title: Pursuing community-oriented primary care in a Russian closed nuclear city: the Sarov-Los Alamos community health partnership.
abstract: The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a "train the trainers" strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications.
authors.affiliation: University of New Mexico School of Medicine, Albuquerque 87131, USA. rrhyne@salud.unm.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Rhyne
authors.forename: Philip A
authors.initials: PA
authors.lastname: Hertzman
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000517:prevention & control; D001942:Breast Feeding; D002648:Child; D018672:Community Health Planning / Q000458:organization & administration*; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000517:prevention & control; D006801:Humans; D007391:International Cooperation; D009516:New Mexico; D009910:Oral Hygiene; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D011634:Public Health / Q000193:education*; D012426:Russia; D012648:Self Care; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012936:Social Medicine / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000517:prevention & control; D014504:Urban Health