Background: Methods around developing de novo (new) clinical practice guidelines (CPGs) are well established with numerous guides, tools, resources and examples. With the growing number of existing CPGs, and taking account of resource implications for de novo development, resource-limited settings need alternative methods to de novo CPG development. Using existing high-quality CPGs to make recommendations relevant to local contexts through adopting, adapting or contextualising are such alternatives. However, limited examples exist showcasing the pragmatic application of this approach in settings where time and budget constraints are a real issue.
Objectives: To develop contextually appropriate evidence-informed CPGs for pre-hospital emergency care providers in South Africa using alternative guideline development methods.
About the project: Following engagement with an expert panel to identify key questions, we searched for and appraised existing CPGs. A process of adapting, adopting or contextualising existing CPGs was used, but not without its challenges, to develop the South African guideline.
Our experience and learning points: The final guideline included more than 270 CPGs culminating in over 1000 recommendations for pre-hospital care. Challenges experienced included the lack of guidelines applicable to the African setting, issues in evidence synthesis including poor-quality guidelines and heterogeneous level of evidence classifications. Essential learning points included focusing of key CPGs, clear knowledge translation strategies and stakeholder engagement while key successes included easy and specific searching strategies, logical evidence mapping leading to easier content management and using an accessible online platform to incorporate expert panel and advisory board feedback.
Conclusions: Re-inventing the wheel to produce CPGs is not always an option. Alternative methods exist that are systematic, transparent, rigorous and most importantly within reach of resource-limited guideline development teams.