Awareness of adapting clinical practice guidelines to a local context

Abstract

Background

Guideline recommendations are often not implemented in practice. This can be attributed to factors such as patient preferences and characteristics, structural conditions, personnel or other resources, as well as cultural or ethical aspects. Adaptations to the local context (e.g., regional or hospital) result in so-called locally adapted guidelines (LAGL), which could improve implementation. We aimed to assess the awareness of LAGL among guideline developers in Germany.

Methods

An online survey was conducted via LimeSurvey in May 2024. The questionnaire, designed based on literature and expert opinions, consisted of 23 items, predominantly with dichotomous response options. Recruitment was conducted via email. Direct contact addresses were identified using the German guideline registry (n = 397). Additionally, a mailing list distribution was conducted through the guidelines working group of the German Network for Evidence-Based Medicine (n = 316). Only fully completed questionnaires were included in the analysis. Data cleaning and descriptive analysis were performed using Excel.

Results

A total of 63 questionnaires were fully completed. The most represented groups were physicians (65%) and methodologists (24%), most frequently in coordination (76%) or as group members (62%). The most judicious reasons for developing a LAGL were differences in patient populations (48%), currency of recommendations (46%), and patient values and preferences (44%). The most commonly cited likely reasons for developing a LAGL were economic considerations (32%), differences in patient populations (30%), and currency of recommendations (30%). Many respondents (59%) were aware of the possibility of adapting existing guidelines to the local context. Among these, approximately half (49%) had already locally adapted a guideline, with 75% using an adaptation framework.

Discussion

LAGLs are known among guideline developers in Germany and are generally developed using adaptation frameworks. Potential reasons for preparing LAGLs are diverse, with some discrepancies between perceived valid and likely reasons.