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Establishing EBM and developing quality of care in PHC through extended networks with PHC doctors and nurses in Northwest Russia

Project title Establishing EBM and developing quality of care in PHC through extended networks with PHC doctors and nurses in Northwest Russia
Database Data inserted through the NDPHS Project Pipeline
ID in the source database 14
Thematic area
  • Alcohol, Drugs, Tobacco
  • Chronic Diseases
  • Communicable Diseases (other than HIV/AIDS and TB)
  • Development of Health Systems and Social Services
  • Lifestyle-related Diseases
  • Primary Health Care
Topic We intend to strengthen the network of doctors and nurses in the Primary Health Care (PHC) in Northwest Russia, the Baltics and Scandinavia. The APO-audit method for bottom-up based quality development will be used as the tool. From a bottom-up approach Evidence Based Medicine and Evidence Based Care (EBM/EBC) as well as Preventive Care will be illustrated in the audit-process. The connection between EBM/EBC and clinical practice will by this be more easy to understand for doctors and nurses in their practices.
Project geographical area
  • Denmark
  • Finland
  • Lithuania
  • Russia
  • Sweden
Substate level / administrative units /regions
  • Arkhangelsk Oblast
  • Kaliningrad Oblast
  • Murmansk Oblast
  • Pskov Oblast
  • St. Petersburg
  • Vologda Oblast
Lead partner (organisation) Landstinget Blekinge, Sweden
Lead partner (owner or/and project manager) Dr Ovhed Ingvar
Partner organisations
Start date 2008-05-01
End date 2009-10-31
Duration (months) 18
Target audience Direct beneficiaries: Those doctors and nurses who participate in the audit registrations and follow ups will meet an EBM/EBC related and updated knowledge. They will get a new perspective on their own clinical practice as well as an integrated continuing medical education. As the audit reports will include comparisons with Scandinavian and Baltic reports it will be a meeting also with the Nordic primary health care systems.
Indirect beneficiaries:
1. Patients to the active doctors and nurses will experience a higher quality of care.
2. Colleagues to the participating doctors and nurses will also be able to raise their professional ability through the dissemination of knowledge among professionals.
3. Family medicine and PHC will get a higher status in academic and clinical medicine.
Other stakeholders:
4. Administrative leaders and politicians will find a raising quality in areas of priority like Primary Health Care and Preventive Care.
Summary The intention of this project is to continue the development of networks of doctors and nurses already established in Primary Health Care (PHC) in Scandinavia since 15 years and in the Baltics and most of the regions of Northwest Russia since 5-10 years. EBM / EBC (Evidence Based Medicine (resp Care) and thus Quality of Care will be focused on, using a bottom-up clinical audit model – the APO-audit, validated in Scandinavia since the beginning of the nineties. The APO-audit is a tool for registration of by the professionals themselves defined variables. The registration takes place in direct connection with the consultation, making it possible also to register qualitative variables. After a computerized collection a report is given, confidentially for the individual, but most important on the group level. During the last year one EU-project “The Happy Audit” using the APO-audit tool has started up in Denmark, Spain, the Argentine, Sweden, Lithuania and Kaliningrad region. In six regions of Northwest Russia are follow-up workshops carried out after the first registration of 7396 consultations to 146 family doctors during four weeks in November 2007. Also family nurses in Murmansk have planned for an audit parallel to PHC nurses in Blekinge county in Sweden. We intend to continue the already on-going work and that way extend and strengthen the existing network between doctors and nurses in Northwest Russia, the Baltics and Scandinavia. Audit will be an important tool in this process. For the project time, May 2008 to October 2009, a schedule is given showing that in Sept 2008 family nurses in Northwest Russia will carry out their first registration of Blood pressure measurement and life-style advices. Follow up workshops during the following 3-4 months will be part of the EBM implementation in clinical practice. In November 2008 family doctors in Murmansk, Archangelsk, St Petersburg, Vologda, Pskov and Kaliningrad will have their second registration of audit on Blood pressure treatment followed by regional workshops. Early during 2009 family doctors will have their first audit on bacterial resistance and antibiotic prescription. From the beginning and parallel to these activities the future tool, a web based technique developed and validated by Conmedic OY, Finland will be introduced. This technique will be tested in Northwest Russia at the end of the project time.
Background East European countries have a long tradition of decentralised specialist care in the old policlinic system giving negative public health effects, which have been accentuated during the last two decades. Because of that there is since the beginning of the nineties a great need of raised resources for generalists and team work in primary health care, preventive care as well as improved quality of care. This is also two of three priorities stated in Russia for the health care as a whole. During the last 15 years different projects on development of primary health care have been carried out in the Baltics and lately especially in the Northwest Russia. The great differences between the Nordic countries and Russia up to mortality and morbidity call for new and powerful actions. Still there is a need for changes and development of the health care system not least from a bottom-up approach. Hitherto most trials have been introduced from a top-down perspective. To get an effective and basal primary health care integrating preventive care of good quality there is a need for an EBM/EBC related and updated knowledge achieved with effective problem based learning. Preventive care as well as development of Primary Health Care are today defined priorities for the Russian Health Care System as well as objectives of the NDPHS.
Objectives To develop quality of care in prevention and primary health in Northwest Russia by narrowing the gap between EBM/EBC and clinical practice.
Specific objectives/indicators To continue the introduction of the clinical APO-audit method started in Northwest Russia among family doctors and family nurses in the areas of hypertension, cardiovascular prevention and the challenge of increasing antibiotic resistance. Audit follow-ups will be a tool for introducing modern EBM/EBC in preventive care / health promotion as well as primary health care. Through the audit process there will be a focus on the needs of continuing postgraduate education for family doctors and family nurses. Monitoring indicators As shown in the schedule each registration will be followed by decentralised seminars and work shops on the results. These results will give several measurable indicators and changes will be possible to show and publish, even scientifically. The process will be easy to monitor as each registration period is short (3-4 weeks). After the computerised data collection (4-6 weeks) the results are restored to the participants in connection with the follow up seminars. The bottom up process may extend over time. Local or regional demands for educational activities will follow besides the audit activities. Such activities will be reported. Summarized; every audit process will produce evident indicators of the flow, of the results and of the monitoring. This is illustrated by the enclosed reports already published during the first part of 2008. References – published lately on APO-audit and to project related issues: Håkansson A, Ovhed I, Jurgutis A, Kalda R, Ticmane G. Family medicine in the Baltic countries. Accepted for publication in Scand J Prim Health Care 2008. Strandberg E L, Ovhed I, Håkansson A, Troein M. The meaning of quality work from the general practitioner’s perspective: an interview study. BMC Family Practice 2006; 7:60. Ovhed I, Håkansson A, Meakin R, Fowler G, Jurgutis A, Lember M. Report from the Universities of Lund/Malmö, London, Oxford, Klaipeda and Tartu. The Baltic Forum 1994–2000: a primary health care research workshop. Scand J Prim Health Care 2001; 19: 211–3. Ovhed I, van Royen P, Håkansson A. What is the future of primary care research? Probably fairly bright, if we may believe the historical development. Scand J Prim Health Care 2005; 23: 248–53. Strandberg E L, Ovhed I, Troein M, Håkansson A. Influence of self-registration on audit participants and their non-participating colleagues. A retrospective study of medical records concerning prescription patterns. Scandinavian Journal of Primary Health Care 2005;23:42-46. Strandberg E L, Ovhed I, Borgquist L, Wilhelmsson S. The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study. BMC Family Practice 2007; 8:8. Munck A P, Hansen D G, Lindmann A, Ovhed I, Förre S, Thorsteinsson J B. Nordic collaboration on medical audit. Scand J Prim Health Care 1998;16:2-6. Hansen DG, Munck AP, Kragstrup J. Methodological problems in comparing audits from the Nordic countries. A critical review of results from audit on Nordic general practitioners’ management of patients with psychiatric problems. Scand J Prim Health Care 2002;20:71-3. Hansen CN, Hansen DG, Kragstrup J, Busch O, Munck A. The role of the APO method in improving diabetes care in general practice: the results of a Danish prospective multipractice audit circle. Quality in Primary Care 2003;11:225-31. Llor C, Cots JM, Boada A, Bjerrum L, Gahrn-Hansen B, Munck A, Forés, Miravitlles y grupo de studio AUDITINFO2. [Variability of antibiotic prescribing for respiratory tract infections in two European countries]. (Spansk). Enferm Infecc Microbiol Clin 2005;23:598-604.
Results 1. By making the APO-audit method a familiar tool for doctors and nurses in the PHC in Northwest Russia, we will offer them possibilities to work with continuing medical education and quality development from a bottom-up perspective. Such local activities will be recognised by other categories in the health care system and by that raise the status of family medicine.
2. The web based audit registration developed by Conmedic AB for the PHC in Finland will be of high importance for a future up to date development of the audit tool.
3. The audit follow-ups give the single doctor or nurse easy understandable examples on the connection between doctor’s and nurses’ own practice and the status of EBM. Thus the gap between EBM and clinical practice and clinical routines will be narrowed. The quality circle model gives continuity as well as sustainability to the process.
4. Primary health care may be seen as one of the most important arenas for primary, secondary as well as tertiary prevention especially for cardiovascular diseases. Recently started audit processes in Northwest Russia focus on this field.
5. Our intention is to make all parts of the process easy to handle. Because of that we will use standardized soft ware like Microsoft Excel, Word as well as easy accessible databases.

In already published reports are shown what quality criterions that can be expected and discussed in the following intervention activities as well as for future quality development. These reports and possible future results will be enclosed. The results from clinical APO-audit registration, like data from national quality registers, may seldom test a hypothesis, but instead, in a remarkable way, generate researchable hypothesis or put an end to myths in practice and thus start a bottom-up process of quality development.
Total foreseen budget EUR 225,230
Total implementation costs
(for completed projects, if available)
no data
Conversion to € was done on
(according to the relevant
exchange rate at
Infoeuro Monthly Files)
no data
Financing agencies / organisations Ministry for Foreign Affairs of Finland
Project's URL / project's website no data
Papers associated with this project no data
Further information no data
Last posted: on 2009-08-26 at 12:20:15

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