Is it time to share paediatric guideline development?

Abstract

The worldwide need for high quality, evidence-based paediatric dental guidance prompted a group of paediatric dentists, representing seventeen countries, to come together to explore the feasibility of developing guidelines through a process of international collaboration and partnership. The meeting was convened by Professor Jan Clarkson and Professor Richard Welbury during the recent International Association of Paediatric Dentistry (IAPD) Conference in July in Glasgow. Discussions highlighted that currently, paediatric dental guideline recommendations are often inconsistent, despite a common source of evidence, with definitions of conditions and treatments varying between and within countries. This was acknowledged to be a significant issue as it often generates a conflict in beliefs that can sway service provision and clinical best practice decisions, influence policy decisions and impact on training and education strategies. Developing international guidelines to address this issue may require a paradigm shift in the guideline development processes but arguably, a collaborative approach could result in the production of an independent and rigorous resource which is both sensitive to cultural differences, geographical locations and economies and which can be unilaterally adopted and adapted to suit local circumstances. Guideline development is costly and time consuming if done well and not all communities have that resource. Participants agreed that a culture of collaborative working, shared knowledge and expertise could provide economic benefits through efficiency savings and make freely available an authoritative resource worldwide. Establishing shared and collaborative working would help reduce duplication of effort and provide a framework for producing guidelines that are collectively agreed and endorsed. Generally there is resistance to using guidelines produced by other countries which is often predicated in uncertainty about the guideline development process employed. This is exacerbated when there is a lack of strong evidence or where guidance recommendations are perceived as being influenced by cultural or academic bias. Participants were asked to identify solutions to the challenges and the outcome of the meeting was agreement to take forward some short and long-term goals. There was consensus that IAPD was the appropriate organisation to host a repository for internationally endorsed guidelines and act as a communication hub. It would be a point of reference for sharing knowledge and information, for signposting other organisations such as the Cochrane Oral Health Group and for raising awareness of new projects and providing opportunities for collaboration. It was agreed that evidence-based guidelines in development including American Academy of Paediatric Dentistry’s Pulp Therapy and Pit and Fissure Sealants and Scottish Dental Clinical Effectiveness Programme’s Prevention and Management of Caries in Children will be circulated to all participating groups at the consultation and peer review stage presenting the opportunity for endorsement or accreditation. The concept of international guideline development is an aspirational one that would require politics and egos to be laid aside if it is to work. Identifying the funding and & J. Clarkson j.e.clarkson@dundee.ac.uk