To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development.
To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development.
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DOI：
10.1186/s13104-016-2244-7
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发表时间：
2016-09-13
影响因子：
1.8
通讯作者：
Grimmer K
中科院分区：
文献类型：
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作者：
Dizon JM;Machingaidze S;Grimmer K
制定新的临床实践指南（CPG）可能既耗时又昂贵。一个更有效的方法可能是采用、调整或结合现有高质量的中央政策指南的建议，以便所产生的指导适合当地的情况。第一步是搜索与您的情况具有相似目的、最终用户和患者的国际CPG。第二步是批判性地评估CPG的方法质量，以确保您的指导基于可信的证据。然后决定开始。您是否可以简单地“采用”此（母）临床实践指南，并在您的环境中完整地实施建议，而不进行任何更改？如果是，则不需要进一步的工作。然而，这种情况是罕见的。更有可能的是，即使母临床实践指南中的建议可以被采纳，但如何实施这些建议需要解决当地问题。因此，您可能需要通过解决当地劳动力、培训、卫生系统、设备和/或服务获取等实施问题，将指南“情境化”。通常，这意味着需要额外的信息（实践/背景点）来支持临床实践指南建议的有效实施。在某些情况下，您可能需要“调整”指南，您将对建议进行更改，以便护理与您当地的环境相关。这可能涉及额外的工作，以寻找当地的研究，或获得当地的共识，关于如何最好地适应建议。例如，适应可能反映用一种药物替代另一种药物（药物具有类似的效果，但推荐药物的替代药物可能更便宜，更容易获得或更容易被文化接受）。临床实践指南术语缺乏标准化，导致临床实践指南活动往往概念化或报告不佳。我们提供了一种方法，将有助于提高效率和标准化的临床实践指南活动。
Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context. The first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply ‘adopt’ this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to ‘contextualise’ the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to ‘adapt’ the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.