What Is a Clinical Practice Guideline? – a Roadmap to Their Development. Special Report from the Guidelines Task Force of the International League Against Epilepsy
Abstract number :
1.395
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2022
Submission ID :
2204617
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Nathalie Jette, MD MSc – Icahn School of Medicine at Mount Sinai; Martin Kirkpatrick, MBBS, FRCPE – University of Dundee; Katia Lin, MD, PhD – Federal University of Santa Catarina; Sanjaya Fernando, MBBS, DCH, MD – Colombo North Teaching Hospital; Jacqueline French, MD – NYU Grossman School of Medicine New York University; Lara Jehi, MD, MHCDS – Cleveland Clinic Epilepsy Center; Eva Kumlien, MD, PhD – Uppsala University; Chahnez Triki, MD – University of Sfax; Samuel Wiebe, MD, MSc, FRCPC – University of Calgary; Jo Wilmshurst, MB, BS, MRCPaed, FCPaed, MD – University of Cape Town; Francesco Brigo, MD – Hospital of Merano (SABES-ASDAA)
Rationale: Clinical practice guidelines (CPGs) contain evidence‐based recommendations to optimize the quality of care and inform policy decisions based on the best available evidence. The lack of internationally accepted standards for CPG development across different countries leads to marked heterogeneity in the quality of existing CPGs. The aim of this work was to provide an overview of what distinguishes quality CPGs from other documents, to highlight the recently revised International League Against Epilepsy (ILAE) CPG development process and to elaborate on the barriers and facilitators to guideline dissemination, implementation, and adaptation.
Methods: A working group consisting of CPG development experts and methodologists with representation from all ILAE region reviewed the latest CPG practices and updated the previously published 2015 ILAE CPG development process and toolkit accordingly. Minimum standards that should be followed as part of the guideline development process and to obtain ILAE endorsement are explicitly reported with the aim or promoting the development of high-quality CPGs, keeping in mind settings with limited human and financial resources. A practical handbook and toolkit were developed to facilitate the implementation and use of these CPG development processes. Finally, we briefly reviewed the literature on barriers and facilitators to guideline implementation. Good evidence about the most appropriate tools to promote guideline implementation is lacking.
Results: Important elements of a high-quality CPG include (Figure 1): (1) informed by a systematic review of the evidence; (2) developed by a multidisciplinary panel of experts and key stakeholders; (3) incorporates patient preference, where applicable; (4) based on a systematic and transparent process to minimize bias and conflict of interest; (5) provides a description of alternative care choices and health outcomes; (6) provides ratings of the quality of the evidence and strengths of recommendations; and (7) revised regularly to incorporate the latest evidence, where applicable.
Conclusions: Clinical practice guidelines are statements that provide evidence-based recommendations aimed at optimizing patient care. However, many other documents are often published as “guidelines” when they are not, i.e., these documents, although also relevant in clinical practice, are usually not systematically produced following rigorous processes linking the evidence to the recommendations. Specifically, the ILAE guideline development toolkit aims to ensure that high-quality CPGs are developed to fill knowledge gaps and optimize the management of epilepsy. In addition to adhering to key methodological processes, guideline developers need to consider that effective CPGs should lead to improvements in clinical processes of care and healthcare outcomes. This requires monitoring the effectiveness of epilepsy-related CPGs and interventions to remove the barriers to epilepsy CPG implementation.
Funding: NJ is the Bludhorn Professor of International Medicine.
Health Services (Delivery of Care, Access to Care, Health Care Models)