Training Family Doctors and Primary Care Nurses in Evidence-based Prevention, Screening and Management of Cardiovascular Risks in Western Ukraine: A Longitudinal Study

Interactive Training as a Method to Change the Attitude to the Vaccination at the Example of COVID-19 Vaccine

The new infectious disease COVID-19 was first registered in late 2019 in Wuhan (China) and has since spread significantly around the world. It is known that 2020 was a year of quarantine measures in most countries around the world, where quarantine was set in attempt to stop or slow the spread of the disease until the vaccine is developed. The vaccination campaign began in late 2020 in a number of developed countries. To date, several coronavirus vaccines have been registered in Ukraine: Pfizer / BioNTech, Moderna, CoronaVac / Sinovac Biotech and Oxford-AstraZeneca. However, the pace of vaccination in the country is slowing down due to the low readiness of certain segments of the population for vaccination. The objective: to analyze the changes at family doctors and nurses attitude who had the moderate or low readiness for COVID-19 vaccination before and after the interactive training; development of interactive training using practical and theoretical techniques to increase motivation for vaccination. Materials and methods. The study was conducted with the participation of 541 nurses (doctors and nurses) of different gander, aged from 19 to 67 years, employees from urban and rural clinics, who participated in interactive training about COVID-19 vaccinatoin. At the time of the training, 265 health workers had been vaccinated. The trainings were scheduled for 6 months (March-September 2021). Results. A comparison of the ratio of readiness to be vaccinated before and after training was calculated. Statistical analysis showed the link between the profession (doctor or nurse) and the level of readiness for training. The number of health workers who were completely unready to be vaccinated decreased from 9% before training to 1% – after it; the number of those who assessed themselves as unready – decreased from 14% to 5%. The number of people who hesitated – decreased from 57% to 23%. At the same time, the number of those who were ready to be vaccinated increased from 19% to 55%, and those who were absolutely ready - from 1% to 16%. Conclusions. Interactive trainings or special course in education curriculum with evidence of vaccination efficacy should be used to ensure readiness for immunoprophylaxis among patients and health professionals. Vaccination remains the most effective strategy for preventing serious illness and death from COVID-19 infection.

Interactive Training and Electronic Web Resource as Method to Increase the Level of Family Physicians Knowledge Concerning Implementation of Evidence-based Recommendations for Cardiovascular Risks Screening into Clinical Practice

Cardiovascular disease is one of the leading causes of death worldwide, and Ukraine is not an exception. The mortality rate due to cardiovascular diseases among non-communicable diseases in our country today is 63%. In the nine months of 2021, 487.9 thousand citizens died in Ukraine, most of them – from cardiovascular diseases. To perform specific and effective preventive actions among the population, it is necessary to have complete and reliable information about the prevalence of risk factors in the population. Epidemiological research, by providing this information, makes it possible to assess the extent of the problem and determine the priorities for action in medical science and practice. There is a need to optimize the continuous medical education of doctors in this problem. It is known that the classical lecture and presentation of information gives the lowest level of assimilation by the audience. Therefore, one of the modern forms of education is interactive training, which successfully combines various forms of activating the attention of trainees and attracting them to the practical actions. The objective: to evaluate the effectiveness of training sessions using the special web resource to increase the level of knowledge of family doctors regarding the implementation of cardiovascular risk screening into their clinical practice. Materials and methods. A 6-hour interactive training “Principles of evidence-based screening in the family doctors’ practice” was held for 95 family doctors from the Transcarpathian region, among whom 70 (74%) worked in rural areas and 25 (26%)– in urban areas. The level of knowledge of the training participants was assessed using 12 test tasks at the beginning, immediately after the training and 3 months after the training. The test was consisted of theд identical questions at all stages of the survey. All participants were divided into two groups: group 1 (n=45) – those who learned the topic only at training; group 2 (n=50) – those who, in addition to the training, received free personal access to the web resource “Recommendations for Prevention and Screening”. The Prevention and Screening Recommendations web resource was developed on the basis of the USPTFS evidence-based program and the generalized recommendations from the European screening protocols; the resource gives list of the needed evidence-based screening recommendations depending on the given to the system patient’s personal data. Results. According to the test results, the average level of knowledge of the participants at the beginning of the training was 6 (5.7) points. Immediately after the training the level increased to 9 (8, 10) points (p<0.001). After 3 months, the average level of knowledge of family doctors decreased to 8 (7.9) points, however, it was statistically higher compared to the average level of knowledge of respondents before training (p<0.001). In addition, the average level of knowledge in 3 months after the training of group 2 participants who had access to the web resource was statistically significantly higher compared to group 1, whose participants got only training (7 vs. 9) (p<0.001) . Conclusions. Interactive training is an effective method of learning which should be implemented into clinical practice, it creates the prerequisites for the active and widespread use of this method in training of medical workers during their continuous professional development. Having access to a web resource helps to improve the learninf results and maintain the proper level of knowledge for a long time.

Steps towards implementing evidence-based screening in family medicine in Ukraine: SWOT-analysis of an approach of multidimensional empowerment

Background

The purpose of this study is to forward the implementation of an operational evidence-based state screening program of common diseases in Ukraine, where currently no state-based and evidence-based screening (EBS) exists. EBS should be performed by Family Doctors in a primary care setting and concern prevalent diseases in adults, such as: obesity (BMI), hypertension (BP measurement), diabetes (glycaemia), dyslipidemia (cholesterol/lipids), colon cancer (FOBT/colonoscopy), breast cancer (mammography), STIs (chlamydia, syphilis), HIV, HBV, HCV (i.e. serology or other rapid tests), HPV (swabs), cervical cancer (test Pap). depression (i.e., PHQ-9), and smoking (i.e., Fagerstrom).

Methods

Four needs-based research actions were led among citizens and healthcare professionals, based on multidimensional empowerment. Internal Strengths and Weaknesses of the ongoing implementation process were identified through these studies, whereas external Opportunities and Threats were determined by the present socio-cultural and political context. This SWOT analysis is likely to guide future state-based initiatives to accomplish EBS implementation in Ukraine.

Results

Internal Strengths are the bottom-up multidimensional empowerment approach, teaching of EBS and the development of an internet-based platform “Screening adviser” to assist shared decision making for person-centred EBS programs. Internal Weaknesses identified for the Family Doctors are a heterogeneous screening and the risk of decreasing motivation to screen. External Opportunities include the ongoing PHC reform, the existent WONCA and WHO support, and the existence of EBS programs in Europe. External Threats are the lack of national guidelines, not fully introduced gate keeping system, the vulnerable socio-economic situation, the war situation in the East of Ukraine and the Covid-19 pandemic.

Conclusions

We started EBS implementation through research actions, based on a multidimensional empowerment of citizens, HCP and in EBS pathways involved stakeholder teams, to foster a sustainable operational human resource to get involved in that new EBS pathway to implement. The presented SWOT-analysis of this ongoing implementation process allows to plan and optimize future steps towards a state based and supports EBS program in Ukraine.