A pragmatic approach to the adaptation and implementation of internationally developed clinical practice guidelines for Kazakhstan

Abstract

Background: The Canadian Society for International Health (CSIH) has developed a systematic approach to support the introduction of high-quality evidence-based clinical practice guidelines (CPGs) in Kazakhstan. We describe a process enabling the large-scale selection and adaptation of high-quality international CPGs requisite to the project, and how these are applied at the points of care to achieve tangible results in terms of improved patient care. Methods: The CPG adaptation and implementation process used was both pragmatic and useful to national contexts and needs. The strategies used robust methods reported in the international medical literature; CSIH provided additional technical support, capacity-building, and customised instruments to aid implementation. The process involved clear assignment of tasks and roles between the partners, emphasising accountability throughout the adaptation and implementation process. Findings: During the 3-year partnership, 100 CPG candidates were identified, 42 of these were adapted for use in Kazakhstan, and implementation of three of these CPGs began. Key challenges at the time of adaptation included obtaining permission to use and translate guidelines and local partners' limited experience with the principles of evidence-based medicine. Barriers to implementation included contradiction between evidence-based CPGs and national clinical protocols, little capacity to perform required tests, and physicians' and patients' attitudes. Interpretation: A preliminary review showed much success with the CPG implementation process at each of the three pilot sites. The monitoring process was a new approach for the implementation sites. It was determined that this approach to CPG implementation could extrapolate to activities at other sites in Kazakhstan. Funding: None.