Approach to guideline development

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Presentation transcript:

Approach to guideline development WHO guidelines on health policy and system support to optimize community health worker programmes 1st meeting of Guideline Development Group Geneva, Switzerland, 10-11 October 2016 Approach to guideline development Elie Akl, MD, MPH, PhD American University of Beirut, Lebanon

Disclosures Member of the GRADE working group and of the GRADE Guidance Group Consult for groups applying GRADE No other intellectual or financial COI

On my way to Geneva

Outline Describing our task Defining the strength of recommendation Factors that affect the grading of the strength of recommendation

Outline Describing our task Defining the strength of recommendation Factors that affect the grading of the strength of recommendation

The guideline

The recommendation

The recommendation

The recommendations Guidelines should provide answers to the questions raised by the target users A recommendation is a direct answer to a specific policy question The starting point is a policy question addressing different options

The question Policy question: Should LAY HEALTH WORKERS distribute oral supplements to pregnant women?

The question Population/Problem: Poor access to oral supplements for pregnant women Intervention: LHWs distribution of oral supplements Control: No care delivered Outcomes: Use of supplements by pregnant Adverse effects related to use of supplements

The question Population/Problem: Poor access to oral supplements for pregnant women Intervention: LHWs distribution of oral supplements Control: No care delivered Outcomes: Use of supplements by pregnant Adverse effects related to use of supplements

The overall process

Grades of Recommendation Assessment, Development and Evaluation www.gradeworkinggroup.org 2008 BMJ series 2011 JCE series

Adopted by more than 90 organizations

GRADE framework Emphasizes: Uses standardized tables to present: Systematic approach Explicitness Transparency Uses standardized tables to present: Summary of evidence (evidence profile) The factors that affect the final recommendation (Evidence to Decision (EtD) table)

Outline Describing our task Defining the strength of recommendation Factors that affect the grading of the strength of recommendation

Strength of recommendation The extent to which we can be confident that the desirable effects of an intervention outweigh the undesirable effects.

Strength of recommendation A recommendation can have one of 2 strength: Strong : panel is confident that the desirable effects of adherence to the recommendation outweigh the undesirable effects (or vice versa). Conditional : panel concludes that the desirable effects of adherence to the recommendation probably outweigh the undesirable effects (or vice versa), but is not confident.

Implications of strong and conditional recommendations Strong recommendation Conditional recommendation Patients Most people in your situation would want the recommended course of action and only a small proportion would not The majority of people in your situation would want the recommended course of action, but many would not Clinicians Policy makers

Implications of strong and conditional recommendations Strong recommendation Conditional recommendation Patients Most people in your situation would want the recommended course of action and only a small proportion would not The majority of people in your situation would want the recommended course of action, but many would not Clinicians Most patients should receive the recommended course of action Be prepared to help patients to make a decision that is consistent with their own values Policy makers

Implications of strong and conditional recommendations Strong recommendation Conditional recommendation Patients Most people in your situation would want the recommended course of action and only a small proportion would not The majority of people in your situation would want the recommended course of action, but many would not Clinicians Most patients should receive the recommended course of action Be prepared to help patients to make a decision that is consistent with their own values Policy makers The recommendation can be adapted as a policy in most situations There is a need for substantial debate and involvement of stakeholders

Outline Describing our task Defining the strength of recommendation Factors that affect the grading of the strength of recommendation

Factors affecting recommendation GRADE framework Factors affecting recommendation Clinical guidelines PH guidelines 1.0 PH guidelines 2.0 Extent of the problem Quality of evidence Balance benefits/harms Values and preferences Acceptability Resource use Feasibility Equity

Determining strength of recommendation Priority of the problem Quality of evidence Balance of benefits and harms Values and preferences Resource use Equity Feasibility Acceptability

Evidence to Decision table Tool we will be using to move draft the recommendations

Evidence to Decision table

Evidence to Decision table

Evidence to Decision table

Evidence to Decision table

Evidence to Decision table

Evidence to Decision table

Evidence to Recommendation table The table helps with: Using a systematic and explicit approach to making recommendations Making transparent the judgments about the factors affecting the recommendation Providing supporting evidence to judgments

Thank you Questions?

Determinants of quality