Barriers to the implementation of clinical guidelines on lipid metabolism disorders in routine practice in the federal districts of the Russian Federation

Aim. To determine district-specific barriers to the implementation of key points of clinical guidelines on lipid metabolism disorders in practice, with a focus on identifying disagreements and inconsistencies in the perception of problems between health professionals in each district.

Material and methods. Based on the first phase of implementation study, which included survey data from 788 physicians, 124 heads of health facilities and 48 chief consultants from 8 federal districts of the Russian Federation, district-specific barriers were identified through comparative ranking of districts by key points. A discrepancy was revealed between respondents' positions regarding the reasons for insufficiently effective patient management.

Results. Regional differences in the availability of diagnostic and therapeutic options, as well as the management of the lipid service, were determined. The most frequent limitation of in-depth examination of patients with dyslipidemia was noted in the Siberian and Ural districts. Low screening rate for familial hypercholesterolemia is most typical for the Ural and North Caucasian districts. In a number of federal districts of the Russian Federation, the prescription of suboptimal lipid-lowering therapy remains a significant problem, leading to failure to achieve target levels of atherogenic lipids, which is especially pronounced in the Central, North Caucasian and Siberian districts. Insufficient awareness of the need to treat dyslipidemia in patients is especially relevant for the Siberian, North Caucasian and Southern federal districts. Limitation of resources for the lipid service is most often noted in the Ural, Far Eastern and Southern federal districts. Despite a number of common problems, each district faces a unique set of barriers, the causes of which are interpreted differently by medical specialists.

Conclusion. The analysis of district-specific barriers indicates problems both in the implementation of clinical guidelines and in the organization of a seamless service. Based on the first phase of the implementation study, a number of strategies were developed and implemented to eliminate the identified barriers, the effectiveness of which will be assessed as part of a repeat survey in 2025.

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