Towards Evidence-Based Clinical Practice Guidelines: The Case of Bosnia And Herzegovina

This paper focuses on the importance of adaptation of evidence based clinical practice guidelines (CPG) in developing countries like Bosnia and Herzegovina in a culturally competent way. Evidence based CPG guidelines are not routinely used in Bosnia and Herzegovina. The first adapted, evidence-based guideline on the care of women requesting induced abortion was published in 2007 following a 2004 publication by the Royal College of Obstetricians and Gynecologists (RCOG) (Evidence-based Clinical Guideline Number 7, ʹThe Care of Women Requesting Induced Abortionʹ). The first adapted clinical guideline initiated the development of a second one related to secondary prevention of cervical carcinoma. Appraisal of Guidelines for Research and Evaluation (AGREE) were used to assess the development of clinical practice guidelines with the purpose of assuring methodological quality. After receiving permission, electronic searches of medical databases were performed to identify research performed in international settings similar to ours and research that took place after the publication of the RCOG guideline. 226 articles were selected, yielding 68 recommendations related to clinical assessment questions. Using expert consensus and external reviews, recommendations were generated that provided the clinical guideline development group with an evidence base from which to make recommendations on the best possible clinical practice. Variation in values, needs, costs and resources were considered systematically in order to make a decision about which policies should be implemented locally. For the first time in B&H, the evidenced-based clinical guideline development process fostered a supportive environment for educating health care providers on evidence based methodology, and new evidence based guidelines can be initiated for potential health care providers.