Developing and Deploying Clinical Practice Guidelines

Next week, we are teaming up with the Canadian College of Healthcare Leaders @CCHL_CCLS on a tweetchat that will explore clinical practice guidelines in a pandemic. There are two aspects that we plan to discuss.

First, we will be discussing clinical practice guidelines themselves. What are these? According to the American Academy of Family Physicians (AAFP), clinical practice guidelines or CPGs (we love our acronyms in healthcare don’t we?) are “statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence, and an assessment of the benefits and harms of alternative care options. CPGs should follow a sound, transparent methodology to translate best evidence into clinical practice for improved patient outcomes. Additionally, evidence-based CPGs are a key aspect of patient-centered care.” As such, CPGs take time to develop and are challenging to disseminate/implement.

There is also the issue of consistency. In Canada alone there are over 1,800 CPGs. You can search them here: https://joulecma.ca/cpg/homepage

Second, we will dive into the question of how we can/should we take the lessons learned from past outbreaks like H1N1 and apply them in developing CPGs.

Joining @CCHL_CCLS in leading the discussion will be the two authors of the article that this week’s chat is based on: Thilina Bandara, PhD @Thilina_B and Dr. Cory Neudorf, MD @CoryNeudorf. *Please note that @CCHL_CCLS has kindly made the published article from Bandara and Neudorf freely available to HCLDR for a limited time. The link is below.


Public health physician perspectives on developing and deploying clinical practice guidelines

by Thilina Bandara, PhD, and Dr. Cory Neudorf, MD

Like heart attacks are to cardiologists, pandemics require the intuition and leadership of the public health and preventative medicine physicians to be managed. The public health field has learned from the evergreen threat of infectious disease throughout Canada’s history, from the outbreaks of cholera, smallpox and typhoid during the inception of the country, to today’s COVID-19 crises. One of the formative recent outbreaks that has helped prepare public health for COVID-19 was the H1N1 influenza pandemic of 2009.

While each outbreak is unique, there are commonalities between them that can help improve the public health system. Our article highlights seven key lessons that local Canadian public health physicians learned as a result of the 2009 H1N1 pandemic. Here we will outline some broad themes from our inquiry.

1. Public health in Canada and the US is highly decentralized

An effective model of collaboration and communication must be an ongoing project in a highly decentralized system.

Between federal, provincial/state, and local public health authorities, there are a lot of chances for communication gaps and inefficient processes, especially when making guidelines that are to dictate front-line responses to a previously-unknown pathogen. During a pandemic, these gaps become amplified.

To maintain a high level of rigour in developing and deploying clinical guidelines, public health organizations across all levels of jurisdictions must have clear respective roles that are consistent across Canada. They must also continually iterate their communication channels based on the communication needs across agencies, emergent communication technologies and norms that change over time.

2. Baseline public health capacity is essential

Pandemics take a considerable amount of human resources to manage. While “surge capacity” – that is, the ability to scale operations in times of high demand – is the current model to face pandemics, there is a level at which capacity at baseline needs to be at for surging to proceed effectively.

There is a prevailing sentiment among local public health physicians that baseline public health capacity is just not there yet. And not only are baseline level of public health workforce and capacities low, they are highly variable across the country, especially between the urban/rural divide.

Robust baseline public health operations ensure that pandemic demands do not completely deplete the ongoing routine demands of public health practice, like immunizations, environmental health, and sexual health, for example.

3. We know very little about organizational best practices in the public health sector

Unfortunately, there is a marked lack in public health systems and services research in Canada (and perhaps the US), even at a descriptive level. A robust body scientific knowledge and ongoing inquiry can help improve the public health system as it does in any other part of health care.

Moving toward the development of the comprehensive national-wide PHSSR agenda that includes the federal, provincial, and local public health activities can help us better capture the lessons like those we report in our paper. These can then be turned into best practices to help improve future responses to health emergencies like pandemics.

On Tuesday, June 16, at 8:30 p.m. EST (for your local time click here), join Thilina Bandara, PhD, a Research Officer at the Urban Public Health Network, and Dr. Cory Neudorf, MD, the Chief Medical Health Officer for the Saskatoon Health Region, as they talk about what they’ve learned from connecting researchers and clinicians during a pandemic.

Their article is part of a themed edition of Healthcare Management Forum, the official journal of the Canadian College of Health Leaders, pandemics. The Guest Editor of that edition, Dr. David Butler-Jones, MD, was the Chief Public Health Officer of Canada and Deputy Minister for the Public Health Agency of Canada from 2004 to 2014. Their article can be found here: https://journals.sagepub.com/doi/full/10.1177/0840470420917412

Specific questions to be discussed include the following:

  • T1 Clinical practice guidelines support public health and inform clinical practice. How might we better disseminate these guidelines to more healthcare organizations during a pandemic?
  • T2 What lessons could we have taken from past outbreaks like H1N1 to apply to COVID-19?
  • T3 How can health leaders ensure these lessons are better ingrained into standard operating procedures? Are clinical practice guidelines enough?
  • T4 What can health leaders do right now to plan for the next wave of this pandemic?

About the Authors

Thilina Bandara, PhD. As a researcher I am interested in understanding the implementation and effects of universal vs. targeted policy approaches in health and social systems, as well as in public and private innovations that work to improve health equity. I have experience conducting epidemiological and policy-based analyses in academic, healthcare, non-profit and governmental settings. Bandara is currently a Research Officer at the Urban Public Health Network and an Adjunct Professor at the University of Saskatchewan.

Dr. Cory Neudorf, MD Dr. Cory Neudorf describes himself as a health geek. “It’s an apt description of a man who has spent the past 24 years dedicated to promoting and protecting the health of people in communities in Saskatchewan and around the world. From his home base in Saskatoon, he has travelled to northern Saskatchewan, as well as Eastern Europe and Central Asia – nearly 20 countries all together – in the interest of global health.” Dr. Neudorf is currently a Medical Health Officer in the Saskatchewan Health Authority (https://www.saskhealthauthority.ca/) and a Professor at the University of Saskatchewan

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