Adapting clinical practice guidelines for diabetic retinopathy in Kenya: process and outputs
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RESEARCH
Open Access
Adapting clinical practice guidelines for diabetic retinopathy in Kenya: process and outputs Nyawira Mwangi1,11* , Muchai Gachago2,4, Michael Gichangi3, Stephen Gichuhi2, Kibata Githeko4, Atieno Jalango5, Jefitha Karimurio2, Joseph Kibachio6, Lawrence Muthami7, Nancy Ngugi8, Carmichael Nduri9, Patrick Nyaga8, Joseph Nyamori2, Alain Nazaire Mbongo Zindamoyen10, Covadonga Bascaran11 and Allen Foster11
Abstract Background: The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations. Methods: We describe the process used to adapt clinical guidelines for diabetic retinopathy in Kenya, using validated tools and manuals. A technical working group consisting of volunteers provided leadership. Results: The process was intensive and required more time than anticipated. Flexibility in the process and concurrent health system activities contributed to the success of the adaptation. The outputs from the adaptation include the guidelines in different formats, point of care instruments, as well as tools for training, monitoring, quality assurance and patient education. Conclusion: Guideline adaptation is applicable and feasible at the national level in Kenya. However, it is labor- and time -intensive. It presents a valuable opportunity to develop several additional outputs that are useful at the point of care. Keywords: Clinical practice guidelines, Diabetes mellitus, Diabetic retinopathy, Guideline development, Guideline adaptation, Kenya
Background The first definition of clinical practice guidelines (CPG), hereafter referred to as “guidelines,” was provided by the Institute of Medicine (IOM) in the USA in 1990: “systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific circumstances” [1]. Guidelines-related initiatives have subsequently increased globally since the 1990s. This definition was revised in 2011 to: “statements that include recommendations to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care * Correspondence: [email protected] 1 Kenya Medical Training College, Nairobi, Kenya 11 London School of Hygiene and Tropical Medicine, London, UK Full list of author information is available at the end of the article
options” [2]. Guidelines constitute one tool for good decision-making in clinical practice, which has potential to reduce variations in health care and its cost. Although a plethora of barriers may compromise their effective
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