Abstract
AimDeveloping new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context.ResultsThe first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply ‘adopt’ this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to ‘contextualise’ the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to ‘adapt’ the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.
Highlights
The volume of literature available to support the construction of new evidence-based clinical practice guidelines (CPGs) was recently highlighted by Schünemann et al in a recent comprehensive international international CPG repositories are generally freely available via the internet [8,9,10,11] and a simple search highlights a wealth of good quality CPGs already written, for a large number of clinical conditions
Dizon et al BMC Res Notes (2016) 9:442 could query why clinicians, managers or policy makers might develop yet another local CPG, when so many already exist? One answer may be that if a CPG group decides to use guidance developed by others, there are usually immediate challenges related to putting it into practice, largely reflected by the question of whether the CPG can be effectively implemented in a new setting [12,13,14]
Critical elements of clinical guidance In a paper we recently published, we proposed a CPG classification system [the ‘South African Guidline Evaluation (SAGE) Clinical Practice Guideline Development Framework’] that has a base of transparent evidence synthesis processes; layered with clinical contexts; which in turn supports end-products tailored for different contexts, users and purposes—classified as ‘evidence-based summary recommendations’, ‘patient management tools’, or ‘protocols’
Summary
The volume of literature available to support the construction of new (de novo) evidence-based clinical practice guidelines (CPGs) was recently highlighted by Schünemann et al in a recent comprehensive international international CPG repositories are generally freely available via the internet [8,9,10,11] and a simple search highlights a wealth of good quality CPGs already written, for a large number of clinical conditions. There are many issues which influence effective CPG implementation, including but not limited to comprehensiveness and currency of the evidence-base, acceptance by local policy-makers, clinicians and/or patients, cultural relevance, local contexts, availability of care, affordability, equity and access [15]. It is perhaps understandable why CPG groups in particular settings choose to develop de novo CPGs, rather than use CPGs already written by others. In LMIC countries, building on CPGs which have been developed elsewhere, and using a structured process to make recommendations relevant to local contexts might be a persuasive alternative to undertaking de novo CPG activities, and a way of breaking down barriers to implementation
Sign-in/Register to view highlights & summary 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.
