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How to addressing equity in guidelines: a review

Date and Location




Monday 23 September 2013 - 13:30 - 15:00


Presenting author and contact person

Presenting author

Chunhu SHI

Contact person

Kehu Yang
Abstract text
Background Over the past decade, clinical practice guidelines (CPGs) have increased to assist practitioner and patient decisions for specific clinical circumstances. And they also have focused on the effectiveness and cost-effectiveness of interventions to balance benefits versus harms and cost. However, equity rarely is addressed in CPGs. Objectives To review methodologies on how to incorporate equity into CPGs. Methods We electronically searched MEDLINE, retrieved references and browsed guidelines development organizations’ websites to identify eligible studies that described when, how and to what extent equity should be incorporated into CPGs. Then, general characteristics and checklists/frameworks from included studies were investigated. Ignoring the irrelevant content of studies, we only retrieved all questions/items on equity issues from checklists/frameworks and grouped them into different themes. Finally, according to these checklists/frameworks, content analysis was independently conducted to decide whether they covered the most themes. Results Finally, 10 studies (17 checklists/frameworks) were included. Then 87 questions/items were collected from them and grouped into 6 themes (scope, search, appraisal, formulate recommendations, monitor implementation, assess the quality of CPGs). With content analysis, only “checklists for scoping, early guideline development and formulating recommendations” from NICE 2012 covered the most themes. But they did not recommend any grading systems or criterion on scores. Four studies (Eslava-Schmalbach J 2011, Aldrich R 2003, NHMRC 2003 and Keuken DG 2007) recommended a process to address equity issues into CPG, including identifying equity issues, searching evidence, appraising evidence and making recommendations. Conclusion We find that when guidelines are to be developed, NICE 2012 checklists have the most potential to be as a tool to guide how to address equity into guidelines. However, important limitations, such as a lack of the recommended search strategy and monitoring stategy of CPGs implementations need to be dealt with.