ADAPTING CLINICAL PRACTICE GUIDELINES TO DIGITAL TOOLS: A METHODOLOGICAL STUDY
Background: In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, implementing such guidelines within local contexts and at the point of care is still an important challenge. Digital tools for decision support can promote clinical practice guideline implementation and dissemination.
Objectives: To report a methodology process involved in transforming the guidelines into Digital tools (cards) for decision support for routine use in primary health care settings in Northeastern Brazil, an initiative from Hospital Sírio-Libanês, Brazil, conducted from 2022 to 2023, to support the TeleNordeste Project, funded by the Brazilian Ministry of Health initiative (PROADI-SUS).
Methods: This is a methodological study for adapting clinical guidelines to digital tools (cards) for decision support for routine use in primary health care settings. This study included the following steps: (1) identification and selection of guidelines published by the Ministry of Health; (2) adaptation of clinical guidelines using the ADAPTE method; (3) adaptation of the guidelines in a user-friendly format according to the Practical Approach to Care Kit; and (4) preliminary adaptation using WHO Smart Guidelines approach. For the development of the first three stages, three working groups were established consisting of specialists and general practitioners, whereas the fourth stage was developed by a technology team specialized in digital health.
Results: From 2022 to February 2023, we developed 32 digital tools from the adaptation of clinical guidelines in different areas: Orthopedics (n=7, mechanical arthralgia), cardiology (n=5, hypertension 1 and 2, cardiac insufficiency, cardiac arrhythmias, and chest pain), endocrinology (n=5, diabetes, hypothyroidism, hyperthyroidism, thyroid nodule, and metabolic syndrome), neurology (n=5, stroke, headache 1 and 2, dementia, and epilepsy ), urology (n=3, benign prostatic hyperplasia, erectile dysfunction, and urolithiasis), pneumology (n=3, chronic obstructive pulmonary disease 1 and 2 and cough), rheumatology (n=2, inflammatory arthralgia and chronic pain) and psychiatry (n=2, depression and anxiety).
Conclusions: This project has contributed to facilitating the adaptation of recommendations through digital systems. It is expected that these digital tools will support the implementation of evidence-based practices in the primary care settings in Northeastern Brazil.