Priority areas for improving the regulatory framework in the field of children and adolescents health protecting: the cardiometabolic diseases prevention

Cardiometabolic diseases, such as hypertension, diabetes mellitus, obesity, and lipid disorders, are becoming more common among young people, which has a negative impact on their health and ability to work in the future. Improving the regulatory framework in this area is an important step for improving the effectiveness of the organization of prevention, diagnosis, and treatment of these diseases. Objective. To develop proposals for improving the organization of prevention of cardiometabolic diseases in children and adolescents based on the content analysis of the current regulatory legal acts of the Russian Federation. Materials and methods. The content of the current regulatory legal acts regulating medical care for children and adolescents with cardiometabolic diseases (orders of the Ministry of Health of the Russian Federation, clinical guidelines) was reviewed. The analysis was based on the regulatory framework regulating the organization of follow-up medical care, diagnosis, treatment, and prevention of cardiometabolic diseases (arterial hypertension, obesity, diabetes mellitus, lipid metabolism disorders) in children and adolescents. Results. To improve the organization of medical care for children and adolescents with arterial hypertension, it is necessary to 1) develop specific clinical guidelines, 2) approve the profile standard of medical care, 3) regulate the criteria for the quality of diagnosis and treatment of arterial hypertension via amendments to the order of the Ministry of Health of the Russian Federation dated May 10, 2017 No. 203n, «On Approval of the Criteria for Assessing the Quality of Medical Care». In order to improve medical care for children and adolescents with type 1 and type 2 diabetes, it is necessary to 1) establish the standard of the frequency of lipid metabolism testing and the scope of follow-up medical care via adjusting the current standards of medical care, 2) regulate the criteria for the quality of diagnosis and treatment of type 1 and type 2 diabetes mellitus in children and adolescents. To improve the organization of medical care for children and adolescents with arterial hypertension, it is necessary to 1) increase the current standards for the frequency of lipid and carbohydrate metabolism testing, physical therapy, training in the «School for Patients with Overweight and Obesity»; 2) update the current standard of resort care by increasing the standards for the frequency of cholesterol and blood glucose testing, as well as physical therapy. In addition, there is a need to develop clinical guidelines and standards of care for children with lipid metabolism disorders. In the order of the Ministry of Health of Russia dated 16.05.2019 No. 302n, «On Approval of the Procedure for the Follow-Up Medical Care for Minors, Including during the Period of Education and Upbringing in Educational Institutions», it is necessary to determine a 3-day period for including into the follow-up medical care, establish a coverage rate of at least 90% for persons with cardiometabolic diseases. To improve the continuity of medical care, it is necessary to develop a normative regulation for the transition of 18-year-old adolescents for medical care from the pediatric to the adult outpatient network. Conclusion. The study results support improving regulatory documents concerning cardiometabolic diseases in children and adolescents. Implementing the proposed measures will improve the quality of medical care, reduce morbidity and improve the younger generation’s health.