Evaluation of evidence-based literature and formulation of recommendations for the clinical preventive guidelines for immigrants and refugees in Canada

Abstract

Background: This article describes the evidence review and guideline development method developed for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada by the Canadian Collaboration for Immigrant and Refugee Health Guideline Committee.

Methods: The Appraisal of Guidelines for Research and Evaluation (AGREE) best-practice framework was combined with the recently developed Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to produce evidence-based clinical guidelines for immigrants and refugees in Canada.

Results: A systematic approach was designed to produce the evidence reviews and apply the GRADE approach, including building on evidence from previous systematic reviews, searching for and comparing evidence between general and specific immigrant populations, and applying the GRADE criteria for making recommendations. This method was used for priority health conditions that had been selected by practitioners caring for immigrants and refugees in Canada.

Interpretation: This article outlines the 14-step method that was defined to standardize the guideline development process for each priority health condition.

Figure 1:

Sample logic model for HIV (adapted from US Preventive Services Task Force). Open rectangles designate the potential screening population and patient factors to be considered; shaded rectangles designate interventions and related outcomes; and circles and numbers provide points in the evidence chain that were used to develop the search questions. Note: ARV = antiretroviral, EIA = enzyme immunoassay.