Abstract
Objective: To evaluate the current state of dispensary observation for patients with chronic non-communicable diseases, including the contribution of nurse-led independent consultations, using the example of a primary health care organization in Kokshetau, Kazakhstan. Methods. A combined study design was employed, comprising a retrospective analysis of medical records and a cross-sectional sociological survey. The retrospective component analyzed dispensary observation data from Viamedis Ltd., a primary health care organization in Kokshetau (Akmola region, Kazakhstan) serving an enrolled population of 93,851 individuals across 71 clinical districts, including 6 dedicated dispensary units. Data were extracted from the electronic medical information system for the period 2022 to 2024 and included population dynamics, dispensary coverage rates, structure of chronic diseases, and competency center outputs. The cross-sectional component consisted of a structured questionnaire survey of 87 patients registered for dispensary observation. The questionnaire comprised two sections: sociodemographic characteristics and patient evaluation of nurse-led independent consultations. Written informed consent was obtained from each participant. Descriptive statistics were used for quantitative and categorical variables. Results. Over the three-year period, the enrolled population remained stable with a 1.0 percent increase, reaching 93,851 in 2024. Dispensary observation coverage averaged 85.5 percent across all districts, ranging from 72.4 percent to 93.6 percent. Cardiovascular diseases accounted for 75.8 to 79.4 percent of all dispensary cases. Coverage for diabetes mellitus and ischemic heart disease reached 79.0 to 80.8 percent, while arterial hypertension coverage was only 57.6 percent despite representing the largest patient cohort. Specialized competency centers served a combined total of over 3,300 patients. The survey demonstrated that 94.3 percent of respondents were aware of nurse-led consultations and 88.5 percent had attended them. Among those who attended, 77.0 percent rated the quality of nurse-led consultations at 4 or 5 out of 5 points. The most frequently reported activity pattern (37.9 percent) included blood pressure measurement, lifestyle counseling, medication compliance monitoring, and well-being assessment, indicating a comprehensive rather than procedural approach to nurse-led care. Conclusions. Nurse-led independent consultations in a primary health care setting demonstrated broad patient awareness, high attendance, and favorable quality ratings. Dispensary coverage indicators remained at adequate levels across most nosological categories, with room for improvement in arterial hypertension follow-up. The findings support the role of dispensary nurses as an effective component of chronic disease management in primary health care in Kazakhstan. Keywords: primary health care, nurse-led consultations, chronic disease management, dispensary observation, non-communicable diseases, patient satisfaction, Kazakhstan.