Open Access 01-12-2006 | Review
Improving the use of research evidence in guideline development: 2. Priority setting
Published in: Health Research Policy and Systems | Issue 1/2006
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Background
Objectives
Methods
Key questions and answers
What criteria should be used to establish priorities?
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WHO has limited resources and capacity to develop recommendations. It should use these resources where it has the greatest chance of improving health, equity, and efficient use of healthcare resources.
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We suggest the following criteria for establishing priorities for developing recommendations based on WHO's aims and strategic advantages:
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Problems associated with a high burden of illness in low and middle-income countries, or new and emerging diseases.
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No existing recommendations of good quality.
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The feasibility of developing recommendations that will improve health outcomes, reduce inequities or reduce unnecessary costs if they are implemented.
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Implementation is feasible, will not exhaustively use available resources, and barriers to change are not likely to be so high that they cannot be overcome.
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Additional priorities for WHO include interventions that will likely require system changes and interventions where there might be a conflict in choices between individual and societal perspectives.
What processes should be used to agree on priorities?
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The allocation of resources to the development of recommendations should be part of the routine budgeting process rather than a separate exercise.
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Criteria for establishing priorities should be applied using a systematic and transparent process.
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Because data to inform judgements are often lacking, unmeasured factors should also be considered – explicitly and transparently.
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The process should include consultation with potential end users and other stakeholders, including the public, using well-constructed questions, and possibly using Delphi-like procedures.
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Groups that include stakeholders and people with relevant types of expertise should make decisions. Group processes should ensure full participation by all members of the group.
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The process used to select topics should be documented and open to inspection.
Should WHO have a centralised or decentralised process?
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Both centralised and decentralised processes should be used. Decentralised processes can be considered as separate "tracks".
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Separate tracks should be used for considering issues for specific areas, populations, conditions or concerns. The rationales for designating special tracks should be defined clearly; i.e. why they warrant special consideration.
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Updating of guidelines could also be considered as a separate "track", taking account of issues such as the need for corrections and the availability of new evidence.