Primary Care Respiratory Journal (2008); 17(3): 136-137 EDITORIAL

• Other Authors: The Pennsylvania State University CiteSeerX Archives
• Format: Text
• Language: English
• Subjects: palsa
• Online Access: http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.634.6260; http://www.thepcrj.org/journ/vol17/17_3_136_137.pdf

Adapting valid clinical guidelines for use in primary care in low and middle income countries 136PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org doi:10.3132/pcrj.2008.00055 Development of evidence-based guidelines suitable for use in resource-poor settings is a challenge for two main reasons. First, most high quality evidence originates from rich countries and may not be relevant or applicable to the needs of low-income countries1 – and relevant evidence is difficult to retrieve. Second, the development of valid clinical guidelines is expensive, time-consuming, and requires certain expertise.2 None of these are in abundance in low-income countries. Adaptation of a current and valid clinical guideline to local circumstances is a solution that mainly addresses the second challenge. Adaptation also promotes local ownership and allows benefit from evidence of less quality but of more relevance to local needs. Despite advances in the methodology of developing new guidelines,3,4 our knowledge of the validity of the guideline adaptation process is meagre.5 The ADAPTE is attempting to rectify this situation.6 In this issue of the Primary Care Respiratory Journal, there is a report of a successful project on the adaptation of an international guideline for respiratory care to district level needs in South Africa (PALSA).7 It has certain advantages over similar initiatives. One is the deliberate attempt to identify the barriers to good quality care and to address those barriers. The other is the iterative process in which the authors used the target users ’ feedback to refine the recommendations. Another advantage, missing from many high quality guidelines, is that it formally assessed the effectiveness of the developed guideline in improving quality of care. The reported process from PALSA is less explicit than what we expect from development of original guidelines.4 This, in a way, is the result of the immaturity in adaptation methodology as explained above. Using the AGREE instrument for choosing and appraising the ...