Supporting Improvements in Continuity of Care for Hypertension and Diabetes in North Macedonia : Findings from a Cascade Analysis

North Macedonia, an Eastern European nation of 1.836 million inhabitants, has a growing burden of noncommunicable diseases (NCDs). An aging population and high levels of NCD risk factors are mainly responsible, with tobacco, raised blood pressure, and unhealthy diets driving mortality and disability. To better address the needs of its rapidly aging population, the growing challenges posed by chronic conditions, and improve overall health system performance, the country is developing a new primary health care (PHC) model. This model should improve the quality of care and the efficiency of primary care by reducing fragmentation, enhancing coordination, prioritizing prevention, and strengthening the role of primary care nurses. Aim of the study is to strengthen the evidence on quality and continuity of care for diabetes and hypertension - the two conditions driving the burden of chronic NCDs and associated health care costs in North Macedonia - a cascade analysis was carried out using a mixed methods design. The assessment drew on secondary quantitative data from national and international sources, primary quantitative data from 2,400 patients in 12 general practitioner (GP) practices, and primary qualitative data from health care providers and patients. Patient data were extracted from the eHealth system (MojTermin) and paper medical records from September to November 2021