Territorially Adaptive Organisation of Geriatric Care in a Post-Soviet Primary Care System: A Controlled Evaluation in the Samarkand Region of Uzbekistan

Abstract

Background. Populations are ageing rapidly across Central Asia, but the primary care systems inherited from the Soviet period were built around episodic attendance rather than continuous, coordinated follow-up. No controlled evaluation of an organisational model of care for older people has been reported from the region. We evaluated a territorially adaptive organisational model of geriatric care in the Samarkand region of Uzbekistan.
Methods. A controlled, non-randomised (quasi-experimental) study was conducted in six territories of the Samarkand region spanning urban, peri-urban, foothill, agricultural-plain and remote settings, between 2020 and 2025. Six hundred residents aged 60 years and over were allocated to an intervention group (n = 320), managed under the adaptive model, or to a control group (n = 280), receiving usual care; 180 health workers and 30 experts were surveyed. The model comprised an initial organisational–medical assessment, three-level risk stratification, an individual follow-up plan, a standardised routing algorithm with documented referral and mandatory written feedback to primary care, and monitoring of adherence. Forty process, access, continuity, clinical, social and resource indicators were compared using the chi-square test; risk ratios with 95% confidence intervals were calculated.
Results. At baseline, 63.7% of the cohort had no individual follow-up plan, 60.7% received no feedback from specialists into primary care, and 45.2% waited more than seven days for a specialist. Territorial gradients were steep for transport difficulty (18.3% in the regional centre vs 49.0% in the most remote district, p < 0.001) and for dissatisfaction (31.7% vs 54.0%, p = 0.032), but absent for specialist waiting time (p = 0.163). After implementation, the intervention group exceeded the control group on every indicator. The largest gains were in rule-governed components: an individual plan was formulated for 92.5% versus 37.1% (risk ratio 2.49, 95% CI 2.13–2.91) and adherence was monitored in 88.1% versus 34.3% (RR 2.57, 2.17–3.04). Gains were smaller for capacity-governed components, notably home visiting (33.8% vs 15.4%) and transport difficulty (22.5% vs 34.3%, RR 0.66, 0.51–0.85). Unjustified attendance at specialist level fell from 24.3% to 9.4% and hospitalisation for deterioration from 16.8% to 8.8% (RR 0.52, 0.34–0.81, p = 0.004). Overall effectiveness was rated high in 63.8% versus 20.7% (p < 0.001).
Conclusions. An organisational model requiring no additional clinical technology substantially improved the structure, continuity and perceived quality of care for older people in a post-Soviet primary care system, and reduced hospitalisation for deterioration. The pattern of effect indicates where such redesign works and where it reaches its ceiling: what can be specified as a rule changed markedly, whereas what depends on physical capacity — home visiting and transport — changed least. Specialist waiting time improved not by adding supply but by removing unnecessary demand.