International Guidelines: Adapt to local clinical practice or not?




Poster session 3 Friday: Evidence Tools / Evidence synthesis - creation, publication and updating in the digital age


Friday 15 September 2017 - 12:30 to 14:00


All authors in correct order:

Broos P1, Rake E1, Ensink R2
1 Knowledge Institute of Medical Specialists, Netherlands
2 Gelre ziekenhuizen Zutphen, Department of Otorhinolaryngology, Netherlands
Presenting author and contact person

Presenting author:

Pieter Broos

Contact person:

Abstract text
Background: International medical scientific organisations often develop generic clinical practice guidelines, which may also be used in The Netherlands. However, one-on-one adoption of an international guideline is not possible as such because the organisation of healthcare and the patient perspective from Dutch practice must be taken into account. Therefore, it is not always clear whether adaptation of the international guideline is more efficient and thus preferred.

Objectives: The goal of this project was to develop a practical tool to support the process of deciding whether adaptation of the international guideline is preferred over initiating a regular guideline development process from scratch.

Methods:Bases on experiences from two pilot projects, adaptation of guidelines on work-related asthma and bladder cancer, a step-by-step plan for the adaptation of a guideline was developed. International initiatives such as the ADAPTE toolkit for guideline adaptation and the AGREE II tool (Appraisal of Guidelines for Research & Evaluation) were used.

Results: A practically applicable step-by-step plan was developed, including a checklist that helps to make an advance assessment of the need for adaptation. The checklist consists of three main domains; I. assessing the independence of the guideline, II. checking the (methodological) quality, and III. assessing the project scope, including the framework assessment.

Conclusions: Based on the experiences of both pilot projects, it was concluded that adaptation of an international guideline can potentially result in more efficiency. However, both pilot projects also made it clear that an assessment of the methodological quality of the international guideline prior to the project start is essential. Adding population and regional specific considerations to an international guideline is essential in making a guideline suitable for local practice. The developed checklist supports a well-considered decision when choosing between adaptation and starting a guideline project from scratch.