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Key Events and Achievements


Healthcare Organization and Management

At the request of the Samara Oblast Healthcare Department, partners developed job descriptions for general practitioners and nurses; these did not previously exist. They also developed regulations on outpatient services, home care, and patient education schools, and quality assurance methodologies.

As a result of the partnership work and improvements at her center, the chief physician of polyclinic No. 15 wrote an article, “Finance Management and General Practice,” that was published in Zdorovie Magazine.

City Polyclinic No. 15 was acknowledged by the Russian Ministry of Health as an example of successful innovation in the area of primary care. The Minister of Health presented the polyclinic’s chief physician with an award for outstanding achievements in the provision of care. The chief physician credits her US partners for many of the changes.

Polyclinic No. 15 has become known as an excellently operated center and practitioners from Moscow Oblast and other regions of Russia have visited the center and received practical training.

Changes implemented in patient care protocols at Polyclinic No. 15 resulted in substantial savings in costs due to a reduction in hospitalizations.

As a result of training from the US partners, the implementation of an economic model for the polyclinic resulted in physicians and nurses becoming more accountable for the financial resources in their clinics. Equally important, an incentive system for the care providers was implemented to promote good patient care and community outreach.
Partners developed and implemented patient satisfaction surveys at Polyclinics No. 9 and No. 15. The Samara partners began to use the information obtained through these surveys to make management decisions. For example, the patient satisfaction surveys conducted in October 2002 were analyzed and the results demonstrated increased patient satisfaction and acceptance of reforms in the primary healthcare system. Partners added an on-line questionnaire offered on the polyclinic Web site to further assess patient satisfaction.

Partners implemented a patient scheduling system — similar to a system in Iowa that maximizes physician and nurse time and reduces the time patients need to wait to be seen. The Samara partners
reported that the number of patients seen by a physician increased from 29,423 in 2000 to 52,831 in 2002.

Partners developed standard protocols for follow up care for chronic patients that permit segregation of functions and responsibilities of both physicians and nurses.

Although efforts to move patient care away from medical specialists to general practitioners was underway in Samara prior to the partnership, the Russian partners attribute the region’s rapid transition to the use of general practitioners to the USAID-supported partnership and reported a 30 percent reduction in specialist patient load after the partnership was launched.

Samara partners reported an increase in the use of outpatient services and a decrease in urgent care patients and credit time spent in Iowa for helping them learn alternate approaches and reduce resistance to change among healthcare professionals.

Primary Healthcare

Partners opened a General Practice Office at the Medical Sanitary Unit No. 2 in March 2002. The center served an isolated and poor population of 1,700. Specific technical training was provided by the partners to the chief physician and clinic nurses. The office was closed and the equipment was moved to another location in the winter of 2003.

Polyclinic No. 15 established a school for patients with glaucoma and cancer. They also created an asthma screening program, a patient education school, and clinical practice guidelines on the treatment of asthma based on their work with the US partners.

In March 2003, partners hosted a conference on bronchial asthma management, which was attended by more than 80 medical professionals.

In collaboration with the Samara Oblast Ministry of Health, partners from Polyclinic No. 15 began to disseminate their asthma management project in four districts of the oblast. Quality assurance and technical assistance were provided by the US-trained team.

Partners at Polyclinic No. 15 created new evidence-based guidelines on the treatment of arterial hypertension and a patient education program using methodologies learned from their US colleagues. As of June 2004, 193 patients participated in the program and the Russian partners hosted a conference on hypertension that was attended by 90 general practitioners.

Partners created a diabetes school and developed new evidence-based guidelines. Annual statistics showed a decrease in complications each year beginning in 2000 and, as of June 2004, 133 patients were enrolled in the school.

The US partners created a training video for nurses titled, “Assessment of the Clinic Patient.” The training video was reproduced and is now used as a standard training tool in Samara.

Partners developed a clinical care patient survey to increase detection of risk factors; 80 questionnaires were submitted.

Partners at Polyclinics No. 9 and No. 15 conducted a total of 423 health promotion activities attended by 4,861 people in 2003; 377 similar activities were conducted in 2004 and attended by 1,790 people.

Women’s Health

Partners opened Women Wellness Centers (WWCs) at Polyclinics No. 9 and No. 15 in March 2002. These WWCs provide a variety of services, including family planning, education courses for future parents, and an STI prevention program. The centers serve a female population of 34,000.

Staff at Polyclinic No. 15 developed a breast health and mammology program. They launched a public awareness program dubbed the Decade of Mammology in 2002 and provided 576 women with clinical breast exams, 26 with mammograms, and 38 with breast ultrasound examinations.

Partners created patient education and reproductive health counseling programs at each WWC.

The US partners developed demonstration training videos for physicians and nurses on topics such as cervical cancer, puberty and adolescent sexual behavior, STIs, and HIV/AIDS.

Partners implemented patient education programs, including schools for young fathers and young mothers and Lamaze training at the WWCs. These programs are offered on a weekly basis.

Partners at the WWC at Polyclinic No. 15 established “Golden Fall,” a program for peri- and postmenopausal women. Based on patient satisfaction surveys, the number of physicians who see peri-and postmenopausal women at Polyclinic No. 9 was increased to better meet the needs of this segment of the population.

Partners hosted a region-wide domestic violence conference in 2001 as part of its work with vulnerable populations. Of the 90 participants who attended the conference, 50 returned the signed commitment letters and have created many activities and domestic violence initiatives.
The WWC at Polyclinic No. 15 began primary screening for domestic violence among patients. The screening starts with a patient registration form that was modified from a sample presented at the AIHA Women’s Health and Dissemination Conference in December 2001. Physicians provide counseling and refer patients to local crisis centers as appropriate.

The WWCs at Polyclinics No. 9 and No. 15 conducted 1,091 health promotion activities in 2003, which were attended by 3,850 people.

Nursing

Nurses from Samara were trained in Iowa on delivery of family medicine services and patient health assessments, emphasizing the relationships between physicians, nurses, and patients in treatment and
patient education. Nurses at the Samara partner sites now conduct health assessments and patient education on diabetes, hypertension, and other health topics.

Substantial reallocation of responsibilities has occurred at Polyclinics No. 9 and No. 15. Previously, only physicians could make home visits to chronic patients, but nurses now also fulfill this role. Nurses also now perform EKGs, tonometries, otoscopies, cancer exams, test for blood glucose, make lab referrals, prescribe medication for chronic patients, and plan patient education programs.

Training on patient health assessment was conducted for the nurses during their exchanges to Iowa in April and June 2002 and training by Samara healthcare professionals was implemented as a continuing education program. The most often demanded course is the physical assessment training created by the partners.

In March 2004, nurses from Polyclinic No. 15 hosted a conference for nurse administrators and general practice nurses from the municipal and oblast hospitals and polyclinics.

From 2000 to 2002, the Samara partners reported that the proportion of women whose clinical breast examination was conducted by a general practice nurse or midwives independent of a physician increased from 3.1 percent to 6.1 percent. During that same period, the proportion of women who were seen by either nurses or midwives without prophylactic screening was reduced from 68.9 percent to 2.2 percent.

Internet Technology and Distance Learning

The Samara LRC and its healthcare database are considered model programs and the Russian partners often host tours and demonstrations.

With the help of AIHA and the US partners, Samara established an Internet School that teaches medical professionals about medical databases, how to conduct online searches, evidence-based information, and how to conduct standard clinical practice reviews.

The Samara partners established a Web site for Polyclinic No. 15 where patients can learn about services and health information.

The US partners produced numerous training videos for the Samara partners. Several programs were taped, dubbed into Russian, and transmitted to the Samara LRC where they are copied onto compact discs and distributed to local clinics.

The Medical Information and Analysis Center (MIAC) in Samara received a $29,000 grant from the Social and Cultural Projects Fair, “Nizhny Novgorod 2003” funded by the Volga Region Federal District. The grant proposal, developed with the US partners, supported the development of a regional information center and an interregional partnership for the prevention of drug abuse.

Sustainability Activities

In November 2004, USAID awarded the Samara partners a sustainability grant to disseminate and replicate their successful asthma disease management program and improved nursing management techniques in Krasny Yar and Krasnaya Glinka districts. The Chief physician and nurse from Polyclinic No. 9 conducted a series of trainings for general practice nurses at the target sites.

Partners from Polyclinic No. 15 conducted a series of asthma management trainings at both locations and established a monitoring system for the newly created asthma schools.

Partners also conducted a Best Practice Conference in March 2004, which was attended by 82 health professionals. To review the agenda and event report, please click here.

Participating Institutions