Page 48 - Shared Guideline Development Experiences in Fertility Care

Chapter 3
Background
Complex multidisciplinary care is o en fragmented and su ers from so-called ‘clinical linkage de ciencies’ [1]. To resolve such de ciencies, many published reports and articles have stressed the importance of implementing integrated and patient-centred care by building bridges between the groups involved [2-6]. Clinical practice guidelines (CPGs) are potential tools for facilitating this shi in clinical care. Unfortunately, the quality of the guidelines varies, and their impact on delivering integrated and patient-centred care is still suboptimal [7-12]. Several problems still hinder CPG development and uptake, namely, inadequate management of con icts of interest (COIs), limited panel composition, lack of patient involvement, and lack of external review [9]. Furthermore, there is still a strong focus on the single clinical aspects of diseases described in the guidelines rather than on ensuring more integrated care for patients, including attention to matters such as patient-centredness, coordination and continuity of care. Because of all this, the target users feel no a nity with the guidelines, which impedes full implementation [7,8,10].
Clinical networks are de ned as collaborative, professionalized structures ranging from fully integrated service delivery systems to informal communities of practice. ese networks have previously proven e ective in increasing evidence-based practice and improving care models [13,14]. We aimed to resolve the de ciencies in multidisciplinary guideline (MuG) development and to re-centre the focus on the patient’s overall clinical journey rather than independent contributions from each specialty or caring function. us, we used the network approach in a clinical area of complex multidisciplinary care, namely, fertility care. We developed a harmonized set of one MuG and four monodisciplinary guidelines (MoGs) around patient clinical pathways, including any care needed for infertile couples (such as a ercare and care given by physicians, gynaecologists, and/or urologists). We aimed to assess the feasibility of this patient-centred network approach in a detailed evaluation of the process, professionals’ experiences, and the time required.
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