Contextualizing guidelines for the health system of Cyprus: Experiences and lessons learnt

Cyprus is undergoing a major health reform with the recent establishment of the General Healthcare System (GHS). The GHS offers equal healthcare access through one primary insurer (Health Insurance Organization [HIO]) and benefits from a wide collaborative network of public and private healthcare providers. However, unwanted variation in practice makes this transition challenging. Healthcare guidelines could decrease these variations in practice, but Cyprus lacks the capacity to develop them de novo. Through a collaboration with the National Institute for Health and Care Excellence (NICE) in the United Kingdom, the contextualization of NICE guidelines and the derivation of local quality indicators are carried out. This study presents the methodology and experience of contextualizing the first three NICE guidelines and deriving associated quality indicators in Cyprus.

HIO managed the guideline contextualization with the support of a Guidelines Secretariat. For each guideline, a local topic expert committee (TEC) was recruited. Through a series of meetings, followed by public consultation, each TEC made contextual changes to the guideline and derived relevant quality indicators. During this process, NICE assured quality by overseeing several elements of the contextualization procedure such as TEC membership, proposed changes and justification and derived quality indicators.

Between 2022 and 2024, three NICE guidelines, NG196 on Atrial fibrillation (AF), NG230 on Thyroid cancer (TC) and NG203 on Chronic kidney disease (CKD), were contextualized through the modification of several individual guideline recommendations (21/79 [26.6%] in AF, 37/67 [55.2%] in TC and 62/217 [28.6%] in CKD). In parallel, NICE quality indicators were screened for applicability and feasibility in Cyprus while additional indicators were developed if required.

In a country with limited experience in guideline development, a supervised and systematic process supported by an established organization ensures quality, is less resource intensive and builds capability for the sustainability of the process.