Evaluation of the PAHO/WHO Training Workshop on Guideline Development Methods, May 9, 10 2011 Coordination Public Policies and Research Team - Health Systems Based on Primary Health care (HSS)
Objectives The workshop was conducted by Dr. Holger J. Schünemann, Pablo Alonso, Reem Mustafa from the Department of Clinical Epidemiology and Biostatistics at McMaster University and Regina Kulier from the Secretariat of the Guideline Review Committee from WHO. The workshop responds to the findings of the evaluation of PAHO/WHO guidelines (presented at the Managers Meeting in Quito, at the Advisory Committee on Health Research, at the PAHO Meeting on Technical Guidelines in April 2009) as well as to the implementation of the WHO Guideline Review Committee strategy that aims to improve guidelines development.
Summary of commentaries and /questions about guideline development in PAHO: During the sessions, participants and facilitators raised and discussed a number of issues concerning the production of guidelines at PAHO:
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Establishing guide to documents that are not considered “guidelines” by the GRC handbook 1 such as o
Documents containing standards for manufacturing health technologies such as pharmaceuticals and vaccines;
o
Operational manuals
o
Documents that describe standard operating procedures for organizations or systems
o
Documents that state establishes principles
o
Documents that provide information on different options for interventions without recommending any particular intervention
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How will PAHO incorporates the Guideline Review Committee recommended processes?
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How will PAHO develop and implement procedures for guideline development that ensure that guidelines are consistent with internationally accepted best practices?
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Exploring ways to ensure that PAHO guideline proposals and final manuscripts could be evaluated whether by the WHO Guidelines Review Committee or by a PAHO Guidelines Review Committee.
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How PAHO will coordinate and provide support to departments producing guidelines
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Including speaking Spanish, Portuguese and French members as part of the WHO Guidelines Review Committee.
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Ensuring that all guidelines prepared by PAHO staff comply with the WHO handbook for developing Guidelines
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Developing and implementing a plan to ensure that the staff developing guidelines in PAHO have appropriate knowledge of the approved methods for guideline development.
1
Monitoring the quality of PAHO guidelines
World Health Organization. WHO Handbook for Guideline Development March 2010.
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Creating a repository of PAHO guidelines as well as country developed guidelines in the region in the Virtual Health Library.
PAHO is currently updating its publishing policy. The publishing policy is structured into 16 chapters and there are 9 working groups. The Public Policies and Research Team is leading the guideline chapter.
Summary of the training course evaluation Twenty eight participants attended the two-day workshop on "Guideline Development Methods" held in May 9, 10, 2011 at the Washington DC PAHO Headquarters. The purpose of the workshop was to promote the implementation of recommended processes for technical documents and guidelines using scientific research evidence. 20 attendees filled an evaluation form. The results from the evaluation the PAHO/WHO Training Workshop on Guideline Development are presented. Overall, how would you rate this workshop? Only 35% of those attendees that filled the survey had prepared guidelines before attending the workshop. Overall, participants agreed that the objectives of the workshop were met. However, a lower proportion of attendees agreed that there was insufficient time allocated for interactive learning. A more detailed description of the results of the evaluation is reported in box 1: Box 1. Overall, how would you rate this workshop?
Disagree Agree Median.. Range [ ]
The objectives of the workshop were clear.
1
2
[3
4
5]
The content of the workshop met the objectives.
[1
2
3
4
5]
The length of the workshop was appropriate.
[1
2
3
4
5]
There was sufficient time allocated for interactive learning.
[1
2
3
4
5]
The workshop increased my knowledge of how to conduct a Cochrane review.
1
[2
3
4
5]
Usefulness of sessions Overall participants rated the usefulness of each session positively: How useful were the following sessions?
not useful very useful
Overview of guideline development and scoping the guideline
1
2
[3
4
5]
Guideline group: Function and composition Group Process and consensus methods, voting and how to present controversies
1
2
[3
4
5]
Conflict of Interest: What it is, why it is important and how to manage it
1
2
[3
4
5]
Formulating questions and choosing outcomes
1
2
[3
4
5]
Small group work and discussion – question and outcomes formulation
1
2
[3
4
5]
Evidence retrieval and synthesis: Systematic review basics and practicalities
1
[2
3
4
5]
Introduction to assessing the quality of evidence and grading recommendations
1
2
[3
4
5]
An introduction to evidence assessment (see note 1) Using and preparing GRADE tables
1
2
[3
4
5]
Small group work and discussion, then feedback.
1
2
[3
4
5]
Assessing resource use and costs for guidelines
1
2
[3
4
5]
Incorporating values and preferences
1
2
3
[4
5]
Formulating and grading recommendations
1
2
3
[4
5]
Small Group work and discussion: Developing Recommendations
1
2
[3
4
5]
Peer reviewing and publishing your guideline
1
2
[3
4
5]
Take home messages, wrap up
1
2
[3
4
5]
What did you like about this workshop? Response Teachers – top experts in the field The interactive learning Small groups and discussions Capacity building (Knowledge) Methodology of workshop GRADE-pro software
What could be improved about this workshop? Allocate more time for workshop More time for GRADEpro training More clarity on process of creating guidelines More technical support from WHO-PAHO in the countries to strengthen human resources in learning this methodology More clarity on the difference between creating guidelines and recommendations Continuous communications among countries Develop an online training Share more realistic examples in public health
List of participants
Participant
Country
Institution
Gustavo Vargas
Belize
Pan American Health Organization
Susana Hannover
Bolivia
Pan American Health Organization
Roxana Salamanca
Bolivia
Pan American Health Organization
Renato Garcia
Brazil
PAHO/WHO Collaborating center
Laura Ramirez
Ecuador
Pan American Health Organization
Gustavo Bretas
Ecuador
Pan American Health Organization
Guillermo Hegel
Guatemala
Pan American Health Organization
Juanita Rodriguez
Guatemala
Pan American Health Organization
Ana Treasure
Honduras
Pan American Health Organization
Karla Zepeda
Honduras
Pan American Health Organization
Ing Lourdes Ramirez
Honduras
Pan American Health Organization
Marilyn Entwistle
Jamaica
Pan American Health Organization
Roger Emilio Montes Flores
Nicaragua
Pan American Health Organization
Amaia Lopez
Panama
Pan American Health Organization
Giovanni Escalante
Peru
Pan American Health Organization
Eva De Weever
St. Maarten
Ministry of Public Health, Social Development & Labour, St. Maarten
Fleur Hermanides
St. Maarten
Senior Policy Worker. Ministry of Public Health, Social Development & Labour, St. Maarten
Guillermo Troya
Trinidad
Pan American Health Organization
Malhi Cho
USA (WDC)
Pan American Health Organization. Health Technologies for Quality of Care - Health Systems based on Primary Health Care
Dolors Monserrat-Capella
USA (WDC)
Pan American Health Organization. Health Technologies for Quality of Care - Health Systems based on Primary Health Care
Pamela Bravo
USA (WDC)
Pan American Health Organization. Family and Community Health.
Dra Elisa Prieto
USA (WDC)
Pan American Health Organization. Health Surveillance and Disease Prevention and Control
Luis Gabriel Cuervo
USA (WDC)
Pan American Health Organization. Public Policies and Research team Health Systems based on Primary Health Care
Evelina Chapman
USA (WDC)
Pan American Health Organization. Public Policies and Research team Health Systems based on Primary Health Care
Cristina Schneider
USA (WDC)
Pan American Health Organization. Health Surveillance and Disease Prevention and Control
Andrea Gerger
USA (WDC)
Pan American Health Organization. Health Surveillance and Disease Prevention and Control
Andrea Vicari
USA (WDC)
Pan American Health Organization. Family and Community Health
Ludovic Reveiz
USA (WDC)
Pan American Health Organization. Public Policies and Research team Health Systems based on Primary Health Care
Regina Kullier
Switzerland
World Health Organization. Guideline Review Committee Secretariat.
Holger Sch端nemann
Canada
McMaster University. Department of Clinical Epidemiology & Biostatistics
Pablo Alonso
Canada
McMaster University. Department of Clinical Epidemiology & Biostatistics
Reem Mustafa
Canada
McMaster University. Department of Clinical Epidemiology & Biostatistics