Article
Creating and adapting a high-quality national clinical guideline with limited resources
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Authors
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M. Tristan
- IHCAI Foundation - Central America & Spanish-speaking Caribb Cochrane Branch, San Jose, Costa Rica
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A. Ramirez
- CAJA COSTARRICENSE DE SEGURO SOCIAL - IHCAI Foundation, San Jose, Costa Rica
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B. Alper
- Editor in Chief, Dynamed Medical Director, EBSCO Publishing, Ipswich, MA, United States
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J.R. Te Paske, B.S
- University of Connecticut School of Medicine, Farmington, Connecticut, United States
| Published: | July 10, 2012 |
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Outline
Text
Background: The creation of a clinical practice guideline (CPG) is difficult for a middle-income country with few resources. We present a novel validated methodology for CPG adaptation and development.
Context: We were asked to develop a country national CPG for the treatment of breast cancer. We were given one month despite a two-year estimate for the effort required. This required a different approach.
Best Practice: We utilized the ADAPTE (modified) framework to find and adapt published CPGs from other organizations. Our methodology furthers this framework by utilizing evidence summaries from DynaMed and EBM Guidelines to update the information base with the most current evidence. The GRADE method was used to ensure the quality and transparency of our guideline. The final step included 64 experts representing multiple disciplines and regions of the country to develop clinical recommendations specific to the context of the country healthcare. We were able to complete our CPG in 12 months, a 50% reduction in estimated effort. It was evaluated by 23 local external and 4 international raters using the AGREE instrument with an average rating of >90%. The CPG was more current than and not lacking evidence compared to four CPGs from other countries.
Lessons learned: Using DynaMed substantially reduced the effort to identify and critically appraise evidence. Using critical appraisal applied by others requires supplemental critical appraisal to fit the GRADE methodology but was overall more efficient. Clear presentation of evidence eliminated disagreements among the experts.
