IMPROVEMENT OF CARDIOVASCULAR DISEASE PREVENTION IN ISTRIAN REGION – IMPORTANCE OF CROSS-SECTORAL COOPERATION AND SUSTAINABILITY ISSUES

Istarska županija (IŽ) od 2005. godine prioritetno ulaže u prevenciju kardiovaskularnih bolesti na svom području iznad nacionalnih standarda. Poseban iskorak učinjen je putem EU projekta LOVE YOUR HEART: kreirano je 107 edukativnih materijala, izobraženo je 139 stručnjaka, pripremljen je informacijski sustav koji integrira rad stručnjaka primarne i sekundarne razine zdravstvene zaštite, nabavljene su dodatna medicinska i informatička oprema za rad, otvoren je Županijski centar za prevenciju KVB. Evaluacija sedamnaestomjesečnog probnog rada Centra pokazala je vidljive rezultate i evaluacijom procesa i evaluacijom učinka na zdravstvene ishode. Planski je uspostavljena suradnja među različitim pružateljima preventivnih usluga na različitim razinama i među profesijama. Učinjen je probir 2625 rizičnih pacijenata, 637 ih je educirano, a 1124 pregledano od kardiologa. Liste čekanja na kardiološki pregled i dijagnostiku su značajno skraćene, a broj obavljenih dijagnostičkih pregleda srca i tlaka u IŽ je porastao. Kod pacijenata obuhvaćenih projektom zamijećeni su porast izdržljivosti i opće kondicije, značajan gubitak kilograma, smanjenje terapije za hipertenziju i bolji nalazi kontrolnih ergometrija. Program prevencije KVB razvijen i provođen u IŽ primjer je dobre prakse koji treba nastaviti, proširiti i institucionalizirati čime bi se osigurao bolji učinak (ovako koncipirane cjelovite intervencije) na zdravstvene ishode cjelokupne populacije.Cardiovascular diseases (CVD) are the major public health problem and the leading cause of death in Croatia. Notwithstanding CVD are very preventable, there is not a comprehensive strategy for their control and prevention in Croatia. The Istrian region has chosen CVD prevention as one of its public health priorities from 2005 to 2016 and has developed an integrative model of good practice with services above national standards. There are several aims highlighted in this article: to show the methodology and results of the activities implemented through the Istrian Health Plan and the LOVE YOUR HEART project; to explain the need for development of services above national standards; to emphasize the importance of cooperation at different levels; and to address the sustainability issues. The methods used during the process of CVD prevention improvement were strategic planning and evaluation, SWOT analysis, investing in preventive services above national standards in health care institutions, supporting nongovernmental organizations through public tenders, and using European Union funds through cross border cooperation programs. During the implementation period, 107 different educative materials for professionals and citizens were created, and at least 139 professionals were educated. Signifi cant resources for equipment and infrastructure were invested and an integrative informative system was created. The fi rst Istrian center for CVD prevention was established and its experimental work lasted for 17 months with 2625 risk citizens screened, 637 risk citizens/patients educated, and 1124 patients viewed by cardiologists. Several cooperation networks among various providers of preventive services at different levels were established intentionally. Since there is no comprehensive strategy for CVD prevention in Croatia, the Istrian region has developed its own strategy/CVD prevention model above national standards and piloted it for 17 months. The process evaluation showed signifi cant results, the end users were satisfied, and evaluation of short-term impacts was satisfactory. Cross-sectoral cooperation, networking at various levels and broad coverage through economically viable and wide-ranging programs available at the lowest local level were essential for success. However, in order to be completely successful and to reduce CVD morbidity and mortality, the regional CVD prevention program should expand and provide a far greater range and attainability to the population at large, for a long period of time. Unfortunately, regional government has no strength and resources to support complete sustainability of the fully developed program, and sustainability issues occur. In order to sustain a prevention program that addresses the biggest national public health problem and which is expanded to the whole population, help from the national level institutions is needed. In conclusion, the Istrian region has developed an integrative model of CVD prevention services above national standards, through its Health Plan and through the LOVE YOUR HEART project. The achieved results were very satisfactory and the role of cross-sectoral cooperation at different levels was crucial