Background: The development and maintenance of high-quality clinical guidelines requires substantial resources. Working in partnership with international colleagues we have developed a low-cost process for adapting or contextualising existing high-quality guidelines for other healthcare settings. Guideline contextualisation enables rapid development of high-quality guidelines in response to emerging healthcare priorities. Antimicrobial resistance is an increasing concern globally, with governments committing substantial resource to the development of strategies to slow the development and spread of antimicrobial resistance.
Objectives: To describe both the process for contextualising clinical guidelines developed by the National Institute for Health and Care Excellence (NICE) for the New Zealand health care context and its application to a suite of guidelines addressing disease-specific (respiratory tract infections and sepsis) and system-wide approaches to antimicrobial stewardship.
Methods:A process for contextualising clinical guidelines based on the ADAPTE framework was used to contextualise three NICE guidelines - Respiratory tract infections-the prescribing of antibiotics in primary care (CG69); Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (NG15) and Sepsis: recognition, diagnosis and early management (NG51).
Results: Awareness of antimicrobial resistance in the treatment and management of disease is important in ensuring the antimicrobial medicines are used when needed but that use is reduced without an increase in harm when use is not indicated. Important contextual differences between the UK and NZ health care settings in the treatment and management of these conditions were identified. How these differences have impacted on the contextualisation of guideline recommendations will be presented.
Conclusions: We have developed a methodologically robust process for the contextualisation of NICE clinical guidelines. Our experience in contextualising guidelines across a number of different areas will helpfully inform similar initiatives.