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

Abstract

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.

Validation of a modified questionnaire to assess Ukrainian Family Physicians’ readiness to implement the evidence-based screening recommendations into their clinical practice, using a mixed method study

“…There is no a state supported evidence-based screening program in Ukraine yet and some of GPs still are used to use post-Soviet routine investigations as a part of routine annual checkups (i.e. CBC, urine test) [ 9 ]. That is why we added those investigations to the general list of investigations (See Additional file 1 : Appendix).…”

“…prevention of complications of arterial hypertension) Quaternary prevention-an action aimed to protect patients from overmedicalization and unnecessary medical invasions questionnaire. As far as the state-based screening program has not yet been implemented in Ukraine, some GPs still follow post-Soviet protocol and recommend adults to follow some routine non-evidence-based investigations during annual check-ups (for example, CBC, urine analysis, lungs X-ray) [9]. To achieve our respondents' knowledge and readiness to follow the new evidence based screening strategies comparing with the old ones, commonly used in family medicine practice as routine annual checkups, we also included the list of such investigation into the questionnaire as well.…”

“…Previous post-Soviet non-evidence-based screening protocol was canceled by the Ukrainian Ministry of Health Care legislation in 2018 [ 8 ]. But the new one has not been offered yet [ 9 ]. The government is still searching for means of implementing and introducing various screening recommendations [ 9 ].…”

“…But the new one has not been offered yet [ 9 ]. The government is still searching for means of implementing and introducing various screening recommendations [ 9 ]. Clinicians' knowledge and readiness for the implementation of new guidelines recommendations into practice also have to be evaluated and taken into consideration, meanwhile they often use the old protocols of annual checkups in their routine practice [ 10 ].…”

The impact of war on cytopathological practice in Ukraine

“…Non-gynecology cytopathology (NGC) specimens obtained mostly by fine needle aspiration biopsy are an important part of the cancer diagnostic work-up and for monitoring of neoplastic diseases, as well as for the follow up and prognostic evaluation of treated cancer patients [6]. Since the beginning of the Russian invasion, most cytopathologic screening procedures (including cancer screening) in Ukraine were minimized or postponed [7], jeopardizing the ability of medical personnel to provide means for early detection of cancer. However, even so, laboratory professionals are still expected to provide timely diagnoses for patients with suspected cancer and premalignant conditions since the delay of diagnosis may seriously imperil their health.…”