[in response to: https://www.hifa.org/dgroups-rss/clinical-practice-guidelines-good-bad-a... ]
The information below may be of help for you:
The SEA-ORCHID (South East Asia - Optimising Reproductive and Child Health in Developing Countries) research project over five years (2004 – 2009) in four SEA countries with an before and after trial with CPG development (using the AGREE tool) and implementation https://australia.cochrane.org/south-east-asia-optimising-reproductive-a... aimed to find out if this could increase CPG interest, development and implementation. Study protocol is found here: https://www.researchgate.net/publication/5951274_Optimising_reproductive...
The result showed if development of evidence-based CPGs in hospital settings is to be increased, new strategies will need to be developed to overcome the substantial barriers and make the process more feasible: https://health-policy-systems.biomedcentral.com/articles/10.1186/1478-45...
For many SEA hospitals, several of these barriers were insurmountable, and as a result, rigorous, evidence-based guidelines are not being developed. Given the acknowledged benefits of evidence-based guidelines, perhaps a new approach to supporting their development in these contexts is needed. https://pubmed.ncbi.nlm.nih.gov/19422716/ and https://pubmed.ncbi.nlm.nih.gov/22128845/
All CPG development and implementation activities were based on Cochrane Systematic Review results. It did show that maternal and infant outcomes improved, but highlighted CPG development and implementation has its challenges. The results of SEA-ORCHID demonstrate that investing in developing capacity for research use, synthesis and generation can lead to improvements in maternal and neonatal health practice and highlight the difficulty of implementing evidence-based practice change. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0023994
I think it is critical that CPG’s need to be contextualised and everyone, including consumers/patients/health care users/managers/policy makers/CPG users (multiple health professional groups)/financial decision makers/minister of health need to be involved in creating a CPG. There has been many research projects that have looked into this area, but CPG development is not often included in health care budgets. Knowledge translation comes into this field as well and a thorough literature search will come up with many articles. Bias and limitation occur when the main focus is not on the context, who the guideline is serving/benefitting e.g. the pregnant woman but power and opinion based and prescriptive e.g. a protocol. Guidelines are there to guide and the application may have to deviate as the context of the woman, hospital, environment suggests otherwise.
Dr Ruth Martis (she/her)
Senior Advisor Midwifery Education – Midwifery Council
Honorary Research Fellow – The University of Auckland, Liggins Institute
PhD, MA, BA SocSci, Grad Dipl Tchng, Registered Midwife (RM), Registered Nurse (RGON), Adv Dip Nrsg
HIFA profile: Ruth Martis is a registered midwife, who holds a PhD from the Liggins Institute, The University of Auckland, New Zealand. Her research centred on glycaemic targets and experiences for women with GDM. Currently she is the Head of the Midwifery School at the Waikato Institute of Technology, Hamilton, New Zealand and a locum midwife for remote rural areas in New Zealand. She is passionate about midwifery education, physiological birth, impact of fear in childbirth, newborn examination, neonatal resuscitation, intermittent auscultation, fetal movements in labour, teenage pregnancies, lactation, gestational diabetes, knowledge transfer and research synthesis and refugee health. Ruth is a Cochrane systematic review author of several reviews. She was involved in the five year SEA-ORCHID research project as clinical educator in South East Asia.
