EBHC principles and the development of trustworthy clinical practice guidelines
The Czech Republic (Middle European) Centre for Evidence-Based Healthcare was established in 2013 and soon gained status as a JBI Centre of Excellence. Since the very beginning, its members have focused on conducting systematic reviews, participated in JBI methodological groups, and cooperated with global partners on innovation and development of new methodological approaches in systematic review development.
The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation works with three key partners: i) The Czech Republic (Middle European) Centre for Evidence-Based Healthcare: A JBI Centre of Excellence; ii) Masaryk University GRADE Centre, Brno, Czech Republic; and iii) Cochrane Czech Republic.
Masaryk University GRADE (Grading of Recommendations Assessment, Development and Evaluation) was established in December 2018, together with Cochrane Czech Republic. The Czech Republic Centre for Evidence-Based Healthcare and Knowledge Translation (CEBHC-KT) is a unique umbrella encompassing various excellent scientific approaches in one place. CEBHC-KT has become a methodological hub within the country, promoting evidence-based healthcare principles and methodologies.
The importance of comprehensive methodological work within policymaking was highlighted when members of The Czech Republic Centre for Evidence-Based Healthcare and Knowledge Translation (CEBHC-KT) were invited to become part of an EU project: the Clinical Practice Guidelines (CPG) Project.
Several factors led to the initiation of the project. There had been a large number of clinical practice guidelines (CPGs) created by various professional healthcare societies; however, any methodological concept that would correspond with evidence-based healthcare and be followed nationally by the CPGs developers, was missing. Thus, the quality of different CPGs was incomparable and could consequently have a negative influence on healthcare provided for patients in different settings. Similarly, the concept of evidence-based healthcare (EBHC) was not widely established among clinicians or healthcare students.
The main aims of the CPG Project are to develop trustworthy CPGs and educate prospective developers and users of CPGs. For the first time in the Czech Republic, there is a project at a national level aiming to bring solid methodology based on evidence-based healthcare (EBHC) principles into the process of adaptation, development and use of clinical practice guidelines.
The project’s activities started at the beginning of 2018 with the development of the Czech National Methodology for the Development of Trustworthy Clinical Practice Guidelines. One of the project goals has been the development of CPGs in different healthcare areas, of which, five were chosen as pilots. Representatives of the project partners, together with the methodologists, gave introductory methodological seminars to CPG developers.
By 2019, the Czech National Methodology for the Development of Trustworthy Clinical Practice Guidelines had been revised, version 2.1 had been developed and more methodologists had joined the project. Further, an approach to a visual transformation of various grading systems of evidence and recommendations was developed (currently in press in Journal of Clinical Epidemiology). The results of this novel line of work have recently been presented at the GIN conference 2021 and will soon be published.
‘We needed to unify the visual style of different methods used in different Czech CPGs’, Dr Klugarová explains. ‘It was a difficult challenge; different tables and scales stratifying different grades of evidence and/or strength of recommendations had to be transformed in a way that would keep the original value and meaning and look the same across all the Czech CPGs.’
With approximately one year left on the project, there are over 40 CPGs in the final stages of development. There are more core members of CEBHC-KT working as methodologists on the project and supporting teams of healthcare professionals in CPG development. The collaboration between methodologists and the healthcare teams has become much closer. In June 2021, clinicians involved in guideline development on the project took part in a five-day training course in EBHC and GRADE organised by CEBHC-KT.
The first Czech national guideline on COVID-19 is currently being prepared as part of the Czech national project for developing clinical practice guidelines. The guideline is also the first-ever ‘living’ guideline developed in the Czech Republic.
The guideline is being developed using a method referred to as ‘adolopment’, which combines the adoption of existing recommendations, their adaptation to specific local conditions and the creation of new guidance when needed. The process rests on evidence-based recommendation development using GRADE frameworks to ensure transparency and unambiguity.
Instead of looking up the existing recommendations in all the possible databases and repositories, the team is using the results of an international project: the COVID-19 Living Recommendations Map and Gateway to Contextualisation. ‘We believe the guideline will set the standards for COVID-19 patient care and facilitate evidence-based decision-making for healthcare professionals and policymakers’, says Dr Klugarová.
The work of CEBHC-KT, led by Dr Miloslav Klugar, was further recognised when it won the bid to host the Global Evidence Summit 2 that will be held in 2023 in Prague.
‘The whole team at CEBHC-KT strives towards ensuring that the principles of EBHC become a natural part of healthcare in our country’, says Dr Klugarová.
Further Resources
1. The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation
2. National methodology of CPG development
3. National portal for clinical practice guidelines
Authors
Jitka Klugarová1-3
Tereza Vrbová1,2
Miloslav Klugar1-3
1. The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (The Czech Republic (Middle European) Centre for Evidence-Based Healthcare: JBI Centre of Excellence; Masaryk University GRADE Centre; Cochrane Czech Republic), Brno, Czech Republic
2. Czech Health Research Council, Prague, Czech Republic
3. Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
Jitka Klugarová, Tereza Vrbová, Miloslav Klugar
Disclaimer
Republished with permission from World Evidence-based Healthcare Day
https://worldebhcday.org/stories/story?ebhc_impact_story_id=85