gms | German Medical Science

Background: Georgia has one of the highest stroke case fatality rate in the world. Stroke management is poor, hospital management inadequate, usage of drugs inappropriate and health professionals and patients lack knowledge. A key priority of the Ministry of Labor Health and Social Affairs (MOLHSA)'s health strategy is to develop evidence-based clinical guidelines and processes.

Objectives: The MOLHSA aimed to adapt a NICE guideline for stroke management for Georgia to improve the care of stroke patients and to develop guideline development processes.

Methods: The MOLHSA appointed a local team (systematic reviewer, health economist and project manager). A multidisciplinary guideline development group was chaired by a stroke expert. Systematic reviewing, basic health economic training as well as hand-on support was provided by external experts. Cost impact analysis was undertaken and quality standards produced for 6 key recommendations. The guideline was reviewed by international experts.

Results: All but one of the NICE guideline clinical questions were relevant to Georgia. 42 out of the 57 relevant recommendations from the NICE guideline were adopted verbatim, 10 were adapted (recommendations were reworded or adjusted), 5 were updated (reviews were updated) and 4 new clinical questions of high priority for Georgia were developed. A process manual was produced.

Discussion: internationally-recognised guidelines can be successfully adapted and development processes produced to the needs of middle income countries (MICs) in an optimum time (6 months).

Implications for guideline developers: Successful guideline adaptation in MICs needs the commitment and full involvement of the local government and health authorities.