bluuebunny/crossref_metadata_2025 huggingface dataset:
P314 Barriers And Facilitators To The Implementation Of Clinical Practice Guidelines: A Survey Among Physicians In Specialized Care
Authors: Reviriego E , Iruretagoyena M , Arcelay A , Villanueva G
Published: August 2013

Background

In an era when an increasing amount of clinical information is available to health care professionals, the effective implementation of clinical practice guidelines requires the development of strategies to facilitate the use of these guidelines.

Objectives

Explore the knowledge and attitudes of Specialised Care Physicians (SC) in terms of the use of CPGs; identify the barriers and facilitators to their proper dissemination and implementation; identify the strategies and actions for improvement that contribute to minimising the impact of the barriers that have been detected.

Methods

We conducted a survey in order to assess resources, knowledge and attitudinal barriers of physicians working in Specialised Care towards the Clinical Practice Guidelines.

Results

The questionnaire was completed by 209 SC physicians. The application of the recommendations in the CPGs is considered to be easy by 61.2% of participants, while 28.2% considered this procedure to be difficult. Among the reasons behind the difficulty were: the complicated nature of practical application, the lack of organisational, financial and infrastructure-related resources, the variable nature of the patients, the lack of time, little evidence with low-quality recommendations, disagreement, a lack of interest and motivation and the lack of knowledge of the CPGs due to unsatisfactory dissemination.

Conclusion

Informed by the results of the survey, leading health authorities are making an effort to develop specially designed interventions to implement clinical practice guidelines, including an easily accessible online database.
P317 Implementation Of Evidence Based Healthcare And Guidelines In Clinical Practice
Authors: Steinhausen K , Slordahl S
Published: August 2013

Background

Healthcare received by Europe’s citizens should be based on the best scientific evidence and with involvement of patient and public. Greater emphasis on scientific evidence for a health intervention must be thoroughly analysed, health technology assessment (HTA) must become a cornerstone of healthcare. We have discussed these issues with different interdisciplinary groups and published two strategic papers in 2011 and 2012.

Objectives

The aim is to present and discuss further possible implementation steps for improving implementation of evidence based healthcare and guidelines in clinical practice.

Methods

In 2011 and 2012 workshops with interdisciplinary working groups (knowledge transfer, patient involvement and general practice) took place. Needs for actions and the relevant stakeholders were identified.

Results

Needs for action: Establish a European Institute for Health Research where common issues in European healthcare research and policy can be debated and appropriate strategies formulated. Organise meetings between HTA/EBM leaders and policy-makers and health administrators on the European, national, regional and local level Establish at national level Healthcare Knowledge Centres for improved access to and transfer of unbiased information on patient-oriented research Set up research networks and ensure collaborative research between primary and secondary care Develop incentive systems for using and implementing evidence-based practice, guidelines and policy at medical care level through national European guidelines or even regulations and the relevant stakeholders.

Discussion

It is now important to implement these needs. The involvement of different stakeholders from research, clinical practice, regulation, policy, patients and the public is urgently needed.
P319 Minds Project As Guideline Clearinghouse - Evaluation Of Clinical Practice Guidelines Developed In Japan
Authors: Okumura A , Yoshida M , Kiyohara K , Takahashi N , Hatakeyama Y , Htun N , Sato Y , Kojimahara N , Yamaguch N
Published: August 2013

Background

MINDS (Medical Information Network Distribution Service) is a consignment project for MHLW (Ministry of Health, Labour and Welfare) managed by Japan Council for Quality Health Care. MINDS has been disseminating evidence-based clinical practice guidelines (CPG) as guideline clearinghouse in Japan.

Objectives

To assess the quality of evidence-based CPG developed in Japan.

Methods

We searched Japanese CPG using 10 major databases from January 2007 to January 2013. After two-stage screening process with exclusion criteria, identified CPG were evaluated by 4 reviewers of the CPG evaluation group using the AGREEII (Appraisal of Guidelines for Research & Evaluation II) Instrument.

Results

A total of 1763 literatures were identified by the searching process. After screening process, 168 guidelines were evaluated by the AGREEII instrument from September 2011 to January 2013. The scores mean (SD) of each AGREEII domain were as follows: Scope and Purpose, 64.1 (19.2); Stakeholder Involvement, 46.0 (18.2); Rigour of Development, 39.8 (24.6); Clarity of Presentation, 58.8 (21.3); Applicability, 42.7 (16.3); Editorial Independence, 29.9 (31.4) and Overall assessment, 50.4 (21.1).

Discussion

Among the AGREEII domains, Editorial Independence and Rigour of Development are important factors to improve the quality of Japanese CPG.

Implications for guideline developers/users

It is necessary to cooperate with guideline development group in order to utilise the guidelines evaluation result for improving the guideline development process. MINDS is preparing to hold workshops 2013 focused on guideline methodology for guideline developers.
P321 Dissemination Of The Clinical Practice Guidelines Development Methodology Based On body Of Evidence In Japan ∼ Development Of Educational Package For Clinical Practice Guidelines And Workshop Program
Authors: Yoshida M , Hatakeyama Y , Okumura A , Takahashi N , Kojimahara N , Kiyohara K , Sato Y , Htun N , Yamaguchi N
Published: August 2013

Objective

The dissemination and active support for clinical practice guidelines development method based on the principle of EBM, is one of the main pillars of MINDS (Medical Information Network Distribution Service) consignment project for EBM promotion implemented by Ministry of Health, Labour and Welfare Japan. In 2007, with the publication of MINDS guidance to develop Clinical practice guidelines 2007 by Fukuiet al., a protocol to develop clinical practice guidelines was introduced as the most valid manual at that time in Japan. However, advanced improvements towards the global standards in the CPG development methodology have been established within these 5 years after previous publication, such as GRADE system, AGREE II, IOM etc. Accordingly, the Workshop for Clinical Practice Guidelines development methodology is planned to introduce the latest advanced methodology for medical and healthcare professionals who engaged in the clinical practice guidelines development. 2. Contents This workshop comprises the lectures and group practices, assuming AGREE II as a standard for the educational package development and, using GRADE system for quality of evidence and strength of recommendation, which promote the CPG development methods for disease management. We hope to show the ‘PROGRAMME’ for the progress of the workshop at G-I-N2013. 3. Target Audience For all medical and healthcare professionals who have interest in and for those who engage in clinical practice guidelines development in Japan. 4. Workshop Outline Educational workshops will be held four times within a year 2013 in Tokyo Japan. The first workshop date: 2013-03-20 (Wed) 10:00∼17:00
P327 Overview of Clinical Practice Guidelines in Japan - From The Point Of View Of Patient-Involvement
Authors: Suzuki H
Published: August 2013

Background

In Japan, the official movement to develop Clinical Practice Guidelines (CPGs) began in 1999 with the financial support of the Ministry of Health, Labour and Welfare -MHLW). Since then, CPGs in various fields have been developed and development methods using the principles of evidence-based medicine are becoming popular.

Objectives

The First objective of the study is to clarify how many CPGs developed and published in Japan in 2013. The second is to make clear if patient-involvement is popular or not.

Methods

I have searched the existing CPGs comprehensively. Out of the 600 searched CPGs, well-formulated ones were selected if they met the following criteria: defining clinical questions to be addressed, reviewing evidence, determinig grade of recommendation, and becoming open to the public. I have checked public involvement in developing.

Results

Nevertheless 120 CPGs are selected, the number of CPGs, containing patient/carer member in developing process, is only 6. And the number of patient-version CPGs is only 29.

Discussion

A reason why the patient-involvement doesn’t become popular, came from MHLW decision, stopping the financial support in 2004. This decision resulted in the view that individual professional societies were required to develop CPGs applicable to those topics related to their societies. Accordingly, a given professional society, which should always be involved in the CPG development group as one of the main stakeholders, was the sole party involved in the development of CPGs.
P329 Developing A Strategy To Assess The Reporting Of The Updating Process In Clinical Practice Guideline: A Draft Checklist
Authors: Vernooij R , Sanabria A , Martínez García L , Makarski J , Brouwers M , Alonso-Coello P
Published: August 2013

Background

Scientific knowledge is in constant change and, therefore, clinical practice guidelines (CPGs) require a frequent reassessment. However, the best methodology for updating CPGs is not known and methods are poorly reported in CPGs. A framework to evaluate the quality of reporting the updating process in CPGs and to provide guidance for minimum thresholds for an updating strategy is needed.

Objective

To develop a CPG update reporting checklist.

Methods

An initial list of items has been developed based in a systematic review done for our team about the guidance in updating handbooks. The working group has reviewed the initial list and reached consensus about the items to include. Through a survey, we will present the initial list to a multidisciplinary group of international experts and we will ask them about what is the relevant information that needs to be reported in an updated CPG, and about the elements to be included in a high-quality updating process.

Results

These results will give us insight in what elements are required to be reported an updated CPG. Additionally, we will gain information about what kind of elements include a high-quality updating process.

Discussion and Implications

This checklist will help people responsible for updating CPGs, in conducting and reporting their update in a high-quality manner. Ultimately this might results in more up-to-date recommendations and more valid CPGs.
P334 Challenges And Advantages Adapting Recommendations: Gpc Breast Cancer
Authors: Peña Torres E , Alba M , Sierra F
Published: August 2013

Background

Development of a high-quality Clinical Practice Guideline (CPG) involves spending a significant amount of resources. Frequently, similar strategies are used around the world to achieve similar results. A method to utilise resources in a more efficient manner and to avoid the unnecessary duplication of efforts is to adapt existing guidelines. However, the methodological diversity of CPGs, specific regional conditions, and difficulties in the implementation of recommendations, impose a systematic approach for its adaptation that constitute an important methodological challenge, that must take into account the similarities between ade novodevelopment and an adaptation of guidelines. The process of adaptation requires systematic and transparent activities that disclose the considerations made to adjust the recommendations to a specific context.

Methods

The development of the GPC for breast cancer follows the steps proposed in the Methodological Guideline for the development of GPCs in the Colombian Health System.

Results

The systematic search retributed 176 GPCs, 48 (27%) of which were qualified with the DELBI instrument as “highly recommended”. The Guideline Development Group (GDG) elaborated 41 questions, 30 (73%) were adapted following the methodology proposed by the ADAPTE collaboration. The remaining 11 (27%) developedde novo; 12,000 titles and publication summaries have been reviewed, of which 130 have been included and qualified with the system proposed for GRADE Working Group. The results take into account the challenges implied in the CPG adaptation processes.
P343 Selling Old Wine In New Bottles: Why It Is Worthwhile To Have Another Guideline Development Handbook?
Authors: Muche-Borowski C , Nothacker M , Kopp I
Published: August 2013

Background

Since 1995, the Association of the Scientific Medical Societies in Germany (AWMF) maintains an open access, quality assured guideline register (www.awmf.org), currently containing 676 guidelines developed by 168 societies. While the societies are responsible for topic selection, development and content, the mission of AWMF is to promote, support and coordinate guideline development and to ensure the overall quality of the guideline register. To achieve this goal, AWMF established a new set of recommendations and rules.

Context

Published manuals for guideline developers do not fully meet the requirements of our national guideline system. Our manual takes into account the - development of methodological strategies - international consensus on key criteria for “good guidelines” - target group including guideline novices and clinical experts wishing to be informed about methodological developments but to delegate project management and basic methodological work - informational need to include guidelines into the AWMF register - specific requirements of the German health care system (e.g. the patients’ rights act)

Description of Best Practice

Our manual consists of two parts. The first part includes recommendations and practical advice for guideline developers. The second part includes rules AWMF applies to judge inclusion into the register (e.g. addressing the management of conflict of interests).

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Our guideline development handbook which will be updated continuously may serve as an example for methodological guidance that is based on a systematic review of the international literature as well as the identification of national requirements and experience.
P348 Patient And Consumer Involvement In Guideline Interpretation And Patient Tool Development; A Comparison Of Two Focus Groups And Understanding Cultural Diversity
Authors: Davino-Ramaya C , Ramaya K , Tucker H
Published: August 2013

Incorporating patient and consumer involvement in clinical practice guideline (CPG) activities has become a priority for health care organisations internationally. In diverse populations with potential healthcare disparities the development of culturally competent patient tools based on interpretation of preexisting clinical practice guidelines is also considered important practice for many organisations that adopt external guidelines. In our exploration of the role of consumer engagement in the development of CPG support tools and in addressing healthcare disparities we compare the results of two culturally different groups through the evaluation of pre and post surveys as well as in-person focus groups. Survey intent was to gauge awareness of the existence of CPGs and gauge interest in developing patient and consumer support tools. Results of one culturally diverse group are compared with a minority group. We analyse the perceptions and attitudes of high priority health care issues identified by both groups. Our findings underscore the opportunity for health care organisations with significantly different populations to address healthcare disparities in the development of patient and consumer CPG support tools. As an extension of our previous work on “collaborative engagement” our comparative results emphasise the need to appropriately address cultural, language and health literacy issues as well as addressing health disparities between populations. We focus on identifying barriers to access and treatment and discuss implication for practice as well as future directions.
191WS Software Tools and Action Statement Profiles to Facilitate Guideline Development
Authors: Shiffman R , Rosenfeld R
Published: August 2013

Background

Despite the importance of guideline recommendations being “actionable”, many current guidelines fail to meet standards for clarity, transparency, and implementability. These deficiencies contribute to failure of guidelines to influence care.

Objectives/Goals

Attendees will • Learn how BRIDGE-Wiz software can lead developers to devise clear and actionable statements linked to appropriate indicators of evidence quality and recommendation strength; • Learn how eGLIA software can help to identify obstacles to successful implementation. • Learn how key action statements and action statement profiles can be used to support transparency of the guideline development process and promote successful implementation.

Target Group, Suggested Audience

Guideline developers, guideline implementers

Description of the Workshop and of the Methods used to Facilitate Interactions

Following a brief overview of IOM standards for trustworthy guidelines and common problems in creating actionable recommendations, the facilitators will lead the “panel” through dynamic creation of a guideline recommendation using BRIDGE-Wiz. Attendees will function as a guideline development group responding to prompts from the software and interacting with the facilitators and one another. Facilitators will next provide a brief demonstration of eGLIA software appraising selected recommendations to identify implementability challenges. With audience participation, recommendations will be appraised and conflicting appraisals reconciled to create an implementability report. Finally, the construction and use of action statement profiles will be discussed. Action statement profiles summarise information about each recommendation and make explicit and transparent the process by which evidence and opinion are transformed into recommendations about appropriate care.
258WS Evidence to recommendations frameworks: Diagnosis
Authors: Schünemann H , Alonso P , Bossuyt P , Brozek J , Leeflang M , Deurenberg-Gopalakrishna G , Langendam M , Koster M , Mustafa R , Santesso N
Published: August 2013

Background

Moving from evidence to recommendations (EtR) in guideline development requires balancing evidence quality with the benefits and harms of interventions, patient preferences, and resource and cost considerations. Developing recommendation about diagnostic tests and strategies is particularly challenging and requires tackling complex challenges, different than those needed for therapeutic interventions. The GRADE Working Group, has developed an approach to integrate these factors into development of clinical practice recommendations that is currently further defined in the DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) project. This workshop will introduce this approach and evaluate the EtR framework based on examples and hands-on exercises.

Objectives

To learn how to use and evaluate the EtR framework for diagnostic questions.

Target Group, Suggested Audience

Guideline developers, systematic reviewers, clinicians.

Description of the Workshop and of the Methods used to Facilitate Interactions

This workshop provides a brief didactic overview of GRADE for diagnostic questions. Each group will use a systematic review and a partially pre-filled EtR framework. During the small group work, participants will discuss challenges and advantages of the approach. Participants will then apply these concepts in small groups to develop a recommendation based on the workshop material; there will be a plenary to provide feedback that will help to enhance the work and provide opportunities for collaboration.
002 Public Attitudes to and Knowledge of Healthcare Guidelines, and Methods to Communicate Guideline Recommendations to Patients and the Public – A Systematic Review
Authors: Loudon K , Santesso N , Callahan M , Harbour R , Thornton J , McFarlane E , Treweek S
Published: August 2013

Background

Improving patient versions of guidelines is one way to support an increasing role for patients in health decision making.

Objectives

To evaluate evidence on the public’s attitudes and knowledge of clinical practice guidelines AND what strategies have been used to communicate guideline recommendations to this group.

Methods

We conducted a systematic review of public attitudes and knowledge of clinical practice guidelines to inform the development of dissemination strategies for this population. We searched health databases from 2000 to 01/2013, grey literature, and we contacted guideline producers. Two reviewers independently abstracted, coded, synthesised themes from the studies.

Results

We included 25 published studies and three reports (CCPG, NICE, SIGN). There was a huge variation in the public’s awareness of guidelines (12 studies) from 25–75%. The key themes to communicate guidelines (15 studies) to the public included, predictive factors (amount of education), personalisation, access to care, trustworthiness (evidence behind recommendations), and self-management.

Discussion

Although there were few studies for thematic analysis there were recurrent themes. When developing patient versions, the danger could be to focus on detailed formatting instead of fundamental issues around whether patients dismiss guidelines as not applicable to their unique situation and restricts care. The results will inform work focused on the public and patients being done in EU FP7 DECIDE project.

Implications

Guideline producers will need to increase the public’s awareness of clinical guidelines and developing communication strategies that are clearly personally applicable, trustworthy and useful for patients and carers managing their care.
004 Partnering to Transform Clinical Research Into Evidence-Based Health Care Guidelines
Authors: Wasson N , Chang C , Smith MEB , Qaseem A , Starkey M , Buckley D , Chou R , Saha S
Published: August 2013

Background

A guideline-making body nominated pressure ulcer risk assessment, prevention, and treatment as evidence review topics to support the development of clinical practice guidelines, partnering with a funding agency and a systematic review team to conduct the research.

Context

Collaboration may enhance evidence-based health care given that multiple organisations bring diverse resources and expertise to the process of guideline development. By partnering to develop systematic reviews (SR) with focused research questions, funders, review teams, and guideline committees can effectively evaluate and synthesise the voluminous evidence required to inform guidelines.

Description of Best Practice

We describe our processes for linking reviews to guideline development, including: •Nomination/refinement of focused review topics •Clearly defined roles for each participant •Development of comprehensive SRs •Well defined processes to preserve the scientific integrity of the review while allowing for input from stakeholders •Stakeholder and funder participation throughout the review process •Development of the guideline •Publication of the research results and guidelines.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Challenges include balancing the interests of the nominator/guideline developer and a broader stakeholder audience; answering the clinically important questions needed to develop a guideline; effectively presenting the findings; and coordinating among groups. Collaboration ensures that SRs are focused and relevant to guideline committees, aiding in the development of research that meaningfully informs clinical guidelines. Synergy between partner organisations can lead to wider dissemination of findings and facilitate timely guideline development for implementing best practices to improve health outcomes.
007 Partnering To Transform Clinical Research Into Evidence-Based Health Care Guidelines
Authors: Al-Ansary L , Amer Y , Fattouh R , Adi Y
Published: August 2013

Background

Despite the availability of clinical practice guidelines (CPGs) on the management of diabetes mellitus type 2 (DMT2), optimal control is not achieved in many parts of the world.

Objectives

To assess whether recent nationally-endorsed DMT2 CPGs refer to Cochrane reviews that relate to the recommendations of these CPGs.

Methods

MEDLINE, EMBASE, guideline agency websites and Google were searched for CPGs written in English on the management of DMT2 in any practice setting published between Jan 2008 – Jan 2013. Four raters independently appraised each CPG using the AGREE-II instrument. The Cochrane Library (CL) was searched for published reviews using ‘Diabetes mellitus, Type 2’ [MeSH]. Reviews published one year prior to the CPG’s publication date were considered ‘available’ reviews. Two reviewers independently assessed their relevance for the CPGs’ recommendations.

Results

Five CPGs were identified. The highest scores were for ‘clarity-of-presentation’ and the lowest were for ‘applicability’. The CL search retrieved 45 reviews; 7 of them were assessed as irrelevant. The Canadian-2008, the Australian-2009 and the UK-NICE-2008/2009 guidance referred respectively to 80%, 85.7% and 93.8% of “potential” Cochrane reviews. The American-Diabetes-Association Standards of Medical Care in Diabetes 2013 cited 9/38 and the Malaysian 1/18 recent review. This variation in the uptake of relevant Cochrane reviews was not directly related to the rigour-of-development domain score.

Implications for Guideline Developers, Adaptors, Implementers, and/or Users

Despite the increased production of Cochrane reviews, guidelines developers do not consistently refer to them. This needs to be explored and the practical means for maximising their uptake should be entertained.
P004 Guidelines and Performance
Authors: Daniel Keenan
Published: August 2013

The Guidelines and performance measures allow us to reduce variation in the provision of care and to provide reassurance to all that care is optimum.

In England we continue to look at clinical performance and have focused of the three main tenants of quality; clinical effectiveness, safety and patient experience from institution down to individual. Institutional effectiveness has been looked at in relation to targets which are “must do”, such as primary angioplasty times (previously thrombolysis) and performance against standards such as time to scan for stroke. Next come such measures as the percentage of patients admitted to a dedicated stroke unit and the use of cognitive behavioural interventions. In relation to individual performance, we have looked at mortality rates following open-heart surgery. This year, under the government’s transparency agenda, individual results are to be published from additional national interventional audits. More are to follow and virtually all the national audits and registries will be published with a high degree of granularity in the next few years.

In primary care the quality and outcomes framework, which is a remuneration package for primary care physicians, is used to manage performance and has driven up the quality of the services offered. It is based on a basket of process measures, which are managed by the National Institute for Health and Care Excellence (NICE), and are renegotiated to drive increasing improvement that is evident by improved performance against the indicators.

With recent changes in government policy, increasing interest has focused on the quality of commissioning and measures have been derived from NICE Quality Standards (in effect an amalgamation of guidelines into 12 standards) to assess this. Further, with the introduction in the UK this year of medical revalidation, there is an increased emphasis on individual information to support re licensing.

Overall, therefore, we have a dual track of the increasing development of guidance and the condensation of these into easily manageable standards and the measurement of performance, at many levels, against these standards.
009 Ethical principles in guidelines, it is never ending story
Authors: Licenik R , Klikova K , Osinova D , Doubravska S , Ivanova K
Published: August 2013

Background

Bioethical principles should be an integral part of all guidelines. Recently, there has been a movement towards ethical principles to be explicit in guidelines. They should be systematically evaluated.

Objectives

We have done a systematic review on ethical principles in guidelines and developed an instrument for evaluation of ethical principles in guidelines based on the AGREE II instrument.

Methods

The Questionnaire and User’s guide have been developed and tested. The questionnaire covers basic ethical principles, i.e. respect for autonomy, beneficence, non-maleficence and justice, as well as other very important issues such as health professional-patient relationship and inter-professional collaboration. The last question is whether a particular CPG contains examples of ethical dilemmas. New domain on equity was added. A pilot version of case reports for some domains was developed. The instrument will be disseminated, implemented, evaluated and updated if needed.

Results

Instrument for evaluation of ethical principles in guidelines.

Discussion:

Useful instrument for the evaluation of ethical principles in guidelines has been developing.

Implications for Guideline Developers/Users

The instrument can be used during guideline development process as well as during implementation and for evaluation of the quality.
011 Methodological Issues Related To Mandatory Coverage Policies of the Brazilian Regulatory Agency (ANS) To Be Followed By Brazilian Private Health Plans (BPHP)
Authors: Pazos M Cabanelas , Silva S Alves da , Souza P Pereira de , Cardoso P Rascão
Published: August 2013

Context

Brazilian private health plans (BPHP) are regulated by ANS mainly through a list of procedures for mandated coverage, some of which are supported by guidelines formulated by Medical Societies. Where guidelines exist quality varies widely. Penalties imposed on BPHP by ANS have frequently involved coverage mandates not supported by guidelines. An example is treadmill testing, which is ordered more often than can be administered to patients due to lack of providers. A dialogue for collaboration on specific issues between Brazil’s largest health plan and the regulatory agency started in 2012.

Description of Best Practice

Four areas of interest were selected based on 1)high economic impact; and 2) utilisation issues: cardiovascular and genetic testing, neurosurgery and oncologic procedures. ANS interest focuses on new technologies to be addressed in the upcoming revision of the mandatory coverage list. We used the AGREE II instrument to identify inconsistencies in the ANS guidelines. Most weaknesses related to “Rigour of development” issues.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Brazilian regulators currently seek improved criteria for regulation of health technologies. Independently developed guidelines are sparsely used by regulators in Brazil. We initiated a public-private partnership which brings methodological standards to the table such that scientifically sound guidelines may play an enhanced role in Brazilian regulatory policy. Such a step may increase appropriate utilisation of resources and diminish penalties applied by ANS due to requests not supported by scientific- evidence. Full development of the partnership will require participation of the medical societies.
013 Cases for Action: a new approach to addressing gaps between research evidence and health policy and practice in Australia
Authors: Berry M , McCallum J , Ghersi D , Fitzgerald A , Clydesdale J , Goodwin A , Singh A
Published: August 2013

Background

In 2012, Australia’s peak body for supporting health and medical research established a Research Translation Faculty of 2,500 researchers to address challenges of translating research evidence into policy/practice. The initial focus of the Faculty is developing Cases for Action to address Australia’s major health issues through high-level advocacy.

Objectives

To work collaboratively with senior researchers to develop compelling cases for actions that could be taken to address the most significant gaps between research evidence and health policy/practice in Australia.

Methods

Faculty members will search literature, consult with stakeholder networks and debate issues in developing a paper of published evidence, recommending actions to address each prioritised gap and providing the rationale for prioritisation. Steering Groups will oversee the development of each Case for Action.

Results

This presentation will share the experiences and lessons learnt to-date in developing Cases for Action.

Discussion

There is a gap between what we know and what we do. Cases for Action will draw on the combined expertise of researchers to systematically consider and prioritise actions to best address these gaps. Possible actions that could be proposed include advice to government about health policy, clinical or public health guidelines, or opportunities to collaborate with strategic partners to leverage investment in health or to provide support in the implementation of heath strategies.

Implications for Guideline Developers/Users

The lessons learnt from the Cases for Action process will benefit attendees who are considering how to focus their effort to ensure that healthcare policy and practice best reflects available evidence.
014 Can health care networks develop autonomy over development and implementation of guidance within an environment shaped by accreditation standards?
Authors: Goldman S , Koster M , Schottinger J
Published: August 2013

Background

Standards for clinical practice enacted by external accreditation organisations can limit the ability of health care organisations to develop and implement evidence-based guidance to improve clinical practice and health system efficiency, and reduce unnecessary testing.

Context

As part of a system-wide effort to improve patient quality and access, medical specialists in a large group practice sought to determine whether standard bilateral venous duplex ultrasound (VDUS) scans were medically necessary in patients with unilateral signs and symptoms of deep vein thrombosis (DVT). Typically these patients receive bilateral exams; however, the high number of negative test results in non-symptomatic legs suggested bilateral testing may not be necessary.

Description of Best Practice

An evidence review was conducted to evaluate whether unilateral VDUS scanning accurately identifies patients who can safely undergo unilateral VDUS exams in the symptomatic limb without missing a DVT in the unscanned, asymptomatic limb. The evidence review concluded that the number of undetected DVTs in the unscreened asymptomatic limb was very low, suggesting that unilateral VDUS screening in lower-risk patients (i.e., outpatients and patients without malignancy) could be safely performed. Accreditation standards, however, require bilateral screening in all patients, regardless of DVT risk status.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Accreditation standards can hinder practice change and limit research for more effective and efficient practices. Some accrediting organisations accept feedback and adjust standards as new data emerges. Providing evidence-based information to these organisations may initiate changes in standards.
015 Tracking the Impact of the Agency for Healthcare Research and Quality’s (AHRQ) Effective Health Care Program through Uptake by Clinical Practice Guideline and Quality Measure Developers
Authors: Erinoff E , Coates V , Nix M
Published: August 2013

Background

Public and private funders evaluate health care investments in terms of outcomes and accountability. Citation analysis can approximate the dissemination and impact of funded research outputs.

Objectives

Use references in guidelines and measures represented in the National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) to track the uptake of AHRQ Effective Health Care (EHC) programme outputs.

Methods

442 EHC-related titles were searched against the full-text corpus of the Clearinghouses. Documents that cited the titles were examined for the context of the citations. References were considered strong when tied to a specific metric or recommendation or noted as important to the guideline’s methodology; moderate if discussed in the body of the citing document; and weak if they appeared only in the reference list.

Results

174 individual guidelines and measures cited EHC-related titles (n = 341). 50% of the guideline references were strong, 28% moderate and the remainder weak or undetermined (22%). All measure references were strong.

Discussion

This analysis has been done annually since 2010 with the numbers of detected citations increasing each year. The method used not only assesses whether a work was referenced in a guideline or measure, but its relative importance to the guideline or measure providing evidence of impact of the EHC programme.

Implications

Systematic reviews and other research published through the EHC programme are being used to develop guidelines and measures that meet inclusion criteria for NGC and NQMC. EHC reports may be downloaded and topics nominated atwww.effectivehealthcare.ahrq.gov
018 The Implementation Field Team 6 Years On: Approaches to Engagement and Evaluating Impact
Authors: Moore J , Moore V
Published: August 2013

Background

The Implementation Field Team for this national guidance producing organisation has been established for six years. Seven consultants visit around 800 organisations annually, providing updates on national guidance, sharing examples of implementing good practice, and collecting feedback on our national guidance and barriers to implementation.

Context

We have consistently evaluated our activities, but have found inherent difficulties with identifying impact, and have relied on proxy measures of success. As a new system for commissioning health services develops, we reviewed evidence around effective implementation activities and evaluating their impact. This led to innovative approaches to engagement and improved methods of evaluating impact.

Description of Best Practice

We revised field team implementation strategies and activities to fit better with the new system of health commissioning. We conducted our own small scale survey, and also invited an external organisation to conduct a larger survey with field team clients to evaluate impact and to inform the planning and delivery of services in the future. We have moved from proxy measures of effectiveness evaluated every six months to newly developed “success criteria”, which are outcomes focused, owned by the whole organisation, and identify three year incremental objectives for external engagement. This informs operational plans for future engagement activities.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Evaluating the impact of implementation activities and teams is difficult but important and achievable. Focusing on immediate and intermediate implementation outcomes over longer timescales, and developing success criteria for field team implementation and engagement activities is valuable.
021 Reducing OverPOPulation: Achieving More By Doing Less
Authors: Schottinger J , Koster M
Published: August 2013

Background

Too-frequent screening for cervical cancer can increase costs, lead to unnecessary invasive procedures associated with overtreatment, and shift resources away from the one in five women who do not receive recommended routine screening.

Context

A large, US-based integrated healthcare system with centralised evidence services and eight independent regions developed and implemented an evidence-based guideline for cervical cancer screening. Novel implementation strategies and performance monitoring in one region in Southern California led to significant improvements and are described below.

Description of Best Practice

Graded evidence summaries were conducted by a centralised analytic unit, and recommendations developed by a guideline team with representation from each region. In one large region with more than 3 million patients, interventions aimed at the practitioner, patient and systems levels were implemented for routine Pap and HPV co-testing. Practitioner interventions included electronic distribution of guidelines, point-of-care electronic prompts, and workflow support. Patient-level interventions included point-of-care education, and in-reach/outreach activities. System-level interventions focused on centralised patient outreach letters and reminder calls, computerised decision support, and unscreened cancer lists for panel management. Monthly performance monitoring on a measure of “overpopulation” was reported at medical centre, department and provider levels. In a five-year period, over 100,000 fewer unnecessary Pap tests were performed, while screening rates increased by 7%.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users

Centralised guideline development, coupled with coordinated implementation and performance monitoring, can reduce unnecessary screening and invasive procedures, focus resources on appropriate routine screening in underscreened populations, improve patient access and reduce costs.
025 The Efficiency-Validity Methodological Continuum (EVMC) For Sustainable Guideline (CPG) Development: A Negotiating Tool for Credible Compromises in Quality for Affordable Trustworthy Guidelines
Authors: Browman G , Somerfield M , Lyman G
Published: August 2013

Background

Research methodologists and guideline sponsors are on a collision course as growing demands for scientific rigour raise costs and lengthen delays in CPG production.

Objectives

To design a tool for CPG developers and sponsors to negotiate methodological compromises while preserving CPG trustworthiness. There are already variations in CPG quality that we tolerate. Flawless systematic reviews and guidelines are unrealistic. Methodological compromises are inevitable and imposed by practical constraints. Negotiating and reporting methodological compromises can fill a transparency gap where methodological choices are made in the development of a CPG.

Methods

Three individuals with guideline development experience collaborated to design a tool that aligns stakeholders’ interests while preserving ‘trustworthiness’ and enhancing transparency.

Results

The Efficiency-Validity Methodological Continuum (EVMC) is anchored at the extremes by “practical” at the “efficiency” pole and “best achievable” at the “validity” pole, highlighting the tradeoffs. The continuum between these is represented as a solid line. A ‘zone of preference’ closer to the ‘validity’ and a ‘zone of acceptability’ closer to efficiency are negotiating zones. Beyond the anchors, represented as broken lines, are “expedience” at the efficiency end and “ideal” at the validity end. Guideline development should operate within the solid segment of the continuum. The broken segment towards ‘expedient’ risks methods with unacceptable threats to validity; and towards ideal, an unaffordable standard not worth the incremental costs. Examples highlight the tool’s utility.

Conclusions

Negotiating and reporting compromises in methodological quality can lead to sensible, transparent methodological choices acceptable to both CPG developers and sponsors.
026 What organisational resources have to be considered when adapting guidelines in the context of Low and Middle Income Countries (LMIC)? The Argentinean experience
Authors: Esandi M , Luca M De , Ortiz Z
Published: August 2013

Background

Adapting guidelines in resource-constraints countries represents a great challenge. Availability of organisational resources has to be considered before implementing this methodology.

Objectives a)

To compare the availability of different organisational resources during seven guidelines adaptation initiatives facilitated by the National Academy of Medicine (Argentina) between 2005 and 2013; b) to analyse the relevance of each type of resource category for adapting guidelines in the context of LMIC.

Methods

7 guidelines adaptation initiatives facilitated by the NAM since 2005 and 2013 are described. Organisational resources were categorised in 4 categories: organisational culture, human resources, economic resources, and condition resources (or states) within the organisation. Conservation of resources (COR) theory was used as the theoretical basis for analysing the relevance of each type of resource for the guideline adaptation process.

Results

Four of the 7 initiatives completed the whole process and produced an evidence-based guideline; 1 was interrupted and 2 are still ongoing although 1 of them shows a considerable delay. Among all organisational resource categories, culture and human resource were perceived as the most critical, particularly in what respects to the availability in the guideline developer group of change agents (i.e. internal and external facilitation); disposition to change and motivation and an appropriate mix of skills including leadership, communication, team work, technical competences.

Discussion

Guidelines adapting in resource-constraint countries is not easy, although possible if different critical organisational resources are provided from the outset of the process.

Implications for Guideline Developers/Users

A minimum organisational resource threshold is necessary for guarantying guidelines adaptation in the context of LMIC.
027 Determinants Of Guideline Use Among Primary Care Physiotherapists In Western Sweden: A Cross-Sectional Study
Authors: Bernhardsson S , Johansson K , Nilsen P , Öberg B , Larsson M
Published: August 2013

Background

The understanding of attitudes, knowledge, and behaviour related to evidence-based practice (EBP), in particular evidence-based clinical practice guidelines, in primary care physical therapy is limited.

Objectives

To investigate self-reported attitudes, knowledge, behaviour, prerequisites, and barriers related to EBP and, in particular, guidelines among physical therapists (PTs) in primary care, and to explore associations of self-reported use of guidelines with these social-cognitive factors.

Methods

Cross-sectional survey of PTs (n = 400) in primary care in western Sweden using a web-based, validated questionnaire. Logistic regression analysis was used.

Results

The response rate was 67.8%. Most PTs (82%–96%) had positive attitudes toward EBP and guidelines. Thirty-three percent reported being aware of guidelines, 13% knew where to find guidelines, and only 9% reported having easy access to guidelines. Less than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability and limited access to guidelines, that they are too general and take too long to read. Positive attitudes to EBP and guidelines, knowledge of where to find guidelines, self-efficacy, easy access, ability to integrate patient preferences, and encouragement of EBP in the workplace were associated with frequent use of guidelines.

Discussion

Use of guidelines was not as frequent as could be expected in view of the positive attitudes. Attitudes, knowledge, self-efficacy, easy access, ability to integrate patient preferences, and encouragement of EBP may promote guideline use.

Implications for Guideline Developers/Implementers

The identified barriers and determinants can be addressed in the development of guideline implementation strategies.