A blueprint for contextualising Western clinical guidelines for a developing country

DOI: 10.5176/2251-3833_GHC12.39

Authors: Consuelo Gonzalez-Suarez, Karen Grimmer-Somers, Janine Dizon, Ellena King, Sylvan Lorenzo, Ephraim Gambito, Carolina Valdecanas and Belinda Fidel

Abstract: High quality clinical guidelines support evidence-based care for many health conditions. Most guidelines are based on Western health systems, disease epidemiology and/or workforce, thus may not be readily generalizable or applicable to developing countries. Producing de novo evidence-based guidelines is expensive and resource-intensive, therefore contextualising available guidelines for developing countries is a cost-efficient approach to promoting evidence-based practice. This paper describes a blueprint for contextualising clinical guidelines to two prevalent Filipino health conditions. A working group of Filipino physiatrists (rehabilitation doctors) identified high quality current clinical guidelines for low back pain and stroke rehabilitation. They established aims, purpose and end-users of guidelines for these conditions in the Philippines, and mapped typical Filipino patient journeys. Relevant recommendations from the identified clinical guidelines were then highlighted and contextualised for Filipino settings, using the Australian FORM approach. Implementation strategies were developed congruently with Filipino contextualisation of recommendations. Six high-quality LBP guidelines and 5 stroke guidelines were included. Filipino-adaptation of the recommendations was in the form of context points, mostly addressing availability of diagnostic equipment and training, equity of access, and health provider education. It is unnecessary for every country to develop de novo clinical guidelines, given the developmental resource implications. High quality clinical guidelines are readily available, and require contextualisation only, to local health care services and systems. Using a systematic and transparent approach will ensure that developing countries can more efficiently and effectively adopt evidence-based practice.

Keywords: developing country, clinical practice guidelines, contextualise