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A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries
BACKGROUND: Understanding how clinical practice guidelines and recommendations are adopted in high-income and low-income settings will help contextualise the value and validity of recommendations in different settings. We investigate how major guidelines and recommendations are developed for managem...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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International Society of Global Health
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442582/ https://www.ncbi.nlm.nih.gov/pubmed/34552724 http://dx.doi.org/10.7189/jogh.11.04055 |
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author | Mukonda, Elton Lesosky, Maia |
author_facet | Mukonda, Elton Lesosky, Maia |
author_sort | Mukonda, Elton |
collection | PubMed |
description | BACKGROUND: Understanding how clinical practice guidelines and recommendations are adopted in high-income and low-income settings will help contextualise the value and validity of recommendations in different settings. We investigate how major guidelines and recommendations are developed for management and monitoring of post-diagnosis treatment for three important chronic diseases: HIV, hypertension and type 2 diabetes mellitus (T2DM). METHODS: Eligible guidelines were searched for using PubMed, Google, and health ministry websites for all three conditions. Only guidelines published from 2010 to 2020 were included. The source of the guidelines, year of most recent guideline, and basis of the guidelines were assessed. Additionally, recommendations, the strength of the recommendation and the quality of the evidence for treatment goals of non-pregnant adults and the frequency of monitoring were also extracted and assessed. RESULTS: Of the 42 countries searched 90%, 71% and 60% had T2DM, hypertension and HIV guidelines outlining targets for long-term management, respectively. Most T2DM guidelines recommend an HbA1c target of ≤7.0% (68%) or ≤6.5% (24%) as the ideal glycaemic target for most non-pregnant adults, while hypertension guidelines recommend blood pressure (systolic blood pressure/diastolic blood pressure) targets of <140/90 mm Hg (94%) and <130/80 mm Hg (6%). Of the identified HIV guidelines, 67% define virological failure as a viral load >1000 copies/mL, with 26%, mostly HICs, defining virological failure as a viral load >200 copies/mL. Recommendations for the frequency of monitoring for any diagnosed patients were available in 18 (55%) of the hypertension guidelines, 25 (93%) of HIV guidelines, and 27 (73%) of the T2DM guidelines. Only a few of the guidelines provide the strength of the recommendation and the quality of the evidence. CONCLUSIONS: Most guidelines from LMICs are adopted or adapted from existing HIC guidelines or international and regional organisation guidelines with little consideration for resource availability, contextual factors, logistical issues and general feasibility. |
format | Online Article Text |
id | pubmed-8442582 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | International Society of Global Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-84425822021-09-21 A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries Mukonda, Elton Lesosky, Maia J Glob Health Articles BACKGROUND: Understanding how clinical practice guidelines and recommendations are adopted in high-income and low-income settings will help contextualise the value and validity of recommendations in different settings. We investigate how major guidelines and recommendations are developed for management and monitoring of post-diagnosis treatment for three important chronic diseases: HIV, hypertension and type 2 diabetes mellitus (T2DM). METHODS: Eligible guidelines were searched for using PubMed, Google, and health ministry websites for all three conditions. Only guidelines published from 2010 to 2020 were included. The source of the guidelines, year of most recent guideline, and basis of the guidelines were assessed. Additionally, recommendations, the strength of the recommendation and the quality of the evidence for treatment goals of non-pregnant adults and the frequency of monitoring were also extracted and assessed. RESULTS: Of the 42 countries searched 90%, 71% and 60% had T2DM, hypertension and HIV guidelines outlining targets for long-term management, respectively. Most T2DM guidelines recommend an HbA1c target of ≤7.0% (68%) or ≤6.5% (24%) as the ideal glycaemic target for most non-pregnant adults, while hypertension guidelines recommend blood pressure (systolic blood pressure/diastolic blood pressure) targets of <140/90 mm Hg (94%) and <130/80 mm Hg (6%). Of the identified HIV guidelines, 67% define virological failure as a viral load >1000 copies/mL, with 26%, mostly HICs, defining virological failure as a viral load >200 copies/mL. Recommendations for the frequency of monitoring for any diagnosed patients were available in 18 (55%) of the hypertension guidelines, 25 (93%) of HIV guidelines, and 27 (73%) of the T2DM guidelines. Only a few of the guidelines provide the strength of the recommendation and the quality of the evidence. CONCLUSIONS: Most guidelines from LMICs are adopted or adapted from existing HIC guidelines or international and regional organisation guidelines with little consideration for resource availability, contextual factors, logistical issues and general feasibility. International Society of Global Health 2021-09-04 /pmc/articles/PMC8442582/ /pubmed/34552724 http://dx.doi.org/10.7189/jogh.11.04055 Text en Copyright © 2021 by the Journal of Global Health. All rights reserved. https://creativecommons.org/licenses/by/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License. |
spellingShingle | Articles Mukonda, Elton Lesosky, Maia A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries |
title | A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries |
title_full | A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries |
title_fullStr | A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries |
title_full_unstemmed | A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries |
title_short | A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries |
title_sort | comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442582/ https://www.ncbi.nlm.nih.gov/pubmed/34552724 http://dx.doi.org/10.7189/jogh.11.04055 |
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