Dr Pantoja raised an important question in his email. I agree that it is
very useful to use other researchers' experience and product (i.e.
clinical guidelines) in a new settings. This is especially through when
it comes to adapting guidelines for use in a developing country.
Producing guidelines is expensive and time consuming. However, there are
some other general issues in here:
1. Adapting a guideline (if done properly), could be expensive, too.
Therefore choice of the topic will be very important. Thinking of many
studies showing the guidelines on their own are very unlikely to change
the behaviour, it will be essential to invest in adaptation of those
guidelines who have implementation plan and support.
2. Clearly most of the credible sources of guideline implementation are
located in developed countries. The choice of topics and also the
availability of good quality guidelines will be biased towards the needs
of those countries. Obviously, the limited resources in developing
countries need to be targeted very carefully.
3. Guideline producing centres are, more or less, under influence of
their governments and pressure groups (drug companies, patient groups
etc). Although this might have (questionable) benefits in their own
country, will reduce the validity of their findings and recommendations
in other settings. Unfortunately, it is not always clear to what extent
those recommendations are influenced by these factors.
Regards
Arash
--
Arash Rashidian, MD
Health Services Research Scholar
Department of Health Sciences
Genesis 6
University of York
York, YO10 5DD, UK
Tel: +44 (0)1904 434498
Mobile: +44 (0)7786323559
Fax: +44 (0)1904 324101
Study of Adherence to Guidelines and Evidence (SAGE)
http://www-users.york.ac.uk/~ar130/
Visit HTA for Developing Countries Forum at:
http://groups.yahoo.com/group/HTA-DC/
sivalal sadasivan wrote:
> As someone involved in clinical practice guidelines, I've always felt that
> there's no real point in re-inventing the wheel - if someone else has
> already done a reasonably good guideline, we don't see a problem in
> adapting
> it for our use. However, we may not be able to adopt it per se, but usually
> adapt it (updating if necessary), and taking into consideration our local
> situation and practices. In fact, we have just completed a guideline on
> management of breast cancer which we have put on our web-site inviting
> comments from anyone interested (www.moh.gov.my/medical - go to health
> technology assessment then to CPG)
> Regards
> Dr S Sivalal
> Head, HTA Unit
> Ministry of Health Malaysia
> Level 21, PERKIM Bldg, Jalan Ipoh
> 51200 Kuala Lumpur, Malaysia
> Tel: 603-40457639
> Fax: 603-40457740
>
> >From: A Rashidian <[log in to unmask]>
> >Reply-To: [log in to unmask]
> >To: Health Technology Assessment for Developing Countries
> ><[log in to unmask]>
> >Subject: [HTA-DC] [Fwd: Quick & dirty guidelines]
> >Date: Fri, 29 Nov 2002 13:34:13 +0000
> >
> >You may find this interesting.
> >Arash
> >
> >-------- Original Message --------
> >Subject: Quick & dirty guidelines
> >Date: Fri, 29 Nov 2002 10:13:34 -0300
> >From: Dr Tomas Pantoja <[log in to unmask]>
> >
> >
> >
> >Dear list members:
> >
> >We are a group of Family Doctors in Chile trying to develop Clinical
> >Practice Guidelines for common conditions in general practice under the
> >umbrella of our scientific society (Chilean Society of Family & General
> >Medicine). We have some expertise in methodological issues regarding the
> >development of CPG but we (as none of other specialty societies) don't
> have
> >specific and sufficient resources to allocate to this daunting task. Then,
> >we have discussed the possibility to accomplish our objectives through the
> >"adaptation" of guidelines developed by others (such as NZGG, NICE, SIGN,
> >Clearinghouses,...), with a previous critical appraisal of those
> guidelines
> >(using instruments such as AGREE), and the use of formal consensus
> >techniques such the RAND nominal group technique.
> >
> >We ask for opinions and thoughs from the list regarding
> >does anyone know similar experiences of guidelines development in
> >developing
> >countries?
> >does anyone know how this "quick and (not so) dirty" guidelines
> development
> >process compare with more "formal" processes?
> >
> >Kind regards
> >
> >Tomas Pantoja MD MSc
> >Assistant Professor
> >Family & Community Medicine Programme
> >Catholic University of Chile
> >
> >on behalf of the Chilean Society of Family & General Medicine guidelines
> >development group
> >
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