Learning Resource Centers - Central and Eastern European (CEE) and New Independent States (NIS)

This initiative is built on partnerships, cooperation, capacity-building, and communication. Through its Healthcare Partnerships Program, AIHA, under a cooperative agreement with the U.S. Agency for International Development (USAID), creates partnerships between health care providers working in the United States and their counterparts in the CEE and NIS regions to foster capacity-building programmes that address the health problems they are facing.

Located at various healthcare institutions - hospitals, polyclinics, medical universities, research institutes, and health care administration offices - LRCs are composed of a computer, a printer, and access to the Internet. The Centers are provided with various kinds of equipment (including hardware, telecommunications infrastructure, software) and resources (including CD-ROMs, online databases, reference manuals, dictionaries). To view a complete list, visit the AIHA website. Once set up, each LRC then provides the following:

• Internet/e-mail access
• Training and support - Information Coordinators are responsible for training other staff members, in small groups or one-on-one, on how to use computers and search the Internet
• Access to online and CD-ROM databases and educational resources, including MEDLINE, WHO HINARI, Stat!Ref, and Cochrane Library
• Books and subscriptions on evidence-based medicine, including Users' Guides to the Medical Literature, Clinical Epidemiology, How to Practice and Teach EBM, and Clinical Evidence.

Using these tools, AIHA tries to instill the philosophy and principles of evidence-based practice (EBP) at all of its partner institutions. EBP is an approach that provides a set of criteria for objective evaluation of health care information as part of an effort to ensure effective integration of research evidence with practice. The EBP approach provides a 5-step framework:

1. Formulating a clinically answerable question
2. Finding the appropriate research evidence through a literature search
3. Critically appraising the literature
4. Applying the evidence to practice
5. Evaluating the effectiveness of practice.

As part of AIHA's tool "Practice Standard Review", health professionals gather in discussion groups to work through the first 4 steps of the EBP methodology and compare research evidence to existing practice.

Health, Technology.

In part because of the isolation of physicians working in remote areas like town of Schuche (behind the Ural Mountains of Russia), health institutions have largely been dependent on the often outdated protocols provided by the health ministry to guide their practice.

According to AIHA, "with support from over 150 LRCs in 22 countries, practicing physicians, nurses, educators, hospital managers, researchers and policymakers in the region are slowly bringing about positive changes at all levels of the health care system." For example, at the institutional level, some patient care facilities with LRCs have begun to tap into EBP as a mechanism for reshaping the interaction between physicians and patients. Physicians in the rheumatology department at a large hospital in Vladivostok, Russia have developed and implemented a form for patients called a "protocol of informed consent." This document, adapted to individual diagnoses, explains disease etiology, treatment goals, and the responsibilities of both the physician and the patient, and then lists a variety of treatment options and their associated costs. Together, the patient and the physician decide on the course of treatment, sign the document, and keep a copy for their records. AIHA claims that traditionally authoritarian physician/patient relationships are being transformed into partnerships, resulting in improvements in the quality of health care.

The LRC Information Coordinators have developed a number of resources for outreach and training purposes. Many of these resources are available free of charge, with a note to "feel free to share these materials with your staff and local communities, giving credit to the original developers of these materials." To cite one example, AIHA has recently created LRC Toolkits that include complete information about the LRC project, training materials, and shareware software. In addition to the online version, this toolkit is available on CD-ROM (please see contact details below to request a copy).