Monday, 2 January 2017

Evidence-Based Medicine (EBM) & Clinical Practice Guidelines (CPGs) in the Middle Eastern Context.

There has been a lot of fuzz about following Evidence-Based Medicine (EBM) and creating and implementing Clinical Practice Guidelines. It is heard everywhere from hospital management professionals to clinical practitioners. The whole crux of following EBMs and CPGs is to increase patient safety, better treatment outcomes and reduction of cost.  It is a well know fact and is proven with organizations like NICE in UK (National Institute of Clinical Excellence) and Unites States Institute of Medicine in the forefront of developing CPGs.  Especially in countries like UK, which is public funded, this has been developed and implemented to a greater success.  CPGs are the pivot of clinical governance and have great relevance in this ever changing era of healthcare business.
 But in reality, is this being achieved from an organizational level or national level in the Middle East especially in the UAE? There has been some scattered effort from certain countries in the region like The State of Qatar who are rolling out a National Health Strategy (NHS 2.1.2) which aims to develop a national strategy to develop national clinical guidelines creation and implementation. This project itself is lagging behind the planned implementation and little is known regarding the success (if known, to stress the results to be unbiased).

Sadly, for UAE nothing solid in this matter to my knowledge has been thought about or implemented successfully.   The factors are several ranging from the existence of different regulatory organizations in different emirates to the prevalence of a highly non-regulated private sector in terms of clinical management.  Even though most of the secondary and tertiary care organizations (both public and private) are accreditated by JCI, the adherence to CPGs as demanded by JCI standard GLD 11.2 is not judiciously followed. The standard itself demands implementation of GPGs, clinical protocols and clinical bundles to guide clinical care.  The country is driven by EBM, but here it’s not evidence-based medicine, but instead “Experience-Based Medicine” or simply Opinion based medicine that is rooted on their personal experience and expertise. This can be accounted to the multicultural workforce who obtained their clinical education, experience and expertise in different countries.

What needs to done is to have a national vision on a unified national clinical guideline development with implementation with zeal and vigor.  Various regulatory bodies, public health sector entities, private sector as well as insurance providers should be incorporated to achieve this drive. The result of this will be a well regulated health system rooted on greater treatment outcomes achieved with minimal resources at minimal cost.

My next blogs will be concentrated towards this as I will be circulating this blog for expert opinion and views of many professionals working in the UAE health sector.