Adapting Guidelines for Local Implementation: Fusion Cuisine or Fast Food Leftovers Eddy Lang MDCM...
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Adapting Guidelines for Local Implementation: Fusion Cuisine or Fast Food Leftovers Eddy Lang MDCM CCFP(EM) Head Department of Emergency Medicine Senior Researcher Associate Professor Alberta Health Services University of Calgary
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Transcript of Adapting Guidelines for Local Implementation: Fusion Cuisine or Fast Food Leftovers Eddy Lang MDCM...
Adapting Guidelines for Local Implementation:
Fusion Cuisine or Fast Food Leftovers
Eddy Lang MDCM CCFP(EM)Head Department of Emergency Medicine
Senior Researcher Associate Professor
Alberta Health ServicesUniversity of Calgary
4
Brasiliophilia
• Gilberto Gil• Gal Costa• Caetano Veloso• Feijoada• Caipirinhia• Tropa de Elite
Objectives
1. Should countries adapt other guidelines?
2. What changes behaviour?
3. How you might consider doing it?
World Bank Experience
• Guideline adaptation and implementation in Kazakhstan
A última pesquisa mostra que devemos realmente fazer algo com toda essa
pesquisa
MonitorKnowledge
Use
SustainKnowledge
Use
EvaluateOutcomes
AdaptKnowledge
to Local Context
AssessBarriers to
Knowledge Use
Select, Tailor,Implement
Interventions
Identify Problem
Identify, Review,Select Knowledge
Products/Tools
Synthesis
Knowledge Inquiry
Tailo
ring K
nowl
edge
KNOWLEDGE CREATION
What are guidelines?
Clinical Practice Guidelines are systematically
developed statements to assist provider and patient
decisions about appropriate healthcare for specific
clinical circumstances. (Field & Lohr, 1990)
Their purpose is to make explicit recommendations
with a definite intent to influence what clinicians do.(Hayward et al, 1995)
• The clinical practice guideline is based on a systematic review of evidence as demonstrated by documentation of each of the following features in the clinical practice guideline or its supporting documents.
What is guideline adaptation?
A systematic process that guides local groups to identify, evaluate, adapt and use already available guidelines for their own purposes.
Why Adapt Guidelines?
• Efficiency• Apply fruits of rigorous work to your setting• New insight into health problems• Access to evidence-based
recommendations
What are the risks?
• Poor quality guidelines• Poor evidence synthesis• Biased recommendations• Wrong context• Wrong values and preferences• GOBSAT
Task 4.2 Decision and Selection Options
1. ACCEPT a whole guideline and all of its recommendations After reviewing all of the assessments, the panel accepts the guideline as is.
2. REJECT a whole guideline and all of its recommendations After reviewing all of the assessments, the panel decides to reject the complete
guideline. The decision will be based on how the panel weighs the assessments (e.g., poor AGREE scores, guideline is out-of-date, the recommendations do not apply to the panel’s context).
3. ACCEPT the evidence summary of the guideline After reviewing all of the assessments, the panel decides to accept the description of
the evidence (or parts) but to reject the interpretation and the recommendations.
4. ACCEPT single recommendations After reviewing the recommendations from the guideline or guidelines, the panel
decides which to accept and which to reject which may be from one or more guidelines.
5. MODIFY single recommendations After reviewing all of the recommendations from the guideline(s), the panel decides
which are acceptable but need to be modified.
Potential Benefits I
An alternative to de novo development which requires extensive search and synthesis of primary research data
Reduces duplication of effort while maintaining the validity of recommendations
Encourages participative approach involving key stakeholders to foster local ownership of recommendations and promote utilization
Potential Benefits II Ensures consideration of (regional and local)
contextual factors to ensure relevance for practice and improve uptake by targeted users
Increases knowledge and commitment to evidence-based principles by using reliable methods to ensure quality and validity
Promotes explicitness and transparency in documenting recommendations
When was the last time you changed your practice to support evidence-based
intervention and what made you do it?
“To achieve evidence-based clinical practice requires
evidence-based implementation”
Richard Grol
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Link Barriers to Interventions
Identified barriers Specific interventions
Lack of knowledge Interactive education sessions
Perception/reality mismatch Audit and feedback
Lack of motivation Incentives/sanctions
Beliefs/attitudes Peer influence/opinion leaders
Systems of care Process redesign
V. Palda, 2007
Conclusões• Guideline adaptation has risks and
benefits• If structured approach followed increases
chance of success• Guidance alone doesn’t change practice• Consider evidence based approaches to
achieve implementation
Tool 4.1b: AGREE Instrument
23 items4 (7) point Likert
Scale
Overall Assessment
User Guide & Manual
1. Scope & purpose (3)
2. Stakeholder involvement (4)
3. Rigour of development (7)
4. Clarity & presentation (4)
5. Applicability (3)
6. Editorial independence (2)
SIX Domains
Conclusions
• Guideline adaptation should be an intensive and rigorous process
• Made to optimize credibility and uptake• Not without risks• Adapte away
