Journal Article

GRADE-ADOLOPMENT of clinical practice guidelines and creation of clinical pathways for the primary care management of chronic respiratory conditions in Pakistan

Chaudry, Maryam, Aamdani, Salima Saleem, Irfan, Muhammad, Hussain, Hawra, Haider, Adil H., Ayub, Bushra, Nadeem, Sarah, Zubairi, Ali Bin Sarwar, Khalid, Rameesha, Rehman, Alina Abdul, Ali, Akbar Shoukat, Pervez, Alina, Mustafa, Mohsin Ali, Martins, Russell Seth, Rizvi, Nashia Ali, Shahid, Shayan

2023

Overview

Introduction In Pakistan, chronic respiratory conditions contribute a large burden of morbidity and mortality. A major reason for this is the lack of availability of local evidence-based clinical practice guidelines (EBCPGs) in Pakistan, particularly at the primary care level. Thus, we developed EBCPGs and created clinical diagnosis and referral pathways for the primary care management of chronic respiratory conditions in Pakistan. Methods The source guidelines were selected by two local expert pulmonologists after a thorough literature review on PubMed and Google Scholar from 2010 to December 2021. The source guidelines covered idiopathic pulmonary fibrosis, asthma, chronic obstructive pulmonary disorders, and bronchiectasis. The GRADE-ADOLOPMENT process consists of three key elements: adoption (using recommendations as is or with minor changes), adaptation (effective context-specific changes to recommendations) or additions (including new recommendations to fill a gap in the EBCPG). We employed the GRADE-ADOLOPMENT process to adopt, adapt, adopt with minor changes, or exclude recommendations from a source guideline. Additional recommendations were added to the clinical pathways based on a best-evidence review process. Results 46 recommendations were excluded mainly due to the unavailability of recommended management in Pakistan and scope beyond the practice of general physicians. Clinical diagnosis and referral pathways were designed for the four chronic respiratory conditions, explicitly delineating the role of primary care practitioners in the diagnosis, basic management, and timely referral of patients. Across the four conditions, 18 recommendations were added (seven for IPF, three for bronchiectasis, four for COPD, and four for asthma). Conclusion The widespread use of the newly created EBCPGs and clinical pathways in the primary healthcare system of Pakistan can help alleviate the morbidity and mortality related to chronic respiratory conditions disease in the country.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adaptation / Asthma / Asthma - diagnosis / Bronchiectasis / Bronchiectasis - diagnosis / Bronchiectasis - therapy / Care and treatment / Chronic obstructive pulmonary disease / Clinical medicine / Clinical practice guidelines / Critical Care Medicine / Critical Pathways / Diagnosis / Evidence-based medicine / Fibrosis / Humans / Idiopathic pulmonary fibrosis / Intensive / Internal Medicine / Literature reviews / Lower-middle-income country / Lung diseases / Lung diseases, Obstructive / Medicine / Medicine & Public Health / Methods / Morbidity / Mortality / Pakistan / Pneumology/Respiratory System / Practice guidelines (Medicine) / Primary care / Primary Health Care / Public health / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonology / Respiration Disorders / Respiratory diseases / Services / Systematic review