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BMC Research Notes

, 9:442

Health Services Research


AimDeveloping 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.

ResultsThe 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.

KeywordsClinical practice guidelines Guideline development Guideline adoption Guideline adaptation Guideline contextualisation AbbreviationsCPGclinical practice guideline

LMIClower middle income countries

SAGESouth African guideline evaluation

GRADEgrading of recommendations, assessment, development and evaluations

PARMPhilippines Academy of Rehabilitation Medicine

Autor: Janine Margarita Dizon - Shingai Machingaidze - Karen Grimmer


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