Involvement of Residents in The National Guideline Development Process in Estonia

Madli Pintson1,2, Alar Irs2,3. 1Tartu University Hospital, Tartu, Estonia, 2Division of Clinical Pharmacology, University of Tartu, Tartu, Estonia, 3State Agency of Medicines, Tartu, Estonia

Clinical guidelines are one of the tools to improve the quality of health care. It may be difficult for small countries to develop their own national guidelines because of limitations in time, expertise, and financial resources. Simple translation of international guidelines may not be appropriate and may create implementation problems due to the lack of ownership (1).

Estonian Health Insurance Fund in collaboration with the Medial Faculty of Tartu University launched a national effort to develop and implement evidence-based clinical practice guidelines which involves a structured assessment and adaptation of evidence base developed for the high-quality guidelines in other settings (2,3).

The lack of expertise in evidence synthesis and evaluation was identified early in the process. This was addressed by the involvement of junior doctors in the guideline secretariats with the provision of targeted training by Estonian and international experts.

Training courses in the use of standard assessment methods involving the AGREE, AMSTAR and GRADE as well as in the basics of evidence synthesis have been provided. The junior doctors have been/are involved in the development of national guidelines on the management of essential hypertension (4), asthma, anxiety disorders and bedsores.

The main gains from the involvement of residents in the guideline process have been 1) acceptance of the evidence based approach in medial decision making, 2) training in systematic evidence collection, evaluation and synthesis methods, 3) feeling of ownership of the national guidelines by the junior doctors, possibly supporting their implementation.

References

(1) Taba P, Rosenthal M, Habicht J, Tarien H, Mathiesen M, Hill S, Bero L. Barriers and facilitators to the implementation of clinical practice guidelines: a cross-sectional survey among physicians in Estonia. BMC Health Serv Res. 2012;12:455. doi: 10.1186/1472-6963-12-455.

(2) Bero LA, Hill S, Habicht J, Mathiesen M, Starkopf J. The updated clinical guideline development process in Estonia is an efficient method for developing evidence-based guidelines. J Clin Epidemiol. 2013;66(2):132-9. doi: 10.1016/j.jclinepi.2012.07.007.

(3) World Health Organization. Estonian handbook for guidelines development. WHO, Geneva 2011 https://extranet.who.int/iris/restricted/bitstream/10665/44734/1/9789241502429_eng.pdf

(4) Kalda R, Viigimaa M, Irs A. Uus Eesti ravijuhend „Täiskasvanute kõrgvererõhktõve käsitlus esmatasandil“ Eesti Arst 2012; 91(8):437-439.