Clinical Practice Guidelines

IHCAI’s Clinical Practice Guidelines Development Program

IHCAI Institute has experience in the construction of Clinical Practice Guidelines (CPG) at the level of Costa Rica, Central America and the Caribbean. In each development, you want your guides to be of high quality. To fulfill these purposes, it uses the tools offered by GRADE and Cochrane to try to ensure that the guides contain the most robust and up-to-date evidence possible. Likewise, it has developed a rigorous methodology called RAPADAPTE, inspired by the precepts of the international initiative of the ADAPTE Group. Both this methodology and some of its guides have been founding instruments of other CPGs at a global level due to their strength and prestige.

What is a CPG?

A Clinical Practice Guideline OR CPG is a set of recommendations for improving the health care of a given health condition. There are some of good quality and some of dubious or bad quality. Some are updated and are current and others are not. Some are sensitive to the context and are applicable, others have difficulties in this regard. Both aspects are critical to assess the applicability of a CPG. Regarding quality, it is essential for a CPG to be based on the best evidence available at the time of its preparation. It is also crucial that it has been developed with a robust and proven methodology.

What is a CPG for?

They are potentially useful for facilitating and improving clinical decision making in a given topic. They are aimed at health professionals, but they can also be of benefit to patients. Nowadays they are widely used in the most advanced healthcare systems worldwide.

What is a live CPG?

Science is dynamic and health research offers constant new contributions that must be considered and eventually incorporated into clinical practice. Therefore, as we have mentioned, updating a CPG is critical. Because the core of a guide consists of a series of recommendations, usually a CPG is updated after three to five years of its elaboration. However, this process is expensive in many ways. Especially in countries of medium and low income there is little possibility of maintaining the updating process in an appropriate manner due to limited resources. As an alternative to all this, an innovative method has been generated to individually and gradually update each of the recommendations or components of the CPG, when required. Current technological resources such as the Internet are used to facilitate and optimize the process. This is a live CPG.

We are also interested in using the platform to enrich the applicability and the implement ability of the recommendations of our guides. These aspects are addressed by the GLIA instrument, for example, and are important to ensure that the life cycle of a guide is fulfilled when it is possible to introduce it successfully in a given health system. In this regard, the case of the use of corticosteroids as a treatment to reduce morbidity and mortality in pregnant women with the threat of premature birth is exemplary. This is an intervention that has saved many lives since its application three decades ago. However, new evidence has shown that the use of this therapy in inappropriate conditions can increase neonatal mortality. Hence, considering the context of the application of any health intervention is very relevant.

In this CPG of Preterm Delivery Management recommendation 4-15:

The use of prenatal steroids in women at risk of preterm delivery is recommended for the reduction of neonatal mortality and RDS. The gestational age must be confirmed in a rigorous manner before the administration of antenatal corticosteroids. The condition of women and the possibility of infections in places with high prevalence of infections should be monitored. Strong recommendation in favor

However, this intervention requires special care and may not be valid if the neonate is not receiving adequate care as described in the consideration of the evidence on page 158 of the CPG.

Is this done elsewhere?

Indeed, the CDC, which is the main health agency responsible for the control and prevention of diseases in the United States, has launched the strategic project “Adapting Clinical Guidelines for the Digital Age” to take advantage of the connectivity available today and facilitate the coupling between experts and sanitary solutions.
The main objective of this program is to overcome the various obstacles existing for the implementation of scientific information and improve decision-making through the use of digital products that provide an optimal evidence-based health orientation.
In fact, the methodologists of the IHCAI Institute and authors of our CPGs are already linked and are part of this initiative.

What are the CPGs included in this project?

For the moment, we will begin the work with the following:

  • [Spanish] “GUÍA DE PRÁCTICA CLÍNICA PARA EL MANEJO DE PARTO PRETÉRMINO. Cárcamo, Wendy; Tristán, Mario; Rodríguez, Heriberto; Orozco, Leonardo; García, María Eugenia; Andrino, Rodolfo; Beitía, Alfredo; Guidos, Miguel; Guerrero, Silvia; Cruz, Jorge; Muñoz, Ricardo; Rosado, Flor; Rodríguez, Mariela. San José, Costa Rica – IHCAI Institute, FECASOG. Primera Edición, abril 2018. ISBN FECASOG ISBN 978-9930-9469-8-5

How can I participate?

At this moment we are in the initial phase of finishing designing the project and polishing the platform. You can participate as:

Patient or User: If some of the guidelines are of your interest because you have the condition directly or you are a companion or caregiver of a patient with the disease that is one of the CPGs that IHCAI Institute has developed. We are interested in your opinion about the usefulness of the guide within your social and family reality and welcome any comments that may improve the instrument.

Healthcare professional: If you are a health worker who works daily in the ailment addressed by any of the aforementioned CPGs, we are interested in your comments on the comprehensive information offered by the guide and, in particular, on its implementation within its health context.
Students: If you are a student of any health discipline anywhere in the world, if you have the time and motivation, if you have the academic endorsement and support of your school of origin and want to participate as a collaborator in the update process of the mentioned CPGs, you can contact us to consider an eventual internship as part of the active programs of IHCAI institute for international students.

Soon we will make an update on this page to provide details about participation in the project. We appreciate your interest.