bluuebunny/crossref_metadata_2025_split huggingface dataset:
083PS Incorporating Guidelines into Local Clinical Practice and Policy Through the Use of Practice-Based Health Technology Assessment
Authors: C Umscheid , M Koster , M Marchetti , M Helfand , P Wyer 
Published: August 2013

BackgroundPractice-based health technology assessment (PB-HTA) has the potential to improve the quality, safety and value of patient care by synthesising evidence to provide timely guidance for clinical practice, policy, formulary management, operations, and purchasing decisions. Hospital-based HTA centres are active in Western Europe and Canada, but less so in the US, and some operate in conjunction with formal evidence-based guideline programmes.Objectives/GoalsTo actively engage leaders of PB-HTA to discuss strengths and limitations, lessons learned, and the role of PB-HTA in the development, dissemination, and implementation of guidance within health care systems.Target Group/Suggested AudienceSenior executives/administrators, and clinical policy, quality and safety leaders in healthcare organisations and networks who develop, implement and measure performance related to clinical guidance.Description of Aession and Speaker TopicsDr. Wyer, who leads a PB-HTA capacity building programme for health care organisations at the NYAM SEBHC, will engage the panellists in a discussion of their experiences leading PB-HTA efforts at Kaiser Permanente (Ms. Koster), the Veterans Administration (Dr. Helfand), Penn Medicine (Dr. Umscheid) and the HTA unit at the Catholic University Hospital in Rome, Italy (Dr. Marchetti). The discussion will address the potential for guidance developed by PB-HTA centres to impact the quality, safety and value of patient care, similarities and differences in national and international efforts, and future directions for the field.
P168 Practice Guidelines And Professional Mind-Lines. Qualitative Research On Sysadoas For Osteoarthritis
Authors: Gutiérrez-Ibarluzea I , Ibargoyen-Roteta N , Mateos-del Pino M , Benguria-Arrate G , Regidor-Fuentes I , Domingo-Rico C , González-Santisteban R , Rada-Fdz de Jauregi D 
Published: August 2013

BackgroundThere is still a gap between what good quality CPGs recommend and real practice. For osteoarthritis, although best quality CPGs do not recommend SYSADOAS, a high degree of variability in prescription rates has been observed.ObjectivesTo explore the reasons that explains SYSADOAS prescription for osteoarthritis.MethodsA qualitative research was performed including one focus group to explore what General Practitioners (GPs) thought about this topic, and two in-depth interviews with specialised care. 8 GPs, one orthopaedic surgeon and one reumatologist participated. Focus group and interviews, previous consent recorded, were transcribed and analysed using MAXQDA software.ResultsGPs were aware of the lack of evidence about SYSADOAS efficacy, but they did not know which CPGs they should trust in. Prescription was mainly initiated by specialists, but GPs admitted that they also started it, being the respect for their colleagues and patients’ pressure the main reasons. Specialists did not use CPGs on this issue, but partially admitted that SYSADOAS had no effect. For them, health care pressure, high ratio of patients and a rapid way to discharge them were the main reasons.DiscussionClinician’s knowledge about CPGs and quality standards is scarce. The lack of communication among health care levels and the inadequate management of the disease are, among others, the reasons explaining SYSADOAS prescription.Implications for Guideline Developers/UsersProvide clinicians skills and tools to empower them about which is considered good evidence and how to critically appraise CPGs, and promote the communication between levels to improve patient management.
P172 Challenges of Measuring the Uptake of National Public Health Guidance in the UK: A New Methodology
Authors: Lea R , Griffiths P , Moore V 
Published: August 2013

BackgroundWe use published evidence to measure the uptake of national public health guidance recommendations. Available sources of uptake include national audits and reports, and peer reviewed journal articles. These are summarised and uploaded to an online database. This database is used to inform several streams of work in our organisation, including an internal review decision process for public health guidance. Identifying sources of uptake information in this area is challenging.ObjectivesTo assess the existing information on the database, and report on the effectiveness of a new approach to identifying potential sources of uptake information.MethodsAn evaluation of public health uptake sources on the database was conducted, and a stakeholder mapping tool developed, which was used to systematically search for sources of uptake information. Stakeholders were contacted to provide information. Existing literature search strategies were reviewed and revised. Following these actions, the database was updated with the new sources and the impact of the exercise assessed.ResultsThe evaluation of the current database highlighted significant gaps regarding information relating to the uptake of public health guidance. Use of the methods outlined above identified a substantial amount of new information and a large number of potential sources of uptake for future reference.DiscussionThe uptake of public health guidance is increasingly in the spotlight for the NHS, and knowing if recommendations have been implemented is helpful when deciding if guidance needs to be reviewed and updated. It is therefore important to have an accurate picture of uptake.
P179 Facilitating Implementation Of Guidelines For The Prevention Of Vascular Disease In General Practice
Authors: Harris M , Litt J , Russell G , Mazza D , Lloyd J , Zwar N , Taylor R , Van Driel M , Del Mar C , Krastev Y , Parker S , Smith J 
Published: August 2013

BackgroundAlthough evidence based guidelines have been developed and disseminated, up to a half of patients do not receive guideline based preventive care.ObjectivesThis study aims to evaluate a model for the implementation of preventive care guidelines in general practice.MethodsFollowing a development process for the intervention involving a mixed method study and a pilot carried out in three practices a cluster randomised controlled trial is being conducted in 31 practices across four states. The intervention involves training, preventive care audit, and visits from a facilitator based in the local primary care support organisation. The facilitator assists practices to review their clinical audit and implement a practice plan structured around the 5As to improve the reach and quality of preventive care. Quantitative and qualitative evaluation methods are being used to assess impact on planned change within the practice, recalled and recorded preventive care, and patient behaviours and risk factors for cardiovascular disease.ResultsBaseline data collection has been completed from practice staff and patients and the intervention is now complete. The recorded and patient recalled preventive care varied within and between practices resulting in a varied set of priorities for improvement. Early findings suggest that facilitation visits to review and plan improvements to the implementation of preventive guidelines are feasible, acceptable and can support organisational strategies to address gaps in care.DiscussionOur results may provide a model for local primary care support organisations to assist practices to improve their quality of preventive care.
P181 Snoring, Gasping and ADAPTE!
Authors: Bruinvels D 
Published: August 2013

BackgroundThe Netherlands Society of Occupational Medicine (NVAB) has a tradition of guideline development since 1999. The development of a typical monodisciplinary guideline for occupational physicians takes two years. In order to save time and costs the NVAB initiated an ADAPTE process for a monodisciplinary guideline on Obstructive Sleep Apnea Syndrome (OSAS).ContextOSAS is a major problem in the working population and may attribute to a substantial proportion of work related problems associated with fatigue. Examples are work accidents, work errors and productivity loss. Although a Dutch multidisciplinary guideline on OSAS exists, only a minority of the Dutch occupational physicians actually uses this guideline. To facilitate the implementation of the guideline, the NVAB provided a summary, a PowerPoint presentation, and medical case studies for occupational physicians. However, the guideline was still not implemented in clinical practice. Therefore the NVAB took the initiative to develop a monodisciplinary practice guideline for occupational physicians.DescriptionThe ADAPTE process was used to develop a monodisciplinary practice guideline for occupational physicians based on a Dutch multidisciplinary guideline developed by CBO in 2009. The aim was to develop a monodisciplinary guideline in one year. In the end it took almost 3 years to adapt the guideline.LessonsADAPTE is a practical tool to adapt multidisciplinary guidelines into monodisciplinary practice guidelines. However, the use of the ADAPTE process does not guarantee time savings and reduction of development costs.
167PS Setting New Horizons In Optimizing Guideline Utility
Authors: Scott I , Norris S , Schünemann H , Guyatt G 
Published: August 2013

BackgroundTo maximise uptake, CPG recommendations must avoid of bias and be responsive to the needs of clinicians and patients from different populations and settings.Objectives/GoalTo discuss three key challenges to CPG use: 1) building consensus and minimising conflicts of interest in formulating recommendations for specific patient populations; 2) taking account of patient multi-morbidity; 3) incorporating patient values and preferences for specific outcomes.Target groupSuggested audience Guideline developers and writing groups, clinical researchers, users of guidelines (clinicians, patients).ModeratorProf Ian A Scott, Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Australia.Invited SpeakersDr Susan L Norris, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, USA. SLN is Technical Officer for the secretariat of the Guideline Review Committee at the World Health Association in Geneva, Switzerland and has conducted research on conflicts of interest. Professor Holger J Schünemann, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. HJS is co-chair of the GRADE working group, member of the GIN board of trustees and has co-authored reports on guideline methodology, including multimorbidity. Professor Gordon H Guyatt, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. GHG is co-chair of the GRADE working group and chaired the executive of 9th iteration of the American College of Chest Physicians Antithrombotic Guidelines.Description of session and speaker topicsSession will comprise 3 presentations (15 mins), one for each challenge, with 5 mins for questions of clarification then 30 mins of panel discussion.
P193 Adopting NICE Guidelines In Other Countries
Authors: Gholitabar M , McGuire H 
Published: August 2013

BackgroundAlthough NICE guidelines are developed to inform clinical practice in England and Wales, they attract interest from researchers, clinicians and healthcare organisations all over the world. This has generated discourse about whether, and to what degree, recommendations from NICE guidelines are applicable to different countries.ObjectivesTo consider if NICE recommendations should be adapted for use in other countries in terms of differences in health care systems, values and needs? - To discuss the varying approaches to adopting NICE guidelines and recommendations Methods Using the NICE Intrapartum Care clinical guideline, we will select illustrative examples of recommendations. Factual data and information from one developing country - Islamic Republic of Iran - will be used to evaluate the ease with which these could be implemented. We will consider the Iranian health care setting; economic situation; social values; geographical issues; cultural issues and priority health care policies.ResultsWe will present the findings in three categories corresponding to the ease with which NICE recommendations can be implemented in another country.DiscussionA focused discussion will centre on - whether adopting NICE guidelines and recommendations outside of England and Wales is feasible - what additional work may be need to carried out to facilitate this process - the ethics of such activity in terms of self-reliance and research capacity.Implications for Guideline Developers/UsersThis project will identify areas where existing guidance can be shared across borders thereby reducing duplication of effort; facilitating international collaboration and building capacity in guideline development methodology and implementation.
P198 Adherence To Infertility Guidelines With Regard To Treatment Policy
Authors: Kersten F , Nelen W , Goddijn M , Braat D , Mol B , Hermens R 
Published: August 2013

BackgroundNowadays, prognostic models are increasingly being used in reproductive medicine. One of these models calculates the chances of conception for couples with unexplained infertility and subsequently indicates the right treatment policy. The Dutch national network guideline on infertility recommends the use of this prognostic model to prevent unnecessary treatment. This strategy is supported by international guidelines on the management of infertility (ESHRE and NICE).ObjectivesThe aim of this study is to evaluate guideline adherence regarding treatment policy for couples with unexplained infertility in 25 Dutch clinics.MethodsIn this retrospective study, we assessed guideline adherence with regard to 1) the use of the prognostic model and 2) the right treatment decision. Data were collected from medical records.ResultsIn this abstract we present the preliminary data of ten clinics. At the GIN conference we will have the results of all 25 participating clinics. So far we included 208 couples with unexplained infertility. In 54% of the couples the prognostic model was used. In 69% of the couples the right treatment decision was primarily made. However, ultimately, 41% of all couples received unnecessary treatment.DiscussionThis study shows that adherence to the guideline regarding treatment policy is not optimal. Despite the guideline recommendations, more than one third of couples are exposed to unnecessary treatment and risks.Implications for Guideline Developers/UsersImplementation of the guideline is not optimal. To improve guideline implementation a multifaceted strategy has to be developed and evaluated.
P200 Suicide Risk Assessment According to Best Practice Guidelines: The Development of a Chart Audit Performance Measure
Authors: Santa Mina E , O’Grady C , McCay E 
Published: August 2013

BackgroundBest practice guidelines (BPGs) in suicide risk assessment documentation support nursing care of clients at risk for suicide. Investigation regarding nurses’ adherence to BPGs for suicide risk assessment documentation is minimal.ObjectivesIn a mixed-methods study to investigate nurses’ knowledge of suicide risk assessment documentation, the researchers created a chart audit to measure nursing practice congruence with five recommendations from the suicide risk assessment BPG (RNAO, 2009).MethodsFive recommendations, from the BPG: Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour (RNAO, 2009), were the benchmarks for the chart audit measure. Suicide risk indicators, as determined by the Minimum Data Set for Mental Health (MDS-MH) (Ontario Ministry of Health, 2011), were the criteria to identify charts of suicidal clients. The researchers integrated MDS-MH indicators with the five BPG recommendations and constructed compliance indicators that incorporated the Nurses Global Assessment of Suicide Risk (Cutcliffe & Barker, 2004).ResultsFive BPG recommendations, integrated with provincial suicide assessment criteria and a standardised suicide assessment scale produced a 3-point likert scale chart audit with 15 indicators. Possible ranges of scores for documentation congruence with the BPG are 0 to 30.DiscussionThis performance measure provides objective, proxy data to triangulate with nurses’ self-perception of suicide risk documentation and evaluate practice as per BPGs.Implications for Guideline Developers/UsersA standardised instrument to monitor BPG practices can be used to inform implementation and education strategies.
P204 The Updating Process Guidance In Clinical Practice Guidelines Handbooks: A Systematic Review
Authors: Vernooij R , Sanabria A , Solà I , Alonso-Coello P , Martínez García L 
Published: August 2013

BackgroundUpdating is an important process for maintaining recommendations’ and clinical practice guidelines’ (CPGs) validity. CPGs methodological handbooks are designed to provide guidance on developing and updating CPGs, however, little is known about this guidance about the updating process.ObjectivesTo identify and describe the guidance about the updating process in CPGs handbooks.MethodsWe included methodological handbooks that provide guidance about updating. We conducted a systematic search in the Guidelines International Network library, US National Guidelines Clearinghouse, MEDLINE and contacted main institutions. For extracting data we developed a list of key elements.ResultsWe included thirty-six handbooks. Most of them (97%) focus mainly on developingde novoCPGs and include some information about updating. Half of the handbooks provide a time frame for updating guidelines. The majority of handbooks do not provide guidance about the updating process, namely: literature search, evidence selection, assessment, synthesis and external review. Finally, two handbooks (6%) provide information about publishing an updated CPG.DiscussionOur study highlights that the updating process is poorly described in current methodological handbooks. Handbooks do not contain enough information for executing an optimal update.ImplicationsInstitutions responsible for updating and developing CPGs need to pay more attention to updating and reflect this in their handbooks. This guidance should be more rigorous, explicit and detailed. This could, consequently, lead to a more optimal updating process and, hence, more up-to-date recommendations.
P208 How Could Who Better Support National And Subnational Governments In Their Efforts To Adapt And Implement Global Recommendations And Decisions? A Systematic Analysis Of Health Systems Guidance And World Health Assembly Resolutions
Authors: Patino-Lugo D , Lavis J , Perel P , Wu Y , Haines A , Ranson M , Panisset U , Bosch-Capblanch X , Brouwers M 
Published: August 2013

BackgroundThe World Health Organization’s health systems guidance and the normative standards about health systems endorsed in World Health Assembly (WHA) have the potential to better support national and subnational health systems guidance and policy development processes by including information about the contextual factors that can shape decisions about health systems.ObjectivesTo assess the extent to which WHO health systems guidance and the WHA technical documents include information about how to address a health system problem and how the health system arrangements and political system features can influence decision-making.MethodsWe reviewed all WHO guidance published since 2008 to 2012 and WHA resolutions published from 2005 to 2012 and included those with a focus on health systems. Two reviewers independently screened and applied the selection criteria to all the documents and extracted the information following pre-established data-extraction forms.Results13 out of 78 WHO guidance and 14 technical documents out of 207 WHA resolutions had a health system’s focus. Six WHO guidance and 12 WHA documents included information about how to address a health system problem. All WHO guidance included information about delivery arrangements but only three discussed financial arrangements. Two WHO guidance and five WHA documents discussed key features of political systems.DiscussionsThe inclusion of contextual factors, mainly financial arrangements of health systems and political systems features was infrequent among the reviewed documents.Implications for Guideline Developers/UsersIt is necessary to understand better how to integrate these contextual factors in the process of global guidance development.
P210 Changes In Performance Of The Adaptation Methodology Used For Guideline Development From 2002 To 2012
Authors: Khan C , Schwarz S , Conrad S , Koltermann K , Dippmann A , Ollenschlaeger G 
Published: August 2013

BackgroundGuideline adaptation has always been the methodological basis of the German National Disease Management Guideline (NDMG) Programme. Although it allows highly efficient and resource-saving workflows, the NDMG development process becomes an increasingly time-consuming and resource-intensive challenge.ObjectiveThe objective of the present project was to analyse the performance of the adaptation methods used for the NDMG guidelines development to identify the critical issues causing an extensive effort and to find possible coping solutions.MethodsWe reviewed each NDMG method report from the beginning of the programme in 2002 to 2012. We extracted and evaluated the duration of the process, the number of source guidelines used and number and themes of additional literature searches over the course of years also in comparison of the first and second editions.ResultsOne of the 14 NDMGs was excluded because of missing adaptation method during the updating process. The comparison of first half of the programme between 2002 to 2007 and second half from 2007 to 2012 revealed an average duration of the development process of 22,7 versus 49,9 months. Until 2007 4,5 and after 2007 3,7 source guidelines were used on average. The number of topics of systematic literature searches has been rising over the years. On average 5 additional searches were conducted in the last 5 years. 42% of all topics covered pharmacotherapy.DiscussionThe adaptation methodology is still very useful and efficient. However, prioritisation and consensus processes and strict orientation on the selected source guidelines need to be optimised to reduce the increasing effort.