Fostering the evidence-based methodology in clinical practice guidelines development in the Czech healthcare system
In the Czech Republic, access to the public healthcare system is ensured, so healthcare can be provided to anyone in the country. Heterogeneity of provided care in various settings and areas of healthcare were identified. Guidelines following the evidence-based healthcare (EBHC) principles should help optimize the care, by recommending the best healthcare option(s), and make it available to all patients. There had been no unified or standardized process of clinical practice guideline (CPG) development.
Objectives: The main aim of the 5-year-long project was to implement evidence-based methodology in CPG development in the Czech healthcare system, considering, e.g., GRADE (Grading of Recommendations, Assessment, Development and Evaluation) principles and processes and methods of (inter)national bodies coordinating development of CPGs. The specific objectives were to establish the managing bodies of the project, draft a guideline development process, develop at least 40 CPGs and design a system of education and training in CPG development.
Methods: A baseline audit was conducted in November 2017. Within the national project Clinical Practice Guidelines, led by the Czech Health Research Council, the Ministry of Health, Czech Republic, and Institute of Health Information and Statistics of the Czech Republic, the Czech National methodology for CPG development based on the GRADE approach was drafted, pilot tested and reviewed. Identification of barriers in implementation of evidence-based and GRADE principles and suggestion of steps to overcome the barriers followed. Further audits were conducted in 2019, 2020, 2022 and 2023.
Results: Nearly 1,909 CPGs were identified in 2017, developed by healthcare organizations, differing in ways of development, quality and accessibility. The main obstacles to implementing the drafted Czech national CPG methodology were a lack of both knowledge of CPG development and motivation in healthcare professionals. Workshops focused on the trustworthy CPG development were organized, and methodologists supported teams developing CPGs. The project yielded 41 CPGs informing health and care decisions.
Conclusions: The project has helped to establish a CPG process and enhanced knowledge and skills on EBHC in healthcare professionals. A national center focusing on methodology is being created in the Ministry of Health to sustain and increase the project’s achievements.