Strengthening prehospital clinical practice guideline implementation in South Africa : a qualitative case study
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, research into alternative methods of CPG development using existing CPG documents (CPG
adaptation) — a specific issue for guideline development groups in low- and middle-income countries — is sparse.
There are only a few examples showcasing the pragmatic application of such alternative approaches in settings
with time and budget constraints, especially in the prehospital setting. This paper aims to describe and strengthen
the methods of developing prehospital CPGs using alternative guideline development methods through a case
study design.
Methods: We qualitatively explored a CPG development project conducted in 2016 for prehospital providers in
South Africa as a case study. Key stakeholders, involved in various processes of the guideline project, were
purposefully sampled. Data were collected from one focus group and six in-depth interviews and analysed using
thematic analysis. Overarching themes and sub-themes were inductively developed and categorised as challenges
and recommendations and further transformed into action points.
Results: Key challenges revolved around guideline implementation as opposed to development. These included
the unavoidable effect of interest and beliefs on implementing recommendations, the local evidence void, a
shifting implementation context, and opposing end-user needs. Guideline development and implementation
strengthening priority actions included: i) developing a national end-user document; ii) aligning recommendations
with local practice; iii) communicating a clear and consistent message; iv) addressing controversial
recommendations; v) managing the impact of interests, beliefs and intellectual conflicts; and vi) transparently
reporting implementation decisions.
Conclusion: The cornerstone of a successful guideline development process is the translation and implementation
of CPG recommendations into clinical practice. We highlight key priority actions for prehospital guideline
development teams with limited resources to strengthen guideline development, dissemination, and
implementation by drawing from lessons learnt from a prehospital guideline project conducted in South Africa.
Description
CITATION: McCaul, M., et al. 2020. Strengthening prehospital clinical practice guideline implementation in South Africa : a qualitative case study. BMC Health Services Research, 20:349, doi:10.1186/s12913-020-05111-x.
The original publication is available at https://bmchealthservres.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
The original publication is available at https://bmchealthservres.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
Keywords
Ambulatory medical care -- Practice, Emergency medical services -- Practice, Clinical medicine -- Practice, Medical protocols -- South Africa
Citation
McCaul, M., et al. 2020. Strengthening prehospital clinical practice guideline implementation in South Africa : a qualitative case study. BMC Health Services Research, 20:349, doi:10.1186/s12913-020-05111-x