Algorithms for preventive counseling, prenosological diagnostics and self-diagnosis in the practice of a general practitioner at a Health Center

Background. The article deals with the urgent medical and social problem of preserving the health of young and working-age people against the backdrop of a high prevalence of modifiable risk factors (RF) for chronic non-communicable diseases (CNCD) due to low adherence to a healthy lifestyle (HLS) and the lack of proper effectiveness of state preventive programs. Objective. Analysis of the dynamics of the prevalence of RF for CNCD in patients examined at the Regional Health Center (2010-2022) and development of the universal algorithms for prenosological screening diagnostics (questionnaire self-diagnosis) and preventive counseling (non-drug and drug correction of the main RF for CNCD). Methods. The comparative results of the screening assessment of the health status of 1347 people (examined in 2010-2022 at the Regional Health Center, City Polyclinic № 10, Rostov-on-Don), as well as the experience and results of introducing of additional multifactorial questionnaires, including general questions, questions about nutrition (including DEBQ), physical activity (IPAQ-SF test), smoking (Fagerstrom, J. Lagrue, D. Horn tests), mental disorders - assessment of social adaptation (T. Holmes, R. Rhea), the HADS scale, the level of stress according to the Reeder test (and the scale of O.S. Kopina et al., 1989), the severity of autonomic disorders (according to A.M. Wein), sleep disorders (Ya.I. Levin questionnaire, Epworth scale) in the practice of therapist of the Health Center were analyzed. Results. During the 2010-2022 years analyzed, the prevalence of modifiable risk factors for CNCD remains high among people of different ages (including young people) examined in the Health Center: deviations in body mass index (BMI) in 50.6-56.4% (preobesity in 20.6-32.9%, obesity - in 20.6-25.5%), arterial hypertension in 34.7-38.2% (excluding young people under 30); about a quarter of patients have dyslipidemia, hyperglycemia. 66.3% of people do not keep to diet and 33.3% have physical inactivity (IPAQ-SF). Disorders of the autonomic nervous system were detected in 36.4-92% of the patients (according to the A.M. Vein questionnaire - in 76.6%), reduced adaptive reserves (according to R.M. Baevsky and A.P. Berseneva) were detected in 31,1-35.8%, increased stress level - in 35% (according to Holmes-Ray), and in 64.4% (according to Reeder), anxiety - in 45% and depression - in 27.2% (according to the HADS scale), night sleep disturbances - in 52.2% (according to Ya.I. Levin). The number of active smokers has decreased by 7%, but 35% of respondents are exposed to passive smoking. Almost 58% do not visit a doctor for preventive purposes, 82% have never visited a health center before, and 74.5% of respondents have not undergone medical examinations. Detailed author’s algorithms (schemes) of individual preventive counseling (healthy lifestyles, diets, physical activity, consultations and additional examinations with specialized specialists, drugs for drug correction of risk factors for CNCDs), the Internet sources and social networks for group preventive counseling are given. Conclusion. The use of multifactorial questionnaires compiled by the author at medical appointments expands the possibilities of prenosological screening by self-diagnosis to identify additional risk factors in young people and the working population. Structured algorithms for preventive counseling (non-drug and drug correction of the main RF for CNCDs) will accelerate the provision of planned preventive medical care. Working with patients through social networks and the Internet contributes to raising the awareness of the population about Health Centers and the formation of adherence to a healthy lifestyle.

health centers, risk factors, chronic non-communicable diseases, prenosological screening diagnostics, self-diagnosis, questioning, preventive counseling, young health