Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity.
Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity.
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改善指南开发中研究证据的使用：12。合并公平考虑。
DOI：
10.1186/1478-4505-4-24
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发表时间：
2006-12-05
影响因子：
4
通讯作者：
Fretheim, Atle
中科院分区：
文献类型：
--
作者：
Oxman, Andrew D;Schunemann, Holger J;Fretheim, Atle
与世界各地的许多其他组织一样，世界卫生组织 (WHO) 认识到需要使用更严格的流程来确保医疗保健建议以现有的最佳研究证据为基础。这是 16 项审查系列中的第 12 项审查，这些审查是世卫组织健康研究咨询委员会就如何实现这一目标向世卫组织提供建议的背景资料。我们回顾了有关将公平考虑纳入指南和建议的文献。我们检索了 PubMed 和三个方法学研究数据库，以查找现有的系统评价和相关方法学研究。我们自己没有进行系统审查。我们的结论基于现有证据、对世卫组织和其他组织正在做的事情的考虑以及逻辑论证。我们发现很少有直接相关的实证方法研究。这些答案主要基于逻辑论证。何时以及如何在用作建议背景文件的系统审查中解决不平等问题？ • 应经常考虑以下问题：是否有合理的理由来预测弱势群体和优势群体之间的不同相对影响？ • 如果有合理的理由来预测差异效应，则应在审查中纳入额外的证据，以便对差异效应的可能性做出判断。代表世卫组织提出建议的人应经常解决哪些有关公平的问题？ • 应定期考虑以下附加问题： • 现有研究结果适用于弱势群体和环境的可能性有多大？ • 基线风险的差异有多大可能导致弱势群体和优势群体产生不同的绝对效应？ • 弱势群体和优势群体的预期收益和危害之间的权衡存在重大差异的可能性有多大？ • 对弱势群体和优势群体有不同的影响，或者对解决不平等问题有不同的影响吗？需要哪些特定背景信息来为特定环境下的适应和决策提供有关公平影响的信息？ • 代表世卫组织提出建议的人员应定期考虑以下类型的特定背景数据的重要性并提出建议，这些数据可能需要为特定环境下的适应和决策提供信息： • 弱势群体的效应修正因素以及不同影响的可能性 • 与社会和经济地位相关的基线风险 • 与社会和经济地位相关的护理利用和获取 • 与社会和经济地位相关的成本 • 可能影响解决不平等问题的战略的道德和法律 • 解决不平等问题的资源的可用性不公平 可能需要哪些实施策略来确保建议得到公平实施？ • 组织变革对于解决不平等问题可能很重要。虽然可能只能结合特定环境来考虑这些问题，但应考虑如何最好地为识别和解决组织变革的需求提供支持。在不平等现象普遍存在的国家，可能首先需要进行制度、文化和政治变革。 • 应使用适当的社会和经济状况指标来监测实施建议对弱势群体以及社会和经济状况变化的影响。
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 12th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. We reviewed the literature on incorporating considerations of equity in guidelines and recommendations. We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. We found few directly relevant empirical methodological studies. These answers are based largely on logical arguments. When and how should inequities be addressed in systematic reviews that are used as background documents for recommendations? • The following question should routinely be considered: Are there plausible reasons for anticipating differential relative effects across disadvantaged and advantaged populations? • If there are plausible reasons for anticipating differential effects, additional evidence should be included in a review to inform judgments about the likelihood of differential effects. What questions about equity should routinely be addressed by those making recommendations on behalf of WHO? • The following additional questions should routinely be considered: • How likely is it that the results of available research are applicable to disadvantaged populations and settings? • How likely are differences in baseline risk that would result in differential absolute effects across disadvantaged and advantaged populations? • How likely is it that there are important differences in trade-offs between the expected benefits and harms across disadvantaged and advantaged populations? • Are there different implications for disadvantaged and advantaged populations, or implications for addressing inequities? What context specific information is needed to inform adaptation and decision making in a specific setting with regard to impacts on equity? • Those making recommendations on behalf of WHO should routinely consider and offer advice about the importance of the following types of context specific data that might be needed to inform adaptation and decision making in a specific setting: • Effect modifiers for disadvantaged populations and for the likelihood of differential effects • Baseline risk in relationship to social and economic status • Utilization and access to care in relationship to social and economic status • Costs in relationship to social and economic status • Ethics and laws that may impact on strategies for addressing inequities • Availability of resources to address inequities What implementation strategies are likely be needed to ensure that recommendations are implemented equitably? • Organisational changes are likely to be important to address inequities. While it may only be possible to consider these in relationship to specific settings, consideration should be given to how best to provide support for identifying and addressing needs for organisational changes. In countries with pervasive inequities institutional, cultural and political changes may first be needed. • Appropriate indicators of social and economic status should be used to monitor the effects of implementing recommendations on disadvantaged populations and on changes in social and economic status.