/COPD management in rural facilities. Improving quality of care requires: (1) strengthening continuing medical education, (2) optimizing access to essential medicines, and (3) standardizing patient referral and follow-up pathways.