Primary Health Care Guidelines Planning Meeting Held in Moscow

Steering Committee members review methods of developing clinical practice guidelines.

The Primary Care Clinical Practice Guidelines Steering Committee met in Moscow, April 3-5, to discuss the existing primary care clinical guidelines currently in use in the NIS. Approximately 17 representatives from AIHA's primary healthcare partnerships in the NIS attended the meeting, where several group discussions focused on goals such as identifying existing primary care clinical guidelines, defining the processes used to design those guidelines, and recommending a process that facilitates the review, selection, and adoption of new and existing guidelines. Other objectives included recommending strategies to engage key leaders at the ministries of health and oblast level to approve new practice guidelines, exploring barriers to changing physician behavior related to adopting new practice guidelines, and developing evidence-based implementation strategies that would enhance AIHA's primary healthcare partnership programs and promote primary care practitioner awareness of new and existing guidelines.

Members of the Clinical Practice Guidelines Committee during their Moscow meeting.

A panel discussion summarizing the clinical guidelines currently in use in the NIS was facilitated by Drs. Zinaida Klymenko, deputy head physician at the Kharkiv Rayon Territorial Medical Unit in Kiev; Yuri Komarov, general director at the "MedSoc-EconomInform" Institute in Moscow; Galiya Nanaeva, head of the family medicine department at Kyrgyz State Medical Academy in Bishkek; and Marina Shikhashvili, a general practitioner and head physician at the Polyclinic #20 in Tbilisi. A US resource group panel consisting of Drs. Cynthia Barrett, director of the multi-national child health program at Mattel Children's Hospital at UCLA Medical Center; Geoffrey Lamb, associate professor of internal medicine at the Medical College of Wisconsin; Lewis Morrow, professor of medicine at the University of Nevada School of Medicine; and John Zapp, chairman of the Department of Family Medicine/Family Medicine Residency at Crozer-Keystone Health System, discussed how clinical practice guidelines are used in the US and who develops them. During the three-day meeting, the physicians listed above, along with Dr. Kermit Newcomer, of the Gundersen Lutheran Health System in LaCrosse, Wisconsin, moderated small group discussions.

At the meeting, participants outlined the diverse processes of how new guidelines are developed and existing ones improved for implementation in Armenia, Georgia, Belarus, and Ukraine, as well as generated a list of barriers encountered when trying to apply these guidelines. Reasons why guidelines should be used-including economic, informational, legislative, organizational, scientific, and training-were also enumerated. The Steering Committee developed a list of recommendations for the roles of AIHA, the NIS partners, and the Steering Committee itself in the structuring process. The recommendations require NIS partners to identify and review existing guidelines in their regions and submit them to AIHA. The Steering Committee will then review the guidelines and identify what's missing or needs to be developed and/or adapted in the area of primary care prevention. AIHA will provide informational support as well as facilitate strategic planning in the clinical practice guidelines structuring process.

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