Trustworthy clinical practice guidelines: a national project in the Czech Republic

Article type
Authors
Klugar M1, Klugarová J1, Pokorná A1, Líčeník R1, Ryska M2, Dušek L3
1Cochrane Czech Republic, Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno; Czech Health Research Council, Prague
2Czech Health Research Council, Prague; Department of Surgery, Military Hospital, Prague
3Cochrane Czech Republic, Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno; Institute of Health Information and Statistics of Czech Republi
Abstract
Background: currently in the Czech Republic, there is no National Centre for Clinical Practice Guidelines. In 2018, there were about 123 professional healthcare organizations which have developed around 1933 guidelines. However, the majority of these guidelines are based on expert opinion, or consensus, or recommendations that lack a systematic evidence-based medicine approach with regard to principles and methods. The National Guidelines Project is led by the Czech Health Research Council (CHRC); its first partner is the Ministry of Health of the Czech Republic (MH) and its second partner is the Institute of Health Information and Statistics of the Czech Republic (IHIS). It has support from policy makers, academics, clinicians and members of the Czech National Centre for Evidence-Based Healthcare and Knowledge Translations (CEBHC-KT), which is an umbrella for three very important international collaborations that play a key role in evidence-based healthcare, evidence synthesis, evidence implementation and development of trustworthy guidelines. These are Cochrane Czech Republic, Masaryk University GRADE Centre, and the Czech Republic Centre for EBHC: The Joanna Briggs Institute Centre of Excellence (JBI).

Objectives: to present the Czech national methodology for trustworthy clinical practice guideline (CPG) development and the first results of the ongoing CPG project.

Methods: the project started January 2018 and will last five years. During this time at least 40 trustworthy CPGs will be developed. The Czech national guideline methodology was developed by members of Cochrane Czech Republic, JBI and GRADE centres and is based on the GRADE approach to guidelines development. The methodology was tested on the first five pilot CPGs, which were completed by end of December 2018.

Results: as a first step, managing authorities - including a Guarantee committee (GC) and an Appraisal (Methodological) committee (AMC) - were established. Members of the GC are key stakeholders and policy makers in the Czech Republic, and include the Health Minister. AMC involves methodologists and health analysts, statisticians and information specialists. The first five pilot guidelines were developed in co-operation with the Czech Medical Professional Associations (CMPA), and were successfully reviewed by CMPA, AMC, GC, and are currently receiving public review. After this the CPGs will be published on the National Guidelines Portal and Bulletin of MH.

Conclusions: the first year of the Czech National Guidelines project saw development of a national methodology, the establishment of managing authorities and processes of topic generation and approval, as well as guidelines generation and approval.

Patient or healthcare consumer involvement: one member of the GC is the chair of Czech Patient organizations, and involvement of patients and healthcare consumers in guideline development is part of national CPG methodology.