Dear Sian Williams,
Thank you for your valuable response (below). The three points of criticism suggest there are problems with the way (some) guidelines are developed. Could you or anyone else on HIFA say a bit more about this? It might be useful to focus on specific types of clinical guidelines. For example, WHO produces international guidelines which are intended for adaptation by individual countries (to what extent does this actually happen, and how can the process be improved/facilitated?). It would be interesting to hear from the perspective of those who develop international guidelines, those who adapt guidelines for country use, and frontline clinicians who use guidelines to help with their clinical decision making.
Coronavirus (1426) Adherence of Clinical Practice Guidelines for Pharmacologic Treatments of Hospitalized Patients With COVID-19 to Trustworthy Standard: A Systematic Review (3)
8 January, 2022
Thanks for your question Neil. ["I look forward to comments from those who help to produce, adapt and use international clinical guidelines, and how these can be improved."https://www.hifa.org/dgroups-rss/coronavirus-1422-adherence-clinical-pra... ]
From the point of view of primary care, there has long been criticism of guideline development because
1. Many guidelines do not take account of what resources (knowledge, experience, people, drugs, tests) are available locally; they may be too rigid/insufficiently nuanced, don't take account of level of professional mastery of a topic, and may not take account of cost implications/value
2. They can be slow to develop so don't take account of recent changes in context or evidence
3. May not have been developed transparently and do not declare interests and/or use agreed methodologies, such as grading of evidence.
COVID-19 puts additional pressure on guideline developers because of the volume and speed of evidence and the variation in availability of the interventions.
A methodology that looks interesting is the living guideline. This is used by WHO for COVID-19 drugs (see
and has been used in Australia for their stroke guidelines. Living methodology is also being piloted by Cochrane for systematic reviews. See
An approach that might then work is to publish these living reviews and set general directions of travel about what is possible and what outcomes should be considered and then allow local teams to develop "how to" guidance that can take account of local resources. That's certainly where organisations such as IPCRG believe we can add value - by taking the evidence that has been carefully reviewed, and then debating and proposing "so what does this mean for primary care?" in different settings.
HIFA profile: Sian Williams is Chief Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. sian.health AT gmail.com
Best wishes, Neil