Establishing Obstetric Anesthesiology Practice Guidelines in the Republic of Armenia

Abstract

Background Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report’s aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia. Methods An invited multinational team of physicians conducted six visits to Armenia between 2006 and 2015 to observe current practice and establish standards of obstetric anesthesia care. The Armenian Society of Anaesthesiologists and Intensive Care specialists collected data on the numbers of vaginal delivery, cesarean delivery, and neuraxial anesthesia use in maternity units during the period. Data were analyzed with the Fisher exact or chi-square test, as appropriate. Results Neuraxial anesthesia use for cesarean delivery increased significantly (P < 0.0001) in all 10 maternity hospitals within the capital city of Yerevan. For epidural labor analgesia, there was sustained or increased use in only two hospitals. For hospitals located outside the capital city, there was a similar increase in the use of neuraxial anesthesia for cesarean delivery that was greater in hospitals that were visited by an external team (P < 0.0001); however, use of epidural labor analgesia was not increased significantly. Over the course of the collaboration, guidelines for obstetric anesthesia were drafted and approved by the Armenian Ministry of Health. Conclusions Collaboration between Armenian anesthesiologists and dedicated visiting physicians to update and standardize obstetric anesthesia practices led to national practice guidelines and sustained improvements in clinical care in the Republic of Armenia.

Regional anesthesia global health collaborations- a scoping review of current intervention methods

“…The following data items were extracted: study details, HRC region, LRC region, the intervention focus (e.g., RA, pain medicine), intervention type (e.g., medical education, research), intervention recipients (e.g., anesthesiologists, residents, fellows), intervention basis, needs assessment method (e.g., standardized tools, informal assessment), evaluation of intervention, it's aspects (e.g., impact, educational) and evaluative research methodology utilized (e.g., qualitative, quantitative). A total of 1314 articles identified by the search, 134 qualified for full text assessment for eligibility, with 44 studies qualifying in the final review [20 ▪▪ ,21,22 ▪ ,23,24 ▪▪ ,25 ▪▪ ,26,27,28 ▪ ,29–63]. There were few studies published in the last 18 months (probably due to COVID travel restrictions) but four studies focused on RA were published recently.…”

Scaling up of safety and quality improvement interventions in perioperative care: a systematic scoping review of implementation strategies and effectiveness

“…Three39–41 out of 31 studies (9.6%) reported all of the discrete strategies from the Yamey (n=13) and Barker et al (n=14) frameworks. From the two frameworks combined, 22 (71%) of the studies reported more than 20 discrete strategies 39–60. However, no study made explicit reference to either the Yamey or the Barker et al frameworks.…”