similarly a study by the commonwealth fund of care management programmes that spanned care settings and engaged interdisciplinary teams across the continuum of care found that multifaceted boundaryspanning approaches were associated with reduced hospital use and readmissions mccarthy et al the reforms undertaken to date clearly reflect this moreover the strengthening of primary care continues to be supported by the state health development programme of the republic of kazakhstan densaulyk for key measures envisaged include reducing the size of patient lists for generalists from the current to and the increased delegation of tasks to nurses