Guideline development in lower-middle income countries hosting refugees using GRADE-ADOLOPMENT framework: insights from Jordan

Oral
2024 Prague [Global Evidence Summit]
Abu-Nar O1, Alharasis S2, Almohtaseb A2, Alshokaibi S2, Alzghoul A2, Hammad E3, Megdadi M4, Mustafa R5, Qanno' O6, Rabai N7, Sartawi H8, Shawawreh F9
1Internal Medicine Department, Jordan Hospital, Amman, Jordan
2Non-Communicable Diseases Directorate, Ministry Of Health, Amman, Jordan
3School of Pharmacy, University of Jordan, Amman, Jordan
4Emergency Hospital, Al-Basheer Hospitals Administration, Ministry of Health, Amman, Jordan
5Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, Kansas City, KS, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
6General and Speciality Surgeries Hospital, Al-Basheer Hospitals Administration, Ministry of Health, Amman, Jordan
7Princess Basma Teaching Hospital, Ministry of Health, Irbid, Jordan
8Pharmacy and Clinical Pharmacy Directorate, Ministry Of Health, Amman, Jordan
9Samih Darwazah Cancer Center, Al-Basheer Hospitals Administration, Ministry of Helath, Amman, Jordan

Background:

Jordan is a lower-middle income country (LMIC) that hosts the second most refugees per capita worldwide. The Ministry of Health (MOH) Strategic Plan 2023-2025 prioritized local guidelines development to standardize clinical practice across health sectors. The national committee for cardiovascular and diabetes strategy recommended updating outdated local guidelines on the management of hypertension, diabetes, and cardiovascular risk assessment at the primary-healthcare level. Aiming to ensure sustainable and equitable access for health services for all residents to achieve universal health coverage. However, local expertise in guidelines development using a rigorous methodology was lacking.

Objective:

To share the Jordanian MOH experience in developing a local core team of guidelines developers, and their work across 3 highly prioritized disease areas

Methods:

MOH consulted an expert methodologist who supported a small team to lead the process and recommended the use of GRADE-ADOLOPMENT methodology. Funding was secured to support the conduction of a multiphase training program over 9 months, to qualify a core team of guidelines developers, starting from introductory courses on evidence-based medicine to advanced online and face-to-face courses on GRADE methodology. MOH convened a national guideline development committee. The committee included clinicians, pharmacists, a methodologist, a patient representative, and members from the core team (Graph1). The core team selected source guidelines, extracted PICO questions, filled GRADE and evidence-to-decision tables, and discussed every step with the committee during scheduled meetings to conclude recommendations. The team collected information about facilitators and barriers of using the GRADE-ADOLOPMENT process.

Results:

Starting from 80 trainees, a core team of 22 medical specialists and pharmacists has been developed; 9 of them were included in the committee to update the 3 priority guidelines by applying GRADE methodology on more than 40 PICO questions (Graph1). Key success factors included strong leadership, availability of expert methodologist, a qualified and trained core team, and access to funding and telecommunication technology. Challenges included initial inexperience, time management, resource constraints, and weak administrative support.

Conclusions:

This effort demonstrates a successful case example of implementing GRADE-ADOLOPMENT methodology in an LMIC hosting refugees. It highlights the importance of leadership, methodology training, teamwork, and efficient resource mobilization.