A Protocol to Develop Practice Guidelines for Primary Care Medical Service Trips

Abstract

B A C K G R O U N D North American clinicians are increasingly participating in medical service trips (MSTs) that provide primary healthcare in Latin America and the Caribbean. Literature reviews have shown that the existence and use of evidence-based guidelines by these groups are limited, which presents potential for harm.O B J E C T I V E This paper proposes a 5-step methodology to develop protocols for diagnosis and treatment of conditions encountered by MST clinicians. M E T H O D SWe reviewed the 2010 American College of Physicians guidance statement on guidelines development and developed our own adaptation. Ancestry search of the American College of Physicians statement identified specific publications that provided additional detail on key steps in the guideline development process, with additional focus given to evidence, equity, and local adaptation considerations.F I N D I N G S Our adaptation produced a 5-step process for developing locally optimized protocols for diagnosis and treatment of common conditions seen in MSTs. For specified conditions, this process includes: 1) a focused environmental scan of current practices based on grey literature protocols from MST sending organizations; 2) a review of relevant practice guidelines; 3) a literature review assessing the epidemiology, diagnosis, and treatment of the specified condition; 4) an eDelphi process with experts representing MST and Latin American and the Caribbean partner organizations assessing identified guidelines; and 5) external peer review and summary.C O N C L U S I O N S This protocol will enable the creation of practice guidelines that are based on best available evidence, local knowledge, and equitable considerations. The development of guidelines using this process could optimize the conduct of MSTs, while prioritizing input from local community partners.K E Y W O R D S medical missions, humanitarian health, medical service trips, Latin America, global health, international health Authors' contributions: Christopher Dainton conceived the study and was involved in writing and revision of all sections. Charlene H. Chu was involved in writing and revision of the Methods and Discussion section. Lawrence Loh was involved in the conception and writing of the Discussion section, and in substantial revision and editing of all other sections. Henry Lin and William Cherniak were involved in writing and revision of the Introduction section. All authors reviewed the final version and approved it for publication. Conflict of interest statements and ethics committee approval: The authors have no conflicts of interest to declare. Ethics committee approval was not solicited for this study.

A narrative review of dermatologic protocols for primary care medical service trips in Latin America and the Caribbean

“…Likewise, the prevalence of pyoderma (i.e., impetigo, cellulitis, abscesses) is approximately 5–10% in tropical regions, according to the World Health Organization (WHO) . Finally, the reported prevalence of scabies on MSTs in Latin America and the Caribbean (LAC) appears to total between 3.3 and 4.3% of all patient complaints …”

“…Under such circumstances, best practice guidelines are critical to ensuring consistent clinical management in the field . Despite this, a recent integrative review demonstrated a lack of evidence of guideline use in MST practice in LAC . Many MST‐sending organizations, however, do distribute unpublished training protocols (also referred to as “gray literature protocols”) to support clinicians who travel with them.…”

“…The following narrative review describes the unpublished dermatologic protocols used by North American MST‐sending organizations, as an initial step in understanding the clinical practice of volunteers in Latin America and the Caribbean. This study is positioned within a broader initiative to develop context‐specific clinical guidelines for symptoms commonly managed by MST clinicians . Last, we compare the gray literature protocols with published international practice recommendations.…”

“…3,4 Skin disorders such as scabies, fungal infections, and pyoderma are examples of disease processes that are commonly encountered during MSTs but less frequently seen by volunteer clinicians in their home settings. 5,6 In one epidemiological study, superficial mycosis accounted for 1.4-4.2% of patient diagnoses on five MSTs located in Ecuador, Guatemala, and Dominican Republic, 7 and studies based on mycological examinations indicate a prevalence of 7-33% in children in Africa. [8][9][10][11][12][13][14] Likewise, the prevalence of pyoderma (i.e., impetigo, cellulitis, abscesses) is approximately 5-10% in tropical regions, according to the World Health Organization (WHO).…”

“…15 Finally, the reported prevalence of scabies on MSTs in Latin America and the Caribbean (LAC) appears to total between 3.3 and 4.3% of all patient complaints. 6,7 Evidence-based clinical knowledge of these skin disorders is imperative on MSTs owing to their prevalence, substantial morbidity, relative neglect in guidelines, 16 and to mitigate their common mismanagement and misidentification by healthcare professionals. 16,17 Under such circumstances, best practice guidelines are critical to ensuring consistent clinical management in the field.…”