Assessment of the effects of biological, social, organizational factors, and treatment regimens on the risk of exacerbation of diseases with broncho-obstructive syndrome using the example of institutions of different levels of medical care

Abstract

The relevance of the study is due to the high prevalence of diseases with ronchoobstructive syndrome and the significant social and economic losses they cause. Of particular importance is the need to understand the impact of both treatment regimens and social, biological and organizational factors on the risk of exacerbations, which will increase the effectiveness of medical care at all levels. Taking into account such factors is important both for clinical forecasting and for the development of health care policies. The purpose of the work is to assess the impact of biological, social, organizational factors and treatment regimens on the risk of exacerbation of diseases with bronchoobstructive syndrome, using data from medical institutions of different levels. The study analyzed 731 archival charts of inpatients of three medical institutions in Vinnytsia region for 2019-2024. The effectiveness of ten main and six accompanying treatment regimens was assessed. To model the risks of exacerbations and time intervals to them, a Weibull model with Bayesian MCMC analysis was used based on the R software environment using the libraries «nimble», «coda», «survival», etc. According to the results of the analysis, no significant differences in effectiveness were found between the main treatment regimens. Among the accompanying therapies, regimen No 2 was the least effective with marginal statistical significance. Social and organizational factors were important: employment significantly reduced the risk of exacerbation by 12% (RR=0.885), compliance – by 34% (RR=0.663), and treatment in cluster and supracluster level nstitutions was associated with a significantly lower risk of exacerbation compared to the interdistrict level (RR≈0.48). The diagnosis of asthma was also associated with a 38% risk reduction compared to COPD. Instead, each year of study was associated with an annual increase in risk of 16%. The individual risk of exacerbation of diseases with bronchoobstructive syndrome depends mainly not on the applied treatment regimen, but on social, organizational factors and patient compliance with the treatment regimen. Optimizing the patient’s route and ensuring compliance are key areas for reducing the risk of exacerbations