Online Program

Assessing the application of evidence-based clinical guidelines by medical service trips (MSTs)

Monday, November 2, 2015 : 8:50 a.m. - 9:10 a.m.

Christopher D. Dainton, MD, CCFP, Chatham-Kent Health Alliance, Chatham, ON, Canada
Charlene H. Chu, HBScN, RN, GNC(C), Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Henry C. Lin, MD, The 53rd Week, Brooklyn, NY
Lawrence C. Loh, MD, MPH, CCFP, FRCPC, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Background/aim: North American clinicians increasingly serve on medical service trips (MSTs) that provide primary healthcare in Latin America, but consistent application of evidence-based guidelines by these groups remains unexplored in published literature. This review examines the development, implementation or evaluation of clinical guidelines overseeing the activities of MSTs.

Methods: An integrative review explored the use of evidence-based guidelines during MSTs.  MEDLINE and LILACs were searched using 18 keywords, including “medical brigades”, “Latin America” and “primary health care”.  Reviewed abstracts were published between 2000 and 2015 in any language, and included both qualitative and quantitative study designs. Additional publications were identified by hand-searching the citations of articles reviewed in full.

Results: 391 titles were screened, of which 9 were eligible for review. Eight of the studies were qualitative; of these, six studies described clinician reports of employing non-evidence based guidelines (e.g. expert opinion on treatment of common pathology) and two studies described the presence, but not necessarily consistent application, of limited-content evidence-based guidelines (one describing public health interventions on a MST, the other described evidence-based treatments for parasite and hypertension). Only one quantitative study described the application of American Family Physician guidelines to the management of urinary tract infections on a MST. None of the papers reviewed described the comprehensive and consistent usage of a broad set of evidence-based guidelines by MST participants.

Conclusions: Existing evidence suggests that there has been no effective development, implementation and evaluation of evidence-based guidelines related to the conduct of MSTs in Latin America. Future work must focus on the development and evaluation of culturally sensitive, evidence-based guidelines for the management of patients served by medical service trips.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Ethics, professional and legal requirements
Other professions or practice related to public health
Public health or related education

Learning Objectives:
Describe the critical need for evidence-based guideline development to oversee the practice of medical service trips Identify crucial elements that would underpin medical service trip guidelines, especially considering ethical and contextual implications Formulate strategies by which research could inform the development, implementation, and evaluation of guidelines used in medical service trips.

Keyword(s): Evidence-Based Practice, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an emergency medicine physician who has participated extensively on medical service trips and have evaluated these on the part of organizations that I have worked with
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.