Jacques Genest, Rob Welsh Evidence-Based Marketing National - - PowerPoint PPT Presentation

Harmonization of Guidelines: The C-CHANGE Initiative

Canadian Cardiovascular HArmonization of National Guidelines Endeavour

• Acknowledgements
• Jacques Genest, Rob Welsh
• Evidence-Based Marketing
• National CPG Committee Memberships
• Disclosures
• Speaker/Advisory Board Honorariums
• Research Funding - Sanofi
• National CPG Committee Memberships
• Canadian Diabetes Association 2013
• Canadian Cardiac Rehabilitation Cardiac Rehabilitation (Chair)
• Canadian Hypertension Education Program
• C-CHANGE (Canadian Cardiovascular HArmonization of National Guidelines

Endeavour) (Chair)

• CCS Dyslipidemia 2102
• CCS Smoking Cessation 2011
• CCS Committee on Chronic Stable Angina
• CIHR Committee on Refractory Angina
• Physical Activity for Adults 2011
• Physical Activity for Persons with Spinal Cord Dysfunction (Chair) 2011

Overview

• Who is C-CHANGE?
• What is the history of C-CHANGE?
• Why is C-CHANGE important?
• What are the consequences of not realizing C-CHANGE?
• The Update Process

CPGs: Reality or Illusion?

Who is C-CHANGE?

• 1. Canadian Association of Cardiac Rehabilitation
• 2. Canadian Diabetes Association
• 3. CCS Dyslipidemia Guidelines Group
• 4. Canadian Hypertension Education Program
• 5. Canadian Stroke Network
• 6. Canadian Society for Exercise Physiology
• 7. CCS Smoking Cessation Working Group
• 8. Obesity Canada
• 9. CCS Anti-Platelet Guidelines
• 10. CCS Heart Failure Guidelines
• 11. CCS Atrial Fibrillation Guidelines
• 12. CCS Stable Ischemic Heart Disease Guidelines

C-CHANGE Partners

What is the History of C-CHANGE?

Why do we need Integrated CPGs?

C-CHANGE History

• 2002 – Campbell and Stone

– September 2002 – SOLIDDE

• 2003 – 2007

– Six meetings

• 2008

– CIHR

• Canadian Vascular Coalition

– CPG Development

C-CHANGE History

• 2010

– June – Harmonization Meeting

• 2011

– C-CHANGE Publication

• 2014 - Update

C-CHANGE History

• 2010

– June – Harmonization Meeting

• 2011

– C-CHANGE Publication

• 2014 - Update

Why IS C-CHANGE Important?

Why is C-CHANGE Important?

• Clinical Leadership

– Knowledge of science leads to expertise in the art

• Thought Leadership

– Visionaries – Work horses – Collaborators

• Research Leadership

– Basic science – Clinical trails – Outcomes assessments

• Primacy of Evidence-Informed Clinical Practice

– Evidence informs experience – Enhanced experience leads to enhanced outcomes

What are the Consequences of Not Realizing C-CHANGE?

“All for One and One for All!”

No C-CHANGE: Consequences

• CPG anarchy

– Competition for markets – Competition for funding – Competition for development stakeholders – Fragmentation of:

• Prevention
• Chronic disease care
• Teaching and education
• Sub-optimal patient outcomes
• Primacy of practice-informed clinical practice

– Experience is more important than evidence – Return to eminence-based practice

• Recommendation Redundancy

Recommendation Duplication Nutrition

Source Guideline (Location) Recommendation CDA (Health Behaviour Interventions) In diabetes Adults with diabetes should consume no more than 7% of total daily energy from saturated fats and should limit intake of trans fatty acids to a minimum. (Grade D, Consensus) Obesity Canada (Health Behaviour Interventions) A high-protein or a low-fat diet (within acceptable macronutrient distribution ranges indicated in the Dietary Reference Intakes) is suggested as a reasonable short-term (6–12 months) treatment option for obese adults as part of a weight-loss program. (Grade B, Level 2) Obesity Canada (Health Behaviour Interventions) Meal replacements may be considered as a component of an energy- reduced diet for selected adults interested in commencing a dietary weight-loss program. (Grade C, Level 2)

No C-CHANGE: Consequences

Harmonized Recommendations

Translating Scientific Knowledge into Clinical Action

Recommendation Categories

Diagnostic

• Screening
• Risk Stratification
• Diagnostic Tests

Therapeutic

• Treatment Targets
• Health Behaviour Therapies
• Pharmacological Therapies

The Update Process

• 1. Harmonize specific recommendations - same wording
• 2. Do not increase the workload
• 3. Implementation tools must adhere strictly to the recommendations
• 4. All C-CHANGE implementation tools will have C-CHANGE branding
• 5. Recommendations development - include an implementability wording

C-CHANGE Update Process

C-CHANGE Update Process

• 6. Harmonized C-CHANGE recommendations reviewed annually
• 7. Guidelines development requires AGREE II
• 8. Bias reduction remains a constant priority
• 9. Core C-CHANGE implementation tools will not have industry support
• 10. Primary care physicians and allied health care professions:

Recommendation Development Implementation Tool Development

SUMMARY

SUMMARY

• Who is C-CHANGE?
• What is the history of C-CHANGE?
• Why C-CHANGE important?
• What are the consequences of not realizing C-CHANGE?
• The Update Process

SUMMARY

• The KT Ripple Effect

– The Council of The Federation – Alberta Vascular Risk Reduction Project

Summary