Accessibility, inclusivity, and implementation of COVID-19 clinical management guidelines early in the pandemic: a global survey

  1. Caitlin Pilbeam
  2. Deborah Malden
  3. Katherine Newell
  4. Andrew Dagens
  5. Kalynn Kennon
  6. Melina Michelen
  7. Nina Gobat
  8. Louise Sigfrid

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

With a rapidly changing evidence base, high-quality clinical management guidelines (CMGs) are key tools for aiding clinical decision making and increasing access to best available evidence-based care. A rapid review of COVID-19 CMGs found that most lacked methodological rigour, overlooked many at-risk populations, and had variations in treatment recommendations. Furthermore, social science literature highlights the complexity of implementing guidelines in local contexts where they were not developed and the resulting potential to compound health inequities. The aim of this study was to evaluate access to, inclusivity of, and implementation of Covid-19 CMGs in different settings.

Methods

A cross-sectional survey of clinicians worldwide from 15 June to 20 July 2020, to explore access to and implementation of Covid-19 CMGs and treatment and supportive care recommendations provided. Data on accessibility, inclusivity, and implementation of CMGs. were analyzed by geographic location.

Results

Seventy-six clinicians, from 27 countries responded, 82% from high-income countries, 17% from low-middle income countries. Most respondents reported access to Covid-19 CMG and confidence in implementation of these. However, many respondents, particularly from LMICs reported barriers to implementation, including limited access to treatments and equipment. Only 20% of respondents reported having access to CMGs covering care for children, 25% for pregnant women and 50% for older adults (>65 years). Themes emerging were for CMGs to include recommendations for different at-risk populations, and settings, include supportive care guidance, be readily updated as evidence emerges, and CMG implementation supported by training, and access to treatments recommended.

Conclusion

Our findings highlight important gaps in Covid-19 CMG development and implementation challenges during a pandemic, particularly affecting different at-risk populations and lower resourced settings., to improve access in evidence-based care recommendations during an emergency. The findings identifies an urgent need for an improved framework for CMG development, that is inclusive and adaptable to emerging evidence and considers contextual implementation support, to improve access to evidence-based care globally.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.03.31.21254680: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This research was performed in accordance with the Declaration of Helsinki, and was given an exemption from ethical review by the Oxford Tropical Research Ethics Committee (OXTREC) on 16 April 2020.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The survey was programmed onto the REDCap database (16,17), hosted at the University of Oxford, and circulated as an online link with two follow-up reminders to non-responders.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Despite these limitations, the responses represent a wide range of settings globally, and identifies critical gaps and a unique cross-sectional insight into the access, inclusivity, and implementation of CMGs early on during a pandemic response. This study highlights gaps in inclusivity of and access to COVID-19 CMGs for different resourced settings and populations, and challenges in implementation during an emergency. The findings highlight a need for a new evidence-based framework for infectious diseases CMG development. This framework should include stakeholders from different resourced settings, to ensure locally relevant challenges and priorities are addressed. CMGs needs to be flexible, and adaptable to new emerging evidence and situations, considering implementation support for different settings. A living review framework addressing implementation facilitators were recommended. A failure to invest in an updated framework for infectious disease CMG development risks widening health inequalities.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.03.31.21254680v2 on medRxiv
  3. Version published to 10.1101/2021.03.31.21254680v1 on medRxiv