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Are you clear about what a clinical practice guide is? Are they adopted? They adapt? Are updated?

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By: Diana González-Bravo
MD, Epidemiologist
MBE researcher
Neuroeconomix

Definition

The Clinical Practice Guidelines (CPG) are a set of recommendations developed systematically based on the best available evidence, clinical experience and the perspective of patients, to guide health professionals in making decisions in circumstances specific clinics. This with the aim of supporting the health professional to make the appropriate decisions, recommending the optimal treatment and diagnosis guidelines to intervene a pathological condition in a preventive, diagnostic or therapeutic way.

Sometimes the horizon is not clear and the boundary between what is and what is not a clinical practice guideline is blurred.

A clinical practice guide:

  • They are NOT a care protocol.
  • They are NOT "rules" that can be adjusted to all types of patients. In case of exceptions, justification and validation by an expert of the conduct to be followed must be obtained.
  • They are NOT "cooking recipes"
  • They are NOT models of care

 

What is the difference between adopting and adapting a CPG?

Adoption: take GPCs created by other people or groups, without making adjustments of any kind, therefore you must have authorization from the developer group that made it. CPG adoption can occur in two contexts: a recommendation can be adopted when there is a CPG that fits a specific Colombian context, or a recommendation can be adopted by an IPS when it must implement a CPG.

Adaptation: It is the modification of a CPG to adapt it to a different cultural and organizational context for which it was conceived.

Upgrade: CPGs must include periodic monitoring strategies, in order to maintain the validity and quality of the recommendations, it is a range of 2 to 5 years depending on the subject of the guide.

Considering the new evidence resulting from continuous research, CPGs must include periodic monitoring strategies, in order to maintain the validity and quality of the recommendations. The monitoring will be carried out in search of new publications or alerts, whose results could modify conclusions of previous studies and therefore the recommendations. A range of two to five years is estimated to assess the need for updating, which will follow a systematic methodology supported by technical resources from the original guide.

 

If I am an institution, how do I adopt a CPG?

The development of a CPG involves a costly, technically rigorous and extensive process, which requires approximately 12 to 18 months and significant resources to complete. Given the availability of high-quality CPGs developed by national and international organizations and in order to avoid duplication of efforts and resources, the adoption of CPGs is carried out.

In the first measure and as the backbone of the work, it is necessary to have personnel trained in research methodology and synthesis of biomedical literature. Essentially, the team will consist of a methodologist and a multidisciplinary team of clinical experts.

The Methodological Guide Adoption-Adaptation of clinical practice guidelines based on evidence from the Ministry of Health and Social Protection and the IETS, has a chapter where the methodology for the adoption of CPG by health service providers is explained.

Resolution 2003 of 2014, regulates the unique system for the empowerment of health service providers and stipulates that compliance with five basic elements in relation to the CPGs (Methodological Guide Adoption - Adaptation of evidence-based clinical practice guidelines must be ensured , Minsalud):

  • There must be a single institutional procedure to develop or adopt CPG
  • Service providers must have CPG, either of their own elaboration or of adoption from the Ministry of Health and Social Protection, from national or international sources.
  • The CPGs must be made known to all the institution's staff.
  • CPGs must be implemented
  • The CPGs must be evaluated, measured and their processes improved, in accordance with the institution's processes.

The health conditions with the highest prevalence, those that represent greater health risk, or greater variability in clinical practice should be prioritized, depending on the individual context of the CPG and those CPGs that are determined by regulatory mandate (stipulated in Resolution 1442 of 2013 ).

 

Where is there information about the methodology for the development of GPC?

  • IETS (Institute for the Evaluation of Evidence and Health Technologies) in Colombia

http://www.iets.org.co/Documents/Guia_de_Adopcion_VF.pdf

  • Methodological Guide for the elaboration of Clinical Practice Guides in the General System of Social Security in Colombian Health

http://gpc.minsalud.gov.co/gpc/SitePages/buscador_gpc.aspx

 

It is important to be clear about the different methodologies by which clinical practice guidelines can be adopted, adapted, and updated, based on the precise concept and distinction of what a guide is and what is NOT.

For more information about the methodology to adopt and adapt the CPGs in your institution, you can go to the link of our services.

References

Ministry of Health and Social Protection, Institute of Technological Evaluation in Health. Methodological Guide Adoption - Adaptation of Evidence-Based Clinical Practice Guidelines. 2017; 1–63.

Ministry of Health and Social Protection, Institute of Technological Evaluation in Health. Methodological Guide Adoption - Adaptation of Evidence-Based Clinical Practice Guidelines. 2017; 1–63.

Ministry of Health and Social Protection. Methodological Guide for the elaboration of Clinical Practice Guides with Economic Evaluation in the General System of Social Security in Colombian Health. 2014

Coello P, Jose C, Del Campo P, Estrada M, Agirre A, Gonzales C, et al. Updating of Clinical Practice Guidelines in the National Health System. Methodological Manual. 2009. 89 p.

Alonso-Coello P, Martínez García L, Carrasco Gimeno JM, Solá I, Qureshi S, Burgers JS. The updating of clinical practice guidelines: Insights from an international survey. Implement Sci. 2011; 6 (1): 1–8.

Graham R, Mancher M, Miller Wolman D, et al. E. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines Washington (DC): National Academies Press (US). 2011;

Penney GC. Adopting and adapting clinical guidelines for local use. Obstet Gynaecol. 2007; 9 (1): 48–52.

Martínez García L, Arévalo-Rodríguez I, Solà I, Haynes RB, Vandvik PO, Alonso-Coello P, et al. Strategies for monitoring and updating clinical practice guidelines: a systematic review. Implement Sci [Internet]. 2012; 7: 109.

AGREE Consortium. AGREE II instrument. Instrument for the evaluation of Clinical Practice Guidelines. 2009

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4 Comments
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Ana Maria Alvarez
4 years ago

Thanks for sharing, a very important topic.

Maria Ximena Rojas
4 years ago

It would be interesting for the author to discuss the relevance, advantages and disadvantages of the «ADOLOPMENT» strategy proposed by the GRADE working group regarding the de novo adoption, adaptation and development of the CPG recommendations. Here is your reference.
2. Schünemann HJ, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa RA, Manja V, Brignardello-Petersen R, Neumann I, Falavigna M, AlHazzani W, Santesso N, Zhang Y, Meerpohl JJ, Morgan RL, Rojas MX , Rochwerg B, Darzi A, Carrasco-Labra A, Adi Y, AlRayees Z, Riva J, Bollig C, Moore A, Yepes-Nuñez JJ, Cuello C, Waziry R, Akl EA, GRADE Evidence to Decision Frameworks for adoption, adaptation and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT, Journal of Clinical Epidemiology (2016), doi: 10.1016 / j.jclinepi.2016.09.009 Available at: http://www.jclinepi.com/article/S0895-4356(16)30482-6/abstract

Gustavo Arroyo placeholder image
4 years ago

Thank you very much for sharing this presentation that properly orders the subject to be able to apply it in daily practice

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