Commentary| Volume 66, ISSUE 2, P132-139, February 2013

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The updated clinical guideline development process in Estonia is an efficient method for developing evidence-based guidelines

  • Lisa A. Bero
    Corresponding author. Tel.: 415-514-9345; fax: 415-476-1067.
    Department of Clinical Pharmacy, Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 420, San Francisco, CA 94118, USA
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  • Author Footnotes
    1 Current address: Australian Pharmaceutical Benefits Advisory Committee, Department of Health and Aging, 23 Furzer Street, Phillip, ACT, Australia 2606.
    Suzanne Hill
    1 Current address: Australian Pharmaceutical Benefits Advisory Committee, Department of Health and Aging, 23 Furzer Street, Phillip, ACT, Australia 2606.
    Department of Essential Medicines and Pharmaceutical Policy, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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  • Jarno Habicht
    WHO Country Office in Republic of Moldova, World Health Organization, 29 Sfatul Tarii Street, MD2029 Chisinau, Republic of Moldova
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  • Mari Mathiesen
    Estonian Health Insurance Fund, 10 Lembitu Street, 10114 Tallinn, Estonia
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  • Joel Starkopf
    Faculty of Medicine, University of Tartu, Ravila 19, 50411 Tartu, Estonia
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  • Author Footnotes
    1 Current address: Australian Pharmaceutical Benefits Advisory Committee, Department of Health and Aging, 23 Furzer Street, Phillip, ACT, Australia 2606.
Published:September 12, 2012DOI:


      Clinical practice guidelines are one of the tools available to improve the quality of health care. However, it may be difficult for countries to develop their own national guidelines “from scratch” because of limitations in time, expertise, and financial resources. The Estonian Health Insurance Fund (EHIF), in collaboration with other stakeholders, has launched a national effort to develop and implement evidence-based clinical practice guidelines aimed at improving the quality of care. Although the first EHIF handbook for preparing guidelines was published in 2004, there has been wide variation in the format and quality of guidelines prepared by medical specialty societies, EHIF, and other organizations in Estonia. An additional challenge to guideline development in Estonia is that it is a country with limited human resources. Therefore, revision of the Estonian guideline process was aimed at developing an efficient method for adapting current high-quality guidelines to the Estonian setting without compromising their quality. In 2010, a comprehensive assessment of guideline development in Estonia was made by the World Health Organization, EHIF, the Medical Faculty at the University of Tartu, and selected national and international experts in an effort to streamline and harmonize the principles and processes of guideline development in Estonia. This study summarizes the evaluation of and revisions to the process. Estonia has made substantial changes in its processes of clinical practice guideline development and implementation as part of an overall program aiming for systematic quality improvement in health care. This experience may be relevant to other small or resource-limited countries.


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