Abstract
BackgroundGood quality clinical practice guidelines (CPGs) are a vehicle to implementing evidence into allied health (AH) care. This paper reports on the current ‘state of play’ of CPGs in a lower-to-middle-income country (South Africa), where primary healthcare (PHC) AH activities face significant challenges in terms of ensuring quality service delivery in the face of huge PHC need.MethodsA qualitative study was conducted, using semi-structured interviews with purposively-sampled individuals involved in AH PHC CPGs in South Africa. They included national and state government policy-makers, academics and educators, service managers, clinicians, representatives of professional associations, technical writers, and members of informal professional networks. The interview data was transcribed and de-identified, and analysed descriptively by hand-coding. The COREQ statement guided study conduct and reporting. A framework to guide research in other countries into perspectives of AH PHC CPG activities was established.ResultsOf the 32 invited, 29 people participated: of these 25 were interviewed and four provided meeting notes. Most participants had multiple professional roles, being engaged concurrently in clinical practice, academia, professional associations and / or government. Key themes comprised Players (sub-themes of sampling frame, participants, advice, role players and collaboration); Guidance (sub-themes of nomenclature, drivers, purpose, evidence sources) and Role of AH in PHC (sub-themes of discipline groupings, disability and rehabilitation, AH recognition).ConclusionThere was consistently-expressed desire for quality guidance to support better quality AH PHC activities around the country. However no international CPGs were used, and there were no South African CPGs specific to local PHC AH practice. The guidance gap was filled by non-evidence-based documents produced often without training, to deal with specific clinical situations. This led to frustration, duplication and fragmentation of effort, confusing nomenclature, and an urgent need for standardised and agreed guidance. We provided a standardised framework to capture perspectives on CPGs activities in other AH PHC settings.
Highlights
Good quality clinical practice guidelines (CPGs) are a vehicle to implementing evidence into allied health (AH) care
This paper reports on perspectives of CPGs by endusers in primary health care (PHC) settings in South Africa (SA)
We heard consistent reference by most participants to the enormous need in SA primary healthcare (PHC) for better AH and rehabilitation practices, greater political recognition of the role of AH in PHC, and better quality guidance to underpin AH practices. One participant expressed this issue comprehensively: ‘to make them understand that without rehabilitation the burden of care or in terms of mobility burden is spinning out of control, I mean, the country is at increasingly we've got a quadruple burden of disease, people coming with multiple morbidities and a lot of the ability to care or not care for themselves dependent of whether they have access to rehab and whether those families have the support they need to deal with people who have functional challenges and they get the kind of things that promote their independence and their ability to operate in society and without rehab, their chances are very poor’
Summary
Good quality clinical practice guidelines (CPGs) are a vehicle to implementing evidence into allied health (AH) care. Clinical Practice Guidelines (CPGs) were defined by the United States of America Institute of Medicine in 2011 as ‘statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and Methodologically-sound CPGs should be developed using standard internationally-agreed principles, and be based on the best current evidence [3]. Such CPGs can provide policy-makers, clinicians, funders and service managers with time-efficient and reliable sources of current evidence on which to base service-delivery decisions [4]. AH therapies provide care for individuals in primary, secondary and tertiary settings, to improve their function and quality of life from injury or illness [8, 9]
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