Clinical practice guidelines in Brazil – developing a national programme

Abstract

In Brazil, governmental and non-governmental organisations develop practice guidelines (PGs) in order to optimise patient care. Although important improvements have been made over the past years, many of these documents still lack transparency and methodological rigour. In order to conduct a critical analysis and define future steps in PG development in Brazil, we carried out a structured assessment of strengths, weaknesses, opportunities and threats (SWOT analysis) for the development of a national guideline programme. Participants consisted of academia, methodologists, medical societies and healthcare system representatives. In summary, the PG development process has improved in Brazil and current investments in methodological research and capacity-building are ongoing. Despite the centralised processes for public PGs, standardised procedures for their development are not well established and human resources are insufficient in number and capacity to develop the amount of trustworthy documents needed. Brazil's capacity could be strengthened and initial efforts have been made such as the adoption of standards proposed by world-renowned institutions in PG development and enhancement of the involvement of key stakeholders. Further steps involve the alignment between health technology assessment and PG processes for synergy and the development of a national network to promote the interaction between groups involved in the development of PGs. The lessons learned from this paper could be used to foster debate on guideline development, especially for countries facing similar threats on this topic.

The ecosystem of health decision making: from fragmentation to synergy

“…Another example comes from the alignment of HTAs and guideline development in Brazil, a middleincome country where the Ministry of Health now promotes synergy between HTAs and guideline production after a period of independent development within the same ministry. 58…”

“…We supplemented these case studies with the accomplished work in a middleincome country, Brazil, where alignment of HTA and guideline development was achieved by bringing actors together and highlighting the similarities of the processes. 58 We believe that the theory we present about how various actors use similar elements and criteria to arrive at health decisions should not differ globally, but the context that dictates how they are implemented will differ. For example, processes for aligning HTA with the national essential medicines list exist in South Africa, 92 and they could be further aligned with our theory, but the availability of resources and legal frameworks can determine a decision about a specific intervention, which will be context specific.…”

Estimated mortality rates of individuals with sickle cell disease in Brazil: real-world evidence

“…In Brazil, there are published lines of care for SCD; however, there is a need for better implementation of their recommendations. 32 …”

How long does it take to translate research findings into routine healthcare practice?—the case of biological drugs for rheumatoid arthritis in Brazil

“…The drugs can be purchased directly by the Ministry of Health or by States and municipalities, as agreed between SUS managers. Clinical guidelines are used as tools to help manage and regulate access to health technologies, and include clinical indications, dosages, monitoring mechanisms, and parameters related to drug dispensing and clinical management ( 27 ).…”