Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities.
Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities.
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DOI：
10.1186/1748-5908-7-42
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发表时间：
2012-05-11
期刊：
影响因子：
--
通讯作者：
Melville CA
中科院分区：
文献类型：
--
作者：
Mizen LA;Macfie ML;Findlay L;Cooper SA;Melville CA
制定临床实践指南是为了提高医疗保健质量。然而，临床指南可能会加剧弱势群体的健康不平等。本研究使用国际临床流行病学网络 (INCLEN) 开发的公平视角来检验临床指南如何很好地解决智障人士所经历的不平等问题。选择了九个与智障人士经历的健康不平等相关的健康问题。世界各地确定了有关这些疾病的临床指南。 INCLEN 股权透镜被用作专门设计的半结构化数据收集工具的基础。两名评估员独立检查每项指南并完成数据收集工具。每位评级者提取的数据在研究小组共识会议上进行了讨论，并就每项指南的最终股权镜头评级达成了一致。确定了 36 项指南，其中一项 (2.8%) 明确排除智障人士。在剩下的 35 名中，有 6 名 (17.1%) 符合公平视角的第一个标准，即确定智障人士面临特定健康问题的高风险。八份指南（22.9%）包含有关智力障碍的内容。六项指南针对第四个公平透镜标准，具体考虑了在弱势群体中实施该指南的障碍。没有解决第二个、第三个和第五个公平透镜标准的指导方针。公平视角是一个有用的工具，可以系统地检查临床指南是否解决了弱势群体的健康需求和不平等问题。临床指南可能会优先考虑普通人群，从而进一步扩大智障人士和其他弱势群体所经历的健康不平等。需要系统地将考虑弱势群体的方法纳入用于制定临床指南的过程中。
Clinical practice guidelines are developed to improve the quality of healthcare. However, clinical guidelines may contribute to health inequities experienced by disadvantaged groups. This study uses an equity lens developed by the International Clinical Epidemiology Network (INCLEN) to examine how well clinical guidelines address inequities experienced by individuals with intellectual disabilities. Nine health problems relevant to the health inequities experienced by persons with intellectual disabilities were selected. Clinical guidelines on these disorders were identified from across the world. The INCLEN equity lens was used as the basis for a purpose-designed, semistructured data collection tool. Two raters independently examined each guideline and completed the data collection tool. The data extracted by each rater were discussed at a research group consensus conference and agreement was reached on a final equity lens rating for each guideline. Thirty-six guidelines were identified, one of which (2.8%) explicitly excluded persons with intellectual disabilities. Of the remaining 35, six (17.1%) met the first criterion of the equity lens, identifying persons with intellectual disabilities at high risk for the specific health problem. Eight guidelines (22.9%) contained any content on intellectual disabilities. Six guidelines addressed the fourth equity lens criterion, by giving specific consideration to the barriers to implementation of the guideline in disadvantaged populations. There were no guidelines that addressed the second, third, and fifth equity lens criteria. The equity lens is a useful tool to systematically examine whether clinical guidelines address the health needs and inequities experienced by disadvantaged groups. Clinical guidelines are likely to further widen the health inequities experienced by persons with intellectual disabilities, and other disadvantaged groups, by being preferentially advantageous to the general population. There is a need to systematically incorporate methods to consider disadvantaged population groups into the processes used to develop clinical guidelines.
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影响因子：
10.5
作者：
Cooper, Sally-Ann;Smiley, Elita;Allan, Linda
通讯作者：
Allan, Linda
DOI：
10.1002/art.24206
发表时间：
2008-11-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Tugwell, Peter;Maxwell, Lara;Tsikata, Setorme
通讯作者：
Tsikata, Setorme
影响因子：
3.4
作者：
WHITEHEAD, M
通讯作者：
WHITEHEAD, M
DOI：
10.1076/icsp.10.1.11.14117
发表时间：
2003-03-01
期刊：
Injury control and safety promotion
影响因子：
--
作者：
Evans, Tim;Brown, Hilary
通讯作者：
Brown, Hilary
改善指南开发中研究证据的使用：12。合并公平考虑。
影响因子：
4
作者：
Oxman, Andrew D;Schunemann, Holger J;Fretheim, Atle
通讯作者：
Fretheim, Atle