Improving the Applicability and Feasibility of Clinical Practice Guidelines in Primary Care: Recommendations for Guideline Development and Implementation

Abstract

Lu Han,1,2 Linan Zeng,1,2 Yanjun Duan,3 Kexin Chen,4 Jiajie Yu,5 Honghao Li,6 Qiusha Yi,1,2 Youping Li,5 Lingli Zhang1,2 1Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, People’s Republic of China; 3College of Pharmacy, University of Nebraska Medical Center, Chengdu, Sichuan, People’s Republic of China; 4West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 5Chinese Evidence-Based Medicine Centre/Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 6West China Hospital Institute of Management, Sichuan University, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Lingli ZhangDepartment of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu, Sichuan, People’s Republic of ChinaTel [phone]Email [email protected]: To give recommendations for the development of primary care clinical practice guideline (CPG) to improve applicability and feasibility of primary care CPGs in China.Design: A two-round Delphi survey.Methods: A two-round Delphi survey including guideline development methodologists and clinical practitioners from six countries was conducted. In round one, participants were asked to raise special considerations for the development of primary care CPGs through open-ended questions. In round two, participants were asked to rate the level of agreement on each recommendation item generated by round one and to raise additional recommendations. Opinions from participants were reviewed by thematic analysis. Integrated results from the Delphi survey were validated by participants.Results: The necessity of developing recommendations for the development of primary care CPGs were consistently recognized by participants. The main recommendations of guideline development were generated as follows: (1) considering the context of primary care institutions and the applicability of existing guidelines for primary care in planning guideline; (2) involving primary care practitioners and patients in guideline groups; (3) considering the variation of health-care resources between primary care settings when developing recommendations; (4) presenting the difference of recommendations between primary care CPG and general CPG; (5) implementing more active education and training; and (6) considering the changing of primary care medical resource when updating guideline.Conclusion: In this study, we present recommendations to inform the development of clinical practice guidelines in primary care settings. Next steps will include merging these recommendations with general guideline development methods to inform the development of guidelines for primary care.Keywords: primary care, clinical practice guideline, guideline development

Keywords

• primary care
• clinical practice guideline
• guideline development