The basic requirements to medical standards (comparative research of Lithuanians and British standards)

The problem of medical standards is of pivotal importance for Lithuania. This importance arises first of all from the central role of medical standards ensuring the proper quality of health care services. This importance is even more enlarged because Lithuania only started developing its own medical standards system and the best foreign experience is highly helpful designing it. As far, Lithuanian medical standards are very different from ones issued in the most developed countries. Typical Lithuanian standards are very short (several pages) and present only very restricted basic knowledge. It is in sharp contrast with highly developed medical standards in USA, UK, Germany, and etc. The report aims to reveal and discuss the basic differences between Lithuanian and Great Britain medical standards. It is carried out using the comparative analysis of two selected typical Lithuanian and Great Britain (NICE) standards. Both standards are official, nation scale, having identical topic (management of angina chest pain). Eight fundamental differences between both standards have been revealed: the scale in which the latest achievement of the scientific research are used, algorithmic (vs. descriptive) exposition of recommendations, explicit (vs. covert) relation of recommendations with their supporting research data, exact (vs. indefinite) definition of borderline between doctor’s duties and his discretion, active (vs. passive) prevention of possible errors, provision of recommendations on successful implementation of the standard, provision of recommendation on the most proper ways of auditing the implementation, scale of involvement of patients into implementation of the standard. The results of the analysis showed the prevalence of the highly developed NICE standard over Lithuanian one in accomplishing the most important aim of the medical standard- ensuring the proper quality of health care services. These outcomes were used as the basis to propose a set of basic recommendations for Lithuanian standards. The benefits of implementation of these recommendations for the national health care are discussed. It is shown that implementation of NICE –type standards in Lithuania can contribute to solution of the most urgent problems of the national health care: inadequate public expectations, irrelevant doctor’s liability system, defensive medicine.Straipsnio tikslas yra apibūdinti pamatinius reikalavimus medicinos standartui, tai yra tuos, kurie svarbūs užtikrinant pagrindinę medicinos standarto paskirtį – aukštos diagnostikos ir gydymo kokybės užtikrinimas. Medicinos standartai – tai norminiai dokumentai, kurie reglamentuoja gydytojo veiksmus jam sprendžiant tam tikras diagnostines, klinikines, prevencijos ir pan. problemas. Medicininiai standartai užima pamatinę vietą tarp visų norminių aktų, reglamentuojančių sveikatos apsaugos veiklą. Jie nurodo, kokius veiksmus turi atlikti gydytojas, kad pasiektų pagrindinį visos sveikatos apsaugos sistemos tikslą – padėti pacientui. Visų kitų sveikatos apsaugos sistemų dalių (jos valdymo, teisinio reguliavimo, aprūpinimo ištekliais) paskirtis – maksimaliai padėti gydytojui atlikti tai, ko iš jo reikalauja medicinos standartai, sudaryti tam visas būtinas ekonomines, organizacines, teisines sąlygas. Lietuva tik pradeda rengti savo medicininius standartus. Kelia nerimą, kad medicininiai standartai, parengti Lietuvoje, labai skiriasi nuo rengiamų pažangiausiose šalyse: JAV, Didžioji Britanija, Vokietija ir kt. Lietuviški standartai – tai nedidelės apimties (vos kelių puslapių) dokumentai, kurie labai trumpai teikia tam tikrų žinių ir nurodymų apie tam tikrą susirgimą, jo diagnozę bei pagrindinius gydymo metodus. Tuo tarpu užsienio šalyse leidžiami standartai – tai didelės apimties (iki kelių šimtų puslapių) ir sudėtingos struktūros dokumentai, kurių turinys, struktūra, pateikimo forma iš esmės skiriasi nuo lietuviškų. [...