practitioner and patient decisions about appropriate health care for specific clinical circumstances". Their purpose is "to make explicit recommendations with a definite intent to influence what clinicians do". Additionally, guidelines have an important role in standardization care and health policy formation such as health promotion, screening etc.
Cyprus due to the recent financial meltdown has been aiming to reduce the cost and maintain or even improve the quality of care therefore an array of tools have been used to achieve this. Inter alia, the development, implementation and monitoring of clinical guidelines, implementation of clinical governance and clinical audit, implementation of ...view middle of the document...
However, external developed guidelines may not be directly transferable to Cyprus healthcare system, recommendations may refer to services and interventions that are unavailable, or inappropriate, in the target setting. An alternative strategy to developing local guidelines from scratch would be to adapt an existing guideline to local circumstances.
Based on literature review we have implemented a conceptual framework and procedure for adaptation of guidelines.
We are following a 6 steps approach to adapt clinical guidelines under an agreement for technical support from NICE. We are following a similar approach to that proposed one by the ADAPTE Working Group.
1. Defining the clinical question. Our aim is to prioritize and introduce clinical guidelines that are proved to reduce the cost. The clinical questions are prepared, taking into consideration the targeted: population, interventions, healthcare care professionals, health outcomes, healthcare setting in which the clinical guidelines will be introduced. Specifically in Primary care we have selected to start with COPD, hypertension, diabetes mellitus, asthma, heart failure, osteoporosis, osteoarthritis, dyspepsia, irritable bowel syndrome and depression, generalized anxiety disorder. The vast majority of the aforementioned guidelines have already been prepared and introduced in public primary care. First clinical audit results are expected in July 2014.
2. Searching for existing guidelines particularly developed by NICE. We prefer NICE guidelines due to the fact that health economic models are taken into consideration. If NICE guidelines are not available then we search for European guidelines. We have certain cases that departments (i.e ICU) have developed de novo their own guidelines because none existing guidelines would address satisfactorily the posed clinical question.
3. Assessment of the selected guideline clinical content and applicability in the defined local target setting. This is a very important step for successfully implementing the guideline. The National Guideline Group evaluates the clinical content of the source guideline if it covers the posed clinical question in the defined level of care, population and specialty. We perform simultaneously a literature update. Following the clinical content evaluation the NGG assesses the applicability and acceptability of the recommendations to the local context taking into consideration the available resources, personnel, expertise, services, legal or union related issues. Finally the group discusses the change management processes and the potential acceptance or barriers by the target healthcare professionals, policy makers and patients.
4. Evaluation of the source guideline quality. A formal assessment of the source guideline is based on AGREE (Appraisal of Guidelines for Research & Evaluation) instrument by two appraisers (a clinical expert and a...