Cochrane Canada focuses on Evidence-Based Migrant Health

The following is a guest entry from Kevin Pottie MD, Associate Professor of Family Medicine and Epidemiology and Community Medicine, Bruyère Research Institute, University of Ottawa.

In 2007, a group of Canadian researchers, health practitioners and international organizations met to plan the development of the first ever evidence-based migrant health guidelines. 

The Canadian Collaboration for Immigrant and Refugee Health  (CCIRH) initiative emerged thanks to a number of Cochrane methodologists and the training support of Cochrane methods groups.  Most notably, the Cochrane Equity Methods group, led by Peter Tugwell, Vivian Welch and Kevin Pottie, played a key role in supporting the development of the methods that would later guide the initiative. In addition to the Cochrane methodologists, John Feightner, the former Chair of the Canadian Task Force for Preventive Health Care, was also fundamental in the development of the evidence based methods. 

A national guideline stakeholder group selected migrant specific priority health conditions for primary care practitioners. This process led to a consensus on 20 different health conditions that included infectious diseases, mental health, and chronic diseases.  A team including a Cochrane methodologist, a primary care practitioner, and other reviewers addressed each condition. The task of searching and synthesizing evidence for each of these conditions was enormous, but thanks to existing system reviews in the Cochrane Library it was possible to synthesis existing evidence and perform relevant updates.  

In addition, the Cochrane Equity Methods group developed a migrant equity lens that helped the developers consider the directness of the evidence and later the applicability of the recommendations.  This lens included assessment of baseline risk, diet, exercise and cultural beliefs, consideration of preferences of migrant populations and consideration of practice preference of primary care physicians. 

Existing Cochrane Systematic Reviews on priority topics such as Post Traumatic Stress Disorder, iron deficiency anemia, tuberculosis and culturally appropriate diabetes care, provided our initial evidence base and then the groups also were able to integrate other systematic reviews and randomized controlled trials within the synthesis process.   The final guideline development methods ingredients came from the GRADE Working Group, Cochrane methodologists Gordon Guyatt, Holger Schunemann and Andrew Oxman.  The Canadian Evidence Based Guidelines for Immigrant and Refugees represented the first time the GRADE methodology to evaluate the strength of the recommendation and the quality of the evidence was used for preventive care guidelines.   The new Canadian Task Force for Preventive Health Care would soon after integrated GRADE within their guideline methods approach. 

The Canadian Evidence Based Migrant Health Guidelines included over 87 authors and another 150 community practitioners and heath workers.  The impact of evidence based guidelines has included changes at the College of Family Physicians of Canada, Canada as lead methodologists on the European Centres for Disease Control Evidence Based Guidelines for Migrant to European Union, and supported the rapid development and update of an evidence based guideline supplement: Caring for a Syrian Family CMAJ 2016