阿塞拜疆的高血压和糖尿病护理：混合方法级联分析（英）

A MIXED METHODS CASCADEANALYSIS © 2025 International Bank for Reconstruction and Development / The World Bank 1818 H Street NWWashington DC 20433Telephone: 202-473-1000Internet:www.worldbank.org This work is a product of the staff of The World Bank with external contributions. The findings, interpretations,and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board ofExecutive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors,denominations, and other information shown on any map in this work do not imply any judgment on thepart of The World Bank concerning the legal status of any territory or the endorsement or acceptance ofsuch boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of itsknowledge, this work may be reproduced, in whole or in part, for non-commercial purposes as long as fullattribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed to World BankPublications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625;e-mail:pubrights@worldbank.org. ACKNOWLEDGEMENTSv ACRONYMSvii INTRODUCTION1 STUDY OBJECTIVES5 METHODS7 Cascade study design7Study sites8Sampling of participants10Data collection10Quantitative component10Qualitative component12Analysis of quantitative and qualitative data12Ethical considerations13Data sources and challenges13 RESULTS: QUANTITATIVE COMPONENT17 Hypertension care17Diabetes care20COVID-19 vaccination and episodes, influenza vaccination25 RESULTS: QUALITATIVE COMPONENT27Diagnosis27Treatment regimen and medication adherence29Daily management and monitoring30Digital health interventions34Data recording and integration35Solutions proposed by patients and providers37STUDY LIMITATIONS41CONCLUSIONS43RECOMMENDATIONS47REFERENCES51ANNEXES53Annex 1: Definitions of cascade stages53Annex 2: Qualitative instruments55Annex 3: Additional cascades by disease and sub-populations60Annex 4: Heatmaps of cascade data by study site62Annex 5: Profiles of qualitative research participants63 Figures Figure 1. Burden of disease comparison across Eastern Europe and Central Asian countries in DALYrates, 20212Figure 2. Explanatory design of mixed method study8Figure 3. Study sites in Azerbaijan9Figure 4. Hypertension care cascade20Figure 5. Initial and current treatments in the diabetes patient sample23Figure 6. Diabetes care cascade24Figure A3.1. Hypertension care cascade by gender60Figure A3.2. Hypertension care cascade by age group60Figure A3.3. Diabetes care cascade by gender61Figure A3.4. Diabetes care cascade by age group61Figure A4.1. Heatmap for hypertension care by health facility62Figure A4.2. Heatmap for diabetes care by health facility62 Tables Table 1. Adult prevalence of type-2 diabetes and linked chronic kidney disease inEECAcountries, 20212Table 2. Final sample of NCD patients and doctors11Table 3. Participating health facilities and sources of routine data (alphabetic order)14Table 4. Characteristics of the hypertension patient sample18Table 5. Current treatments in the hypertension patient sample19Table 6. Characteristics of the diabetes patient sample22Table 7. Prevalence of COVID-19 vaccinations, COVID-related morbidity, and flu vaccinations25Table 8. Solutions proposed by stakeholders to address specific barriers and challenges37Table A1.1. Hypertension: Definition of the care cascade stages53Table A1.2. Diabetes: Definition of the care cascade stages54Table A5.1. Characteristics of patients participating in-depth interviews63Table A5.2. Characteristics of doctors participating in-depth interviews63Table A5.3. Characteristics of patients participating in FGDs64Table A5.4. Characteristics of doctors participating in FGDs64 This report was prepared under the leadership of Moulay Driss Zine Eddine El Idrissi, Lead Health Economist,World Bank, and Elvira Anadolu, Senior Health Specialist, World Bank, under the general direction of TaniaDmytraczenko and Rekha Menon, Practice Managers for Health, Nutrition, and Population, World Bank.Study design, data collection, and analysis were conducted by the core research team of Nicole Fraser,Ruslan Abdullayev, Rugiyya Ibrahimli, Rana Huseynova, Nisa Aliyeva and Zara Shubber. The study team thanks the Directors and Staff of the Azerbaijan health facilities participating in this studyincluding through in-depth interviews and focus group discussions. We are grateful to the patients whoshared their knowledge and perspectives during the qualitative research phase. The study team is gratefulto the State Mandatory Health Insurance Agency (SAMHI) for granting access to routine data collected inthe country’s health system. The team also acknowledges the advice from Mehmet Akman and ElturanIsmayilov from the WHO Country O