title: Clinical practice guidelines were adapted and implemented meeting country-specific requirements--the example of Kazakhstan.
abstract: OBJECTIVE
  In a twinning partnership between the Canadian Society for International Health and Kazakhstan's Ministry of Health, a project to build capacity and a process for the adaptation and implementation of international clinical practice guidelines (CPGs) was undertaken.
  
  
  METHODS
  A pragmatic CPG adaptation process was developed that took into consideration national and local contexts. A 15-step process ranging from topic prioritization to copyright clearance to final Ministry of Health approval was developed. An implementation strategy was developed and piloted in three local regions using a five-step approach.
  
  
  RESULTS
  High-quality international CPG candidates were identified for all topics; forty-two CPGs were adapted locally by the clinical working groups. Three CPGs using 21 recommendations were implemented locally. Many challenges were identified including priority setting, obtaining permission to use and translate guidelines into Russian and producing high-quality translations, and organizational barriers during implementation. Facilitators included tools to guide the process and the creation of working groups.
  
  
  CONCLUSIONS
  We describe a process of large-scale adaptation of international CPGs with the pilot implementation of selected adapted CPGs and recommendations. Further evaluation and monitoring are required to ensure its integrity.
authors.affiliation: Department of Medicine, University of Ottawa, 85 Primrose Ave, Ottawa, ON, Canada K1N 6M1. Electronic address: jmcgowan@uottawa.ca.
authors.forename: Jessie
authors.initials: J
authors.lastname: McGowan
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1.
authors.forename: Sergei
authors.initials: S
authors.lastname: Muratov
authors.affiliation: Republican Helthcare Development Centre, 4 Orynbor St., Astana, Kazakhstan, 010000.
authors.forename: Anna
authors.initials: A
authors.lastname: Tsepke
authors.affiliation: Canadian Society for International Health Project Manager, Astana, Kazakhstan.
authors.forename: Arman
authors.initials: A
authors.lastname: Issina
authors.affiliation: Canadian Society for International Health, One Nicholas, Suite 726, Ottawa, ON K1N 7B7.
authors.forename: Eva
authors.initials: E
authors.lastname: Slawecki
authors.affiliation: Clinical Department Head for Emergency Medicine, Alberta Health Services, Calgary Zone, Academic Department Head for Emergency Medicine, Associate Professor of Emergency Medicine, Cumming School of Medicine, University of Calgary, RGH, Holy Cross Ambulatory Care, 7007 - 14 St. SW - Room 5A105, Calgary, AB Canada T2V 1P9.
authors.forename: Eddy S
authors.initials: ES
authors.lastname: Lang
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007623:Kazakhstan; D017410:Practice Guidelines as Topic / Q000592:standards
keywords: Evidence-based medicine; Guideline adherence; Health care; Implementation research; Knowledge translation; Practice guidelines as topic; Quality Assurance