Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation

Schünemann, Holger J; Fretheim, Atle; Oxman, Andrew D

The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the thirteenth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Adaptation involves modification according to different circumstances or environmental conditions [1] . In the context of guidelines, it relies on judgments of whether a guideline is applicable (i.e. relevant to a local setting in a specific setting) or transferable from one setting to another. A survey of managed care plans in the US found that they relied on national and other published guidelines as references for their own guidelines. However, most of the surveyed plans did not adopt published guidelines "as is" and adapted them for a variety of reasons [2] . The main reasons were lack of local clinical input, inappropriate consideration of resources, failure to apply to a specific population, too extensive recommendations, a high level of complexity in guidelines for users, and failure to include the most recent information in guidelines.