The updated clinical guideline development process in Estonia is an efficient method for developing evidence-based guidelines

Bero, Lisa; Hill, Suzanne; Habicht, Jarno; Mathiesen, Mari; Starkopf, Joel

doi:10.1016/j.jclinepi.2012.07.007

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…With a staff of almost two FTEs and many external participants we managed to critically appraise and adapt almost 750 out of 1000 summarized guidelines Adapting POC summarized guidelines over a 3-year period. Estonia, also a small country with limited resources, has already demonstrated that it is possible to develop high-quality guidelines when using a formal adaptation process [33]. Our experiences strengthen this conclusion.…”

Section: Discussionsupporting

confidence: 77%

“…However, by providing a clear outlined process description in a handbook, we ensured that the quality of the end results of most participants was very similar despite the differences in their experience. This finding supports the experiences in Estonia that when using formal guideline development methods, small organizations, with limited resources, can develop highquality guidelines [32,33].…”

Section: Improving the Adaptation Processsupporting

confidence: 82%

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Adapting a large database of point of care summarized guidelines: a process description

Delvaux¹,

Velde²,

Aertgeerts³

et al. 2015

Evaluation Clinical Practice

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Rationale, aims and objectivesQuestions posed at the point of care (POC) can be answered using POC summarized guidelines. To implement a national POC information resource, we subscribed to a large database of POC summarized guidelines to complement locally available guidelines. Our challenge was in developing a sustainable strategy for adapting almost 1000 summarized guidelines. The aim of this paper was to describe our process for adapting a database of POC summarized guidelines.MethodsAn adaptation process based on the ADAPTE framework was tailored to be used by a heterogeneous group of participants. Guidelines were assessed on content and on applicability to the Belgian context. To improve efficiency, we chose to first aim our efforts towards those guidelines most important to primary care doctors.ResultsOver a period of 3 years, we screened about 80% of 1000 international summarized guidelines. For those guidelines identified as most important for primary care doctors, we noted that in about half of the cases, remarks were made concerning content. On the other hand, at least two‐thirds of all screened guidelines required no changes when evaluating their local usability.ConclusionsAdapting a large body of POC summarized guidelines using a formal adaptation process is possible, even when faced with limited resources. This can be done by creating an efficient and collaborative effort and ensuring user‐friendly procedures. Our experiences show that even though in most cases guidelines can be adopted without adaptations, careful review of guidelines developed in a different context remains necessary. Streamlining international efforts in adapting international POC information resources and adopting similar adaptation processes may lessen duplication efforts and prove more cost‐effective.

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Section: Discussionsupporting

confidence: 77%

Section: Improving the Adaptation Processsupporting

confidence: 82%

Adapting a large database of point of care summarized guidelines: a process description

Delvaux¹,

Velde²,

Aertgeerts³

et al. 2015

Evaluation Clinical Practice

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“…From its inception, the EHIF implemented a purchasing strategy that prioritised outpatient care over inpatient hospital care through contracting targets and by reallocating funding [3]. Other supply–side changes aimed at improving service quality and efficiency included introduction of clinical guidelines [8], and using new provider payment mechanisms (capitation and of pay–for–performance [P4P] in PHC, and diagnosis–related groups (DRGs) in hospitals).…”

mentioning

confidence: 99%

Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data

Atun¹,

Gurol‐Urganci²,

Hone³

et al. 2016

Journal of Global Health

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BackgroundFollowing independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system.MethodsUsing routinely collected health billing records for 2005–2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co–morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply–side variables, and PHC use.FindingsOver the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow–up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services.InterpretationOur findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions.

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“…A more practical and shorter version of ADAPTE is proposed by them as RAPADAPTE, but further cases are needed to judge whether this would be a tool that could be used in other resource‐limited settings. Estonia has also successfully used a formal adaptation process and developed high‐quality guidelines …”

Section: Discussionmentioning

confidence: 99%

Exploring guideline adaptation strategy for Turkey: Is “ADAPTE” feasible or does it need adaptation as well?

Başer

Kahveci

Artantaş

et al. 2017

Evaluation Clinical Practice

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The updated clinical guideline development process in Estonia is an efficient method for developing evidence-based guidelines

Cited by 5 publications

References 14 publications

Adapting a large database of point of care summarized guidelines: a process description

Adapting a large database of point of care summarized guidelines: a process description

Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data

Exploring guideline adaptation strategy for Turkey: Is “ADAPTE” feasible or does it need adaptation as well?

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