ESPEYB21 13. Global Health for the Paediatric Endocrinologist Endocrinology (7 abstracts)
13.11. GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context
Martins RS , Nadeem S , Aziz A , Raja S , Pervez A , Islam N , Ahmed A , Sheikh A , Furqan S , Ram N , Rizwan A , Rizvi NA , Mustafa MA , Aamdani SS , Ayub B & Masood MQ
BMC Endocr Disord. 2024 Mar 21;24(1):41. doi: 10.1186/s12902-023-01493-1. PMID: 38509509.
Brief Summary: This process study describes the adaptation of previously established clinical practice guidelines for hyperthyroidism to better suit the local healthcare context in Pakistan. Adaptation utilized the GRADE-ADOLOPMENT method.
Hyperthyroidism is more prevalent in Pakistan (2.9%) than in the US and Europe. Pakistan faces unique challenges due to its diverse geography, dietary habits, and healthcare financing issues. Local guidelines are needed because imported guidelines from high-income countries may not fit the local context due to differences in disease epidemiology, healthcare infrastructure, and financial constraints.
The GRADE-ADOLOPMENT method utilized for this project was developed by GRADE (Grading of Recommendations Assessment, Development, and Evaluation) and is a globally accepted and implemented process for development of evidence-based clinical practice guideline. Adolopment describes a combination of adoption, adaptation (contextual modifications), and de novo development. The 2016 American Thyroid Association Guidelines served as the source for guideline development in Pakistan. Out of 124 recommendations in the source guideline, 71 were adopted, 49 excluded, and 4 were adapted. Adaptations included simplifying the use of laboratory tests to reduce patient costs, reflecting the resource constraints in Pakistan.
There were several key adaptations established generally in order to decrease costs, simplify follow-up or due to lack of availability. The process highlighted challenges related to resource constraints, stakeholder involvement, and resistance to change. Solutions included involving more stakeholders, emphasizing the need for local guidelines, and considering the diverse healthcare landscape of Pakistan.
These adapted guidelines provide context-specific, cost-effective recommendations for the management of hyperthyroidism in Pakistan. The authors emphasize the importance of guidelines that are not only evidence-based but also tailored to the local context, ensuring they are both practical and applicable in a resource-limited setting. Future research is needed to validate the effectiveness and feasibility of these adapted guidelines across the country.
References: 1. Schünemann HJ, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa RA, Manja V, et al. GRADE evidence to decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol. 2017;81:101–10.2. Ross DS, Burch HB, Cooper DS, Carol G, Luiza M, Rivkees SA, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343–1421.
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ESPE Yearbook of Paediatric Endocrinology
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