Adapting clinical guidelines in India—a pragmatic approach

Abstract

Adapting international guidelines to suit local context can drive evidence based practice in low and middle income countries, say Abha Mehndiratta and colleagues, as they describe a pragmatic approach to develop standard treatment guidelines for India

Developing a Thai national critical-care allocation guideline during the COVID-19 pandemic: a rapid review and stakeholders’ consultation 

“…Second, we applied a qualitative research methodology, using key informant interviews and stakeholder consultations, to ensure adaptation of the recommendations for acceptability, feasibility and stakeholder buy-in (17). Due to the absence of guidelines from low-and middle-income countries (LMICs), most LMICs resort to international guidelines or those developed by high income countries which may be less likely to be accepted or successfully implemented because of the differences in health systems, cultural and social norms (30,31) The key informant interviews allowed us to compare best practices from the rapid review with current norms and practices of physicians in caring for COVID-19 and ICU patients in Thailand. This is important because less variation from the current practice means less investment on capacity building interventions for healthcare workers especially in the urgent COVID-19 situation.…”

Achieving high-quality universal health coverage: a perspective from the National Health Service in England

“…Yet, for many LMICs, there is benefit in borrowing analysis from NICE and other similar bodies internationally to help set priorities. A good example is the recent national Standard Treatment Guidelines on Diabetic Foot based on NICE guidelines published in India 22. At present, only a few LMICs have functioning priority setting institutions, such as the Health Intervention and Technology Assessment Program in Thailand and CONITEC in Brazil, while a number of others such as China, India and the Philippines are moving in this direction 23–25.…”

Matriz de recomendações para farmacoterapia da osteoporose e da osteoartrite: recurso para subsidiar a adaptação de guias de prática clínica

“…Com o intuito de unificar sugestões de melhores tratamentos baseados em evidências e de auxiliar os profissionais da saúde, Guias de Práticas Clínicas (GPC) são elaborados de forma a reunir em um único documento as melhores evidências científicas obtidas por meio de revisões sistemáticas. Estas são resumidas, graduadas por meio de uma ferramenta reconhecida, debatidas e somente então são liberadas para utilização (23)(24)(25). Como forma de auxiliar o profissional da saúde no momento de tomada de decisão, a Organização Mundial da Saúde vem fomentando o uso de GPC.…”

“…No caso da elaboração de um GPC são necessário recursos, tempo e profissionais capacitados para reunir e avaliar todas as evidências existentes sobre o assunto escolhido. No entanto, a elaboração de GPC se depara, além de falta de evidências para certas doenças e de profissionais qualificados, com o alto custo financeiro de sua preparação (24,25,29).…”

“…No processo de adoção, o GPC escolhido é simplesmente traduzido para o idioma local, sem alterações, e aplicado localmente, não considerando as regulamentações, particularidades regionais ou o custo dos medicamentos (25,29,33,34).…”