Dear Thomas,
A few thoughts:
1. The evidence will remain much the same, though there a some issues about
transferability to different settings, but the biology of people is largely
similar
2. The frequency and spectrum of disease will differ (as it does within
country between primary care and secondary settings) influencing pre-test
probabilities, prognoses, and the likely absolute (rather than relative)
benefits,
3. The constraints (availability, affordability, etc) will vary by setting
and country
4. The politics of local practices will vary, e.g., which of two equivalent
treatments is fashionable, or who does what procedures
Given this implies some need for adaptation, I think the idea of finding,
appraising, and adapting evidence-based guidelines of others is an
excellent idea. My guess is that such a review process might lead to a
better guideline than attempting it from scratch. There are some groups
with experience of this such as:
http://www.tg.com.au/
Whose guidelines have been picked up and adapted by several countries,
Good luck,
Paul Glasziou
At 29/11/2002, Dr Tomas Pantoja wrote:
>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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