DEVELOPMENT OF STANDARD TREATMENT GUIDELINES IN RUSSIA

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DEVELOPMENT OF STANDARD TREATMENT GUIDELINES IN
RUSSIA
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All substances are poisons, there are no
substances, which are not poisons. This is the
correct dose that discriminates between poisons
and medicines.Paracelsus

• 10 years ago the first order (prikaz) of the
  Russian Ministry of health was issued ?277 of
  16.10.1992 On the establishment of the system of
  medical standards (norms) in healthcare of the
  population of Russian Federation.
• TODAY 72 federal protocols standard treatment
  guidelines are being developed for the most
  important (socially) diseases.

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DEVELOPMENT OF STANDARD TREATMENT GUIDELINES IN
RUSSIA official standing

• Resolution of the Government of Russian
  Federation of the 5.11.97 N 1387 About the
  measures on stabilization and development of
  healthcare system and medical science in Russian
  Federation (???????? ????????????????
  ?????????? ?????????, 1997, N46, ??. 5312).
• Resolution of the Government of Russian
  Federation of the 26.10.1999 N 1194 About
  approval of the Program of State guaranties of
  free of charge provision of medical care for the
  citizens of Russian Federation (????????
  ???????????????? ?????????? ?????????, 1997, N46,
  ??. 5322).

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DEVELOPMENT OF STANDARD TREATMENT GUIDELINES IN
RUSSIA the objectives

• Establishment of unified requirements for
  prophylactics, diagnostics and treatment of
  patients.
  
• Unification of the development process of basic
  programs of obligatory medical insurance and
  optimisation of healthcare.
  
• Provision of optimal medical care, access and
  quality of medical care for patients in the
  framework of State guaranties of free of charge
  medical care for the citizens.

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DEVELOPMENT OF STANDARD TREATMENT GUIDELINES IN
RUSSIA the results

• APPROVED
• Standard Treatment Guidelines. Bedsores (prikaz
  of the Ministry of health of Russian Federation
  of 17.04.2002 ?123)
  
• Standard Treatment Guidelines. Congestive Heart
  Failure (prikaz of the Ministry of health of
  Russian Federation of 27.05.2002 ?164)

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Republic of Tatarstan

• 1997 - development of medical-economical
  standards (?ES) ICD-10, levels of complexity,
  time requirements, multi-level costs of
  in-patient treatment, 4600 diseases.
• 1999-2000 - standard treatment guidelines
• adaptation of Federal STGs (narcology,
  pulmonology, gastroenterology)
  
• development of the first Republican STG
  (cardio-vascular diseases).
  
• 2001 2002 norms of the time requirements for
  in-patient treatment ( 5 000 diseases). In 2002
  - update

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Republic of Tatarstan Formulary system

• Objective - rational use of limited resources of
  healthcare in the period of reforms.
  
• Initiation - 1999
• WHO support ideology, information, methodology
  and expertise.
  
• Direct supervision - Special project for NIS in
  pharmacy (The Head Dr. Nata Menabde, since 2002
  - Dr. Nina Saoutenkova).
  
• Tatarstan - pilot territory for the introduction
  of formulary system and new educational
  technologies in the field of clinical
  pharmacology and rational drug use.

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REPUBLIC OF TATARSTAN DEVELOPMENT OF FORMULARY
SYSTEM
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REPUBLIC OF TATARSTAN DEVELOPMENT OF FORMULARY
SYSTEM
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REPUBLIC OF TATARSTAN DEVELOPMENT OF FORMULARY
SYSTEM
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Republic of Tatarstan Formulary System,
Guidelines
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Republic of Tatarstan Formulary
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Republic of Tatarstanthe basic principles of
the Formulary System

• limited number
• evidence based approach
• Specialist consultations
• INN
• from a practicing physician to the national
  formulary
  

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DEVELOPMENT OF STANDARD TREATMENT GUIDELINES IN
RUSSIA Evidence based medicine is
Standardisation

• Levels of Evidence
• A) Evidence, proved in prospective
  randomised trials,
  
• B) Evidence, proved in prospective but
  not randomised trials,
  
• C) Evidence, derived from retrospective
  non-randomised trials on large patients
  population,
  
• D) Evidence, derived from the trials on
  the limited number of patients,
  
• ?) Evidence, derived from single
  patient observations.

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Evidence based medicine in standardization
grades of evidence in the drug reference handbook

• ? Cochrane systematic review,
• positive CDR-commentary for the non-Cochrane
  meta-analysis
  
•         Meta-analysis from ?linical Evidence
• B RCT (Cochrane library) - RCT.
• C CCT (Cochrane library) - ?CT.
• D no trials at all or negative results