This review is based on analysis of information sources on the status and development of primary health care (PHC) globally and in selected countries, as well as international evidence-­based guidelines. The paper assesses the incidence of stroke, as well as its prevention and early diagnosis in young patients.

A database of publications, regulatory documents, and online resources was used, using selected keywords and concepts related to PHC management. Priority was given to materials from the last decade related to stroke in young patients.

The increasing incidence of stroke in young patients is a concerning public health issue. The mean age of stroke in young people is decreasing (from 18 years), necessitating effective methods for the prevention, detection, and treatment of this disease.

The steady increase in ischemic stroke rates, disability-­adjusted life years (DALYs), and disease prevalence requires targeted prevention programs. This will reduce the medical and social burden, reduce the pressure on the healthcare system and improve public health outcomes.

Aim. To evaluate the characteristics of risk factors (RFs), the structure of comorbidities, and the clinical performance in patients aged ≥80 years with hypertension (HTN) and heart failure (HF) associated with frailty syndrome.

Material and methods. Patients with HTN and HF (n=161) were divided into two following groups based on frailty syndrome: group 1 — 84 patients with HTN, HF, and frailty; group 2 — 77 patients with HTN and HF without frailty. All participants underwent assessment of risk factors, comorbidities, symptoms, and cognitive status using the mini-mental state examination (MMSE). All participants were assessed for frailty syndrome using the Age Is Not a Barrier questionnaire and 24-hour blood pressure (BP) monitoring.

Results. In group 1, there was a significantly higher incidence of chronic kidney disease (p<0,001), atrial fibrillation (p<0,001), lower body mass index (p=0,029), mild (p=0,031) and moderate (p<0,001) dementia, as well as lower night-time systolic blood pressure (BP) (p=0,026) and daytime and nighttime diastolic BP (p<0,001 and p<0,001, respectively), higher 24-hour and nighttime systolic BP variability (p=0,004 and p<0,001, respectively) compared to group 2.

Conclusion. Outpatient diagnosis of frailty is a main element of preventive medicine and the key to maintaining the quality of life of the elderly.

Aim. To study the prevalence of preserved ratio impaired spirometry (PRISm) and its association with geriatric status and mortality risk. A decrease in forced expiratory volume in 1 second (FEV1) with a preserved FEV1/FVC ratio is a risk factor for obstructive lung diseases, chronic obstructive pulmonary disease, cardiovascular disease, frailty, and all-cause mortality. The prevalence of PRISm in the Russian population aged 65+ is unknown.

Material and methods. This prospective cohort study included random sample of individuals aged ≥65 years (n=379). We assessed spirometry, geriatric status, presence of noncommunicable diseases, complete blood count, and C-reactive protein. The total follow-up period was 6 years.

Results. FEV1/FVC <0,7 (Global Initiative for Chronic Obstructive Lung Disease (GOLD)) was detected in 25,5% of cases, and PRISm (FEV1<80% with FEV1/FVC ≥0,7) was detected in 10,9% of cases. Obstruction, diagnosed as FEV1/FVC < lower limit of normal (LLN), was detected in 9,5% of cases, and PRISm (FEV1/FVC≥LLN and FEV1<LLN) — in 8,4%. After bronchodilator testing, obstructive disorders were confirmed in 59,4% of respondents according to the GOLD criterion and in 20,3% according to the LLN criterion. PRISm was diagnosed in 17,2% and 10,9% of respondents, respectively. The incidence of PRISm was higher in patients with reduced functional status and loss of autonomy. PRISm was an independent risk factor for all-cause mortality [hazard ratio (95% CI) 5,54 (1,35-22,70)].

Conclusion. Data were obtained on the relatively high prevalence of PRISm and its association with low functional status, loss of autonomy, and a high risk of all-cause mortality.

Osteoarthritis (OA) is a socially significant noncommunicable disease with significant impact on quality of life, which is characterized by a steady incidence increase worldwide. Primary care physicians bear the brunt of ma­na­ging such patients. As part of the Expert Council meeting, which included leading specialists in internal medicine, rheuma­tology, neurology, and geriatrics, a resolution was developed reflecting current clinical approaches to the out­patient OA management. The cornerstone of pharmacological treatment are symptomatic slow-acting drugs for osteoarthritis (SYSADOA). OA therapy should be individualized, taking into account patient comorbidities, espe­cially in elderly individuals for whom OA is a risk factor for geriatric frailty. The resolution places particular emphasis on improving therapeutic outcomes through the use of SYSADOA combinations with different mechanisms of action. Data from large-­scale national studies confirm that such strategies result in greater pain reduction and reduced need for non-steroidal anti-inflammatory drugs. The document provides clear clinical management algorithms for primary care physicians, including criteria for referral to a rheumatologist or orthopedic surgeon.

Aim. To assess the current status and identify prospects for harmonizing the training of ge­neral practitioners (GP) (family physicians (FP)) in individual members of the Common­wealth of Independent States (CIS) to improve the quality of primary health care (PHC).

Material and methods. The study data was collected and analyzed in 2025 by researchers from leading medical universities in the CIS member states as part of the international research project GP-FP using specially developed questionnaires. Research methods inclu­ded statistical, analytical, and contextual comparison.

Results. An analysis of regulatory data regarding GP-FP training revealed similar models of ma­naging PHC as the foundation of the entire healthcare system, the systematic GP-FP im­ple­mentation, and the use of the territorial-­district principle, as well as some differences. A comparison of country data on educational and professional standards and residency training programs revealed convergence across most parameters. The country data is sys­tema­tized and presented in tabular format.

Conclusion. The significant similarities and some differences in the training and professional activities of GP-FP highlight the potential for harmonizing programs, requirements, and the regulatory framework for training these specialists across the CIS and, accordingly, outlined areas for further research.

Aim. To analyze the results of interviews with chief medical officers in health facilities in the Commonwealth of Independent States (CIS) members providing primary health care (PHC) on experience with financial and non- financial incentives for staff.

Material and methods. Original interview form was used. The form was available online on a digital platform or on paper. Participation of chief medical officers in the study was strictly voluntary and anonymous. Research methods included sociological, statistical (descriptive statistics), and contextual comparative analysis.

Results. The study revealed both common trends and differences in the approaches to motivating the staff of primary healthcare organizations in the project countries. All countries use incentive payments and traditional forms of non-financial recognition, but the range and implementation of additional measures vary significantly. In the Republic of Belarus, social and household support measures and leisure activities are more developed; in the Russian Federation, comprehensive social assistance measures, mentoring, and professional exchanges are more prevalent; and in the Kyrgyz Republic, there is a limited range of social support tools and a low representation of corporate culture elements, while traditional motivation is more prevalent. Differences were also identified in the degree of specificity of performance evaluation criteria, the availability of conditions for their implementation, and the distribution of management practices related to professional development and staff retention.

Conclusion. The study identified following areas for developing the management of medical staff motivation: improving the conditions necessary for meeting established performance evaluation criteria, expanding interaction with staff regarding performance assessment, etc.; increasing management's attention to employees' personal professional and career growth, and expanding support measures in various life situations. A promising area is the development of a corporate culture in medical organizations providing primary health care, which primarily requires enhancing related management's knowledge.

Aim. To assess the effectiveness of mobile health units (MHUs) in the Moscow Oblast's primary health care system for 2024-2025 and identify the main related management and technical issues.

Material and methods. This retrospective analysis of operational and statistical data on 84 MHUs in the Moscow Oblast was conducted for the period January 1, 2024, to September 30, 2025. Data for the first nine months of 2024 and 2025 were compared. MHUs were classified as diagnostic and treatment-and-preventive. The number of field visits, the scope of preventive examinations, the number of fluorography and mammography procedures performed, the population coverage, and downtime reasons were assessed. Descriptive and analytical statistics, including the Pearson χ² test, two-proportion Z-test, and effect size calculation (Cohen's d) were used. The critical significance level was α=0,01.

Results. Over the first nine months of 2025, MHUs made 8 738 field visits and provided care to 204 179 people. This exceeds results for the first nine months of 2024 by 32,4% and 37,9% in terms of visit count and number of patients served, respectively. A significant increase in the scope of preventive and diagnostic services was noted. The only parameter showing a decrease was influenza vaccination (-28,9%).

Conclusion. MHUs are an effective tool for increasing the accessibility of primary health care in the Moscow Oblast, providing a significant increase in scope of preventive examinations and X-ray investigations for residents of remote and small communities. At the same time, the identified technical and management barriers leading to downtime of some MHUs require targeted management solutions to fully realize their potential at the regional level.

Aim. To assess epistemological (methodological) tools for theoretically and practically formulating the definition of "hospitalization" in an interdisciplinary context and identify its essential features for subsequent application in healthcare management, rule-making, and law enforcement practice.

Material and methods. We used original scientific approach of independent guideline modeling. To conceptualize the concept of "hospitalization," we utilized systemic, axiological, interdisciplinary, comparative legal, risk-oriented, activity-­based, and formal-­logical approaches. Methods of analysis and synthesis, abstraction, analogy, annotation, the hypothetico-­deductive method, deduction and induction, idealization, conceptualization, modeling, generalization, reflection, and comparison were employed.

Results. The essential features of the concept of "hospitalization" were identified. Its essence, structure, scope, content, and functions were established. The key functions of hospitalization in healthcare legislation, research, public, and government practice were defined. The application of approaches and methods for describing and substantiating hospitalization as a scientific concept and a normative, legal, and medical phenomenon was clarified.

Conclusion. Key research areas were formulated, and scientific approaches applicable to the description, forecasting, and development of the concept of "hospitalization" were rationaled. The obtained results can be used in the planning, organization, implementation, and generalization of research in formulating normative, legal, and medical concepts.

Aim. To assess regulatory changes affecting primary health care (PHC) management in the Russian Federation from August to October 2025 was conducted.

Material and methods. A content analysis of Russian regulatory legal acts was conducted for the period from August to October 2025, including the new Compulsory Health Insurance (CHI) rules, amendments to the State Guarantee Program for Free Medical Care for 2025 and 2026-2027, and others. The analysis identified systemic transformations in the organizational, financial, and legal frameworks of the PHC system.

Results. The study shows that the legislative changes create institutional preconditions for PHC system optimization, creating conditions for strengthening public health and improving the healthcare. Key innovations include the digitalization of administrative processes, more detailed financial mechanisms for the CHI system, expanded rights for insured persons, and the development of a multi-­tiered support system. The implementation of these regulatory changes will contribute to improved efficiency in healthcare resource management, patient protection, and accessibility of care.

Conclusion. An analysis of legislative changes from August to October 2025 demonstrates their significant impact on the transformation of the primary health care system in the Russian Federation. Key organizational and legal innovations are aimed at ensuring accessibility and continuity of care, introducing digital technologies into document flow and information sharing, and increasing the transparency and manageability of financial flows in CHI system. The implementation of these measures will create the institutional preconditions for the modernization of health facilities, improving standards of care, and increasing patient satisfaction. This will be the basis for the progressive development of Russian healthcare.

Aim. To assess potential impact of loneliness syndrome (LS) on mental and clinical status in elderly patients with cardiovascular disease (CVD).

Material and methods. A total of 103 elderly patients with CVD were examined, including 51 with LS (study group) and 52 without LS (comparison group). LS was determined using the Russell-­Ferguson UCLA Loneliness Scale. The Mi­ni-­Mental State Examination, the Geriatric Depression Scale, the General Psychological Well-­Being Index, the Insomnia Severity Index, the Epworth Sleepiness Scale, and 10-point visual analogue scales were used. Null hypotheses were rejected at a Type I error <5% (p<0,05).

Results. In elderly patients with CVD, LS can affect not only their mental but also their clinical status. This syndrome contributes to feelings of anxiety, depression, and daytime sleepiness, negatively impacting self-rated health, mental well-being, and vitality. LS is accompanied by increased headaches, shortness of breath, and peripheral edema.

Conclusion. Loneliness is not only a mental but also a medical problem. Its presence in elderly cardiac patients should be considered when managing medical examinations and follow-up.

This guideline describes modern approaches to diagnosing acute decompensated heart failure using ultrasound imaging. Key attention is given to ultrasound use in outpatient settings to assess the congestion severity and monitoring of patients with heart failure by primary care physicians. A detailed description of the methodology, algorithms for performing ultrasound-assisted diagnosis of acute decompensated heart failure, and extensive evidence-based rationale make it relevant, practice-oriented, and useful for healthcare professionals.

This teaching aid can be used by primary care physicians, cardiologists, general practitioners, and other specialists involved in the clinical management of patients with acute decompensated heart failure.

These guidelines present an algorithm for managing patients with obesity and noncommunicable diseases in primary health care facilities. The presented algorithm includes measures aimed at assessing the patient's condition and comorbidities, developing individualized treatment plans and adjusting therapy, and regularly monitoring the therapy effectiveness. Key criteria for monitoring treatment effectiveness are presented to reduce the risk of complications and improve the overall quality of life and life expectancy of patients. The systematization and structuring of modern clinical guidelines and standards in terms of monitoring make this manual relevant, practice-­oriented, and useful for healthcare professionals. The inclusion of research data ensures the high effectiveness of the proposed approaches and their application in routine health practice.

These guidelines can be used by healthcare administrators, heads of primary care facilities and related departments.

This guideline was developed as a result of a pilot project to introduce a holacracy at a primary care site with independent patient admissions by a district nurse. It contains a template for the form to be completed by a nurse during an independent patient admission and the procedure for completing it.

The use of this guideline by personnel of any other facilities is not limited. Responsibility for its correct use lies with the person using it.

This document outlines a standard operating procedure (SOP) for the management of patients at risk for harmful alcohol use in adult health centers. The manual contains step-by-step instructions for managing patient appointments at adult health centers, describing tools and methods for assessing patient risk factors, lists of paraclinical investigations and estimated indicators. It also describes algorithms for individualized in-depth preventive counseling on identified risk factors, as well as the development of individualized healthy lifestyle and dietary programs, and approaches to follow-up monitoring.

This methodological manual is designed to manage workflow in adult health centers based on benchmark processes for effective individualized prevention, and to develop a personalized patient pathway for risk factor modification. This will contribute to increasing the effectiveness of preventive measures and the proportion of persons with a healthy lifestyle. The document is intended for physicians, paramedics, and nurses.

This document outlines a standard operating procedure (SOP) for the management of patients with a combination of risk factors of nicotine and tobacco product use in adult health centers. The manual contains step-by-step instructions for managing patient appointments at adult health centers, describing tools and methods for assessing patient risk factors, lists of paraclinical investigations and estimated indicators. It also describes algorithms for individualized in-depth preventive counseling on identified risk factors, as well as the development of individualized healthy lifestyle and dietary programs, and approaches to follow-up monitoring.

This methodological manual is designed to manage workflow in adult health centers based on benchmark processes for effective individualized prevention, and to develop a personalized patient pathway for risk factor modification. This will contribute to increasing the effectiveness of preventive measures and the proportion of persons with a healthy lifestyle. The document is intended for physicians, paramedics, and nurses.

This document outlines a standard operating procedure (SOP) for the management of patients with a combination of risk factors of overweight and class 1-2 obesity in adult health centers. The manual contains step-by-step instructions for managing patient appointments at adult health centers, describing tools and methods for assessing patient risk factors, lists of paraclinical investigations and estimated indicators. It also describes algorithms for individualized in-depth preventive counseling on identified risk factors, as well as the development of individualized healthy lifestyle and dietary programs, and approaches to follow-up monitoring.

This methodological manual is designed to manage workflow in adult health centers based on benchmark processes for effective individualized prevention, and to develop a personalized patient pathway for risk factor modification. This will contribute to increasing the effectiveness of preventive measures and the proportion of persons with a healthy lifestyle. The document is intended for physicians, paramedics, and nurses.

This document outlines a standard operating procedure (SOP) for the management of patients with a combination of risk factors of low physical activity and unhealthy diet in adult health centers. The manual contains step-by-step instructions for managing patient appointments at adult health centers, describing tools and methods for assessing patient risk factors, lists of paraclinical investigations and estimated indicators. It also describes algorithms for individualized in-depth preventive counseling on identified risk factors, as well as the development of individualized healthy lifestyle and dietary programs, and approaches to follow-up monitoring.

This methodological manual is designed to manage workflow in adult health centers based on benchmark processes for effective individualized prevention, and to develop a personalized patient pathway for risk factor modification. This will contribute to increasing the effectiveness of preventive measures and the proportion of persons with a healthy lifestyle. The document is intended for physicians, paramedics, and nurses.