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Abstract：
BACKGROUND: Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, research into alternative methods of CPG development using existing CPG documents (CPG adaptation) - a specific issue for guideline development groups in low- and middle-income countries - is sparse. There are only a few examples showcasing the pragmatic application of such alternative approaches in settings with time and budget constraints, especially in the prehospital setting. This paper aims to describe and strengthen the methods of developing prehospital CPGs using alternative guideline development methods through a case study design.
METHODS: We qualitatively explored a CPG development project conducted in 2016 for prehospital providers in South Africa as a case study. Key stakeholders, involved in various processes of the guideline project, were purposefully sampled. Data were collected from one focus group and six in-depth interviews and analysed using thematic analysis. Overarching themes and sub-themes were inductively developed and categorised as challenges and recommendations and further transformed into action points.
RESULTS: Key challenges revolved around guideline implementation as opposed to development. These included the unavoidable effect of interest and beliefs on implementing recommendations, the local evidence void, a shifting implementation context, and opposing end-user needs. Guideline development and implementation strengthening priority actions included: i) developing a national end-user document; ii) aligning recommendations with local practice; iii) communicating a clear and consistent message; iv) addressing controversial recommendations; v) managing the impact of interests, beliefs and intellectual conflicts; and vi) transparently reporting implementation decisions.
CONCLUSIONS: The cornerstone of a successful guideline development process is the translation and implementation of CPG recommendations into clinical practice. We highlight key priority actions for prehospital guideline development teams with limited resources to strengthen guideline development, dissemination, and implementation by drawing from lessons learnt from a prehospital guideline project conducted in South Africa.
METHODS: We qualitatively explored a CPG development project conducted in 2016 for prehospital providers in South Africa as a case study. Key stakeholders, involved in various processes of the guideline project, were purposefully sampled. Data were collected from one focus group and six in-depth interviews and analysed using thematic analysis. Overarching themes and sub-themes were inductively developed and categorised as challenges and recommendations and further transformed into action points.
RESULTS: Key challenges revolved around guideline implementation as opposed to development. These included the unavoidable effect of interest and beliefs on implementing recommendations, the local evidence void, a shifting implementation context, and opposing end-user needs. Guideline development and implementation strengthening priority actions included: i) developing a national end-user document; ii) aligning recommendations with local practice; iii) communicating a clear and consistent message; iv) addressing controversial recommendations; v) managing the impact of interests, beliefs and intellectual conflicts; and vi) transparently reporting implementation decisions.
CONCLUSIONS: The cornerstone of a successful guideline development process is the translation and implementation of CPG recommendations into clinical practice. We highlight key priority actions for prehospital guideline development teams with limited resources to strengthen guideline development, dissemination, and implementation by drawing from lessons learnt from a prehospital guideline project conducted in South Africa.
摘要：
背景：开发新的（从头）临床实践指南（CPG）的方法受到了广泛关注。然而,使用现有CPG文件（CPG适应）对CPG发展的替代方法的研究很少，这是低收入和中等收入国家指南发展小组的一个具体问题。只有几个例子展示了这种替代方法在时间和预算限制下的实际应用。尤其是在院前设置。本文旨在通过案例研究设计，描述和加强使用替代指南开发方法开发院前CPG的方法。
方法：我们定性地探讨了2016年为南非院前医疗服务提供者开展的CPG开发项目，作为案例研究。关键利益相关者，参与指南项目的各种过程，是有目的地取样的。从一个焦点小组和六个深入访谈中收集了数据，并使用主题分析进行了分析。总体主题和子主题被归纳地发展并归类为挑战和建议，并进一步转化为行动要点。
结果：主要挑战围绕指南实施而不是开发。其中包括利益和信念对实施建议的不可避免的影响，当地的证据是无效的,不断变化的实施上下文，和反对最终用户的需求。准则的制定和实施加强优先行动包括：i）制定国家最终用户文件；ii）使建议与当地做法保持一致；iii）传达明确一致的信息；iv）解决有争议的建议；v）管理利益的影响，信念和智力冲突；和vi)透明地报告实施决定。
结论：成功的指南制定过程的基石是将CPG建议转化和实施到临床实践中。我们强调院前指南开发团队的关键优先行动，资源有限，以加强指南开发，传播,并通过从南非开展的院前指南项目中吸取的经验教训来实施。
方法：我们定性地探讨了2016年为南非院前医疗服务提供者开展的CPG开发项目，作为案例研究。关键利益相关者，参与指南项目的各种过程，是有目的地取样的。从一个焦点小组和六个深入访谈中收集了数据，并使用主题分析进行了分析。总体主题和子主题被归纳地发展并归类为挑战和建议，并进一步转化为行动要点。
结果：主要挑战围绕指南实施而不是开发。其中包括利益和信念对实施建议的不可避免的影响，当地的证据是无效的,不断变化的实施上下文，和反对最终用户的需求。准则的制定和实施加强优先行动包括：i）制定国家最终用户文件；ii）使建议与当地做法保持一致；iii）传达明确一致的信息；iv）解决有争议的建议；v）管理利益的影响，信念和智力冲突；和vi)透明地报告实施决定。
结论：成功的指南制定过程的基石是将CPG建议转化和实施到临床实践中。我们强调院前指南开发团队的关键优先行动，资源有限，以加强指南开发，传播,并通过从南非开展的院前指南项目中吸取的经验教训来实施。
