Dr Karen Grimsrud

Dr Karen Grimsrud (MD MHSc FACPM)
Senior Medical Advisor and Director, Prevention Guidelines Division | Centre for Chronic Disease Prevention and Control | Public Health Agency of Canada

 

Canadian Task Force on Preventive Health Care: Guideline Development and Knowledge Translation Methods – Seminar by Karen Grimsrud

Thursday 27th February 2014

On 27th February 2014, Dr Karen Grimsrud from the Public Health Agency of Canada (PHAC) visited the Centre for Research in Evidence-Based Practice and gave a seminar on guideline development and knowledge translation. The aim of the talk was to give an overview of how the Canadian Task Force on Preventive Health Care operates in this context.

The Canadian Task Force on Preventive Health is an independent body of 14 voluntary primary care, prevention and methodology experts that develop recommendations in clinical preventive services. The Task Force prioritises topics that will be reviewed, defines the analytic framework and scope of each topic and then develops recommendations for each topic. They work together with the Prevention Guidelines Division within the PHAC and a university based Evidence Review and Synthesis Centre (ERSC) that provide the scientific and technical support throughout the guideline development process. The University of Alberta has been provided funding by the PHAC to enhance dissemination of Task Force guidelines and to conduct evaluation, stakeholder engagement and public communication. Finally, an evaluation strategy has been implemented to assess the impact of the Task Force products. Topics are suggested by Task Force members, primary care practitioners, stakeholders and the public. Criteria for consideration by the Task Force include new or controversial evidence and potential impact on practice. Since 2011, guidelines on five topics have been published (breast cancer screening, type II diabetes screening, screening for hypertension, screening for depression, cervical cancer screening) and another five are currently under development.

Work on each recommendation is led by a workgroup of 2-5 Task Force members and science staff at PHAC. The workgroup may also include an external expert or organization. Each workgroup establishes the research questions and analytical framework for the guideline. These serve as the basis for the evidence reviews. The ERSC then assembles a team of methodologists and performs an evidence summary including a systematic review and summary of the relevant available evidence.

Once the systematic review is available, the Task Force workgroup independently develops the recommendation statements by consensus, based on a detailed review of the evidence. The quality of evidence and strength of the recommendation are determined based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE). External peer reviewers then provide comments on the the recommendations through 3 review stages and finally guidelines and systematic reviews are published and knowledge transfer tools developed for both patients and physicians, tested and launched.

Benefits of the Canadian Task Force on Preventive Health Care methodology:

  • Evidence-based system
  • Rigorous, transparent methods and decision making process
  • Ongoing support from GRADE working group
  • Knowledge transfer evaluation plan in place

Challenges:

  • Resource intensive (human and funding required)
  • Understanding of GRADE by medical community/public
  • Duration of process (12-18 months), although rapid reviews possible
  • Ability of practitioners to do ‘shared decision making’
  • Uptake and implementation by primary care practitioners

After the presentation Dr Grimsrud answered questions from the audience. One question was whether they ever had any serious opposition to a new guideline. Dr Grimsrud acknowledged that the guidelines on breast cancer screening in healthy women age 40-49 years received substantial opposition from some physician groups and NGOs (mainly advocacy groups for breast cancer) and made front page news for about 5 days. It is not clear as to whether GPs in Canada accept the Task Force recommendations in 40-49 year olds.

Dr Karen Grimsrud joined the Public Agency of Canada in February, 2010 as a Senior Medical Advisor and in October, 2011 was appointed the Director of the Prevention Guidelines Division (PGD). The PGD provides technical support to the Canadian Task Force on Preventive Health Care. In additional to her PGD managerial responsibilities, Karen assists the Task Force by providing medical public health input into guideline development.  She is also leading a new initiative to develop national guidelines for public health practitioners. Prior to her current position with the Public Health Agency of Canada, Karen worked in various senior positions in the area of communicable disease control, immunization policy, pandemic influenza preparedness and emergency planning at the local, provincial and federal government level. Karen volunteered with the WHO as a member of the STOP (Stop Transmission of Polio) program in Ethiopia in 2009.

Summary provided by Michele Weber