Abstract
Background: With a rapidly changing evidence base, high-quality clinical management guidelines (CMGs) are key tools for aiding clinical decision making and increasing access to best available evidence-based care. A rapid review of COVID-19 CMGs found most lacked methodological rigour, overlooked at-risk populations, and varied in treatment recommendations. Furthermore, social science literature highlights the complexity of implementing guidelines in local contexts where they were not developed and the resulting potential to compound health inequities. This study aimed to evaluate access to, inclusivity of, and implementation of COVID-19 CMGs in different settings. Methods: A cross-sectional survey of clinicians worldwide was conducted from 15th June to 20th July 2020, to explore access to and implementation of COVID-19 CMGs, and treatment and supportive care recommendations provided. Data on accessibility, inclusivity, and implementation of CMGs were analysed by geographic location. Results: 76 clinicians from 27 countries responded: 82% from high-income countries, 17% from lower middle-income countries (LMICs). Most respondents reported access to COVID-19 CMGs and confidence in their implementation. However, many respondents, particularly from LMICs, reported barriers to implementation, including limited access to treatment and equipment. Only 20% of respondents reported having access to CMGs covering care for children, 25% for pregnant women, and 50% for older adults (>65 years). Identified themes were for CMGs to include recommendations for at-risk populations and settings, include supportive care guidance, and be updated as evidence emerges, and for clinicians to have training and access to recommended treatments to support implementation. Conclusion: Our findings highlight important gaps in COVID-19 CMG development and implementation challenges during a pandemic, particularly affecting at-risk populations and lower resourced settings. This study identifies an urgent need for an improved CMG development framework that is inclusive and adaptable to emerging evidence and considers contextual implementation support, to improve access to evidence-based care globally.
Highlights
The COVID-19 pandemic is a global health emergency, with over 120 million cases and more than 2.7 million deaths worldwide[1]
This study identifies an urgent need for an improved clinical management guidelines (CMGs) development framework that is inclusive and adaptable to emerging evidence and considers contextual implementation support, to improve access to evidence-based care globally
Of the 76 respondents (51% male), caring for patients in 27 different countries, across six continents (Figure 1), most were doctors and 87% worked in a hospital, of which 18% worked in an intensive care unit (Table 1)14. 53% of respondents reported having taken on more responsibility during the pandemic and 40% that they had to work in a different clinical role to support the COVID-19 response, with most supporting COVID-19 care, some supporting research, public health, or diagnostics, and 20% reported stepping up into a more senior clinical role
Summary
The COVID-19 pandemic is a global health emergency, with over 120 million cases and more than 2.7 million deaths worldwide (as of 30th March 2021)[1]. The main treatment early on is supportive care, such as oxygen, fluids, electrolyte balance, and management of complications. To this end, expert bodies have produced evidence-based recommendations and clinical management guidelines (CMGs) for use by frontline clinicians. Developing evidence-based CMGs is resource intensive, and past studies show that in practice, many clinicians across the world may use CMGs produced by international organisations rather than local CMGs. recommendations produced in one context may not be directly applicable to other settings, with different risk factors and available resources[2,3]. Identified themes were for CMGs to include recommendations for at-risk populations and settings, include supportive care guidance, and be
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
