目的:本文报告了国际卫生文献的综合综述,讨论了与临床实践指南(CPGs)相关的卫生公平性。
背景:医疗保健专业人员(HCP),政策制定者,决策者依靠可靠的经验证据,就卫生资源分配和卫生服务提供做出财政上负责任和适当的决定。CPG提供旨在标准化护理的声明和建议,其隐含目标是实现不同人群之间的护理公平。CPG的开发人员在提出建议时必须小心不要加剧不平等。因此,重要的是要确定如何在CPG的背景下讨论公平性。
方法:根据Whittemore和Knafl(2005)概述的综合审查方法进行了综合审查,多伦多和雷明顿(2020)。这些作者概述了一个系统的过程,用于识别跨健康学科的相关文献,以检查与健康公平等现象有关的知识状态。
方法:计算机化数据库PubMed,CINAHL,科克伦,Embase,Medline,和WebofScience使用关键字的组合进行搜索。搜索参数包括国际同行评审发布,全文,英语文章,社论,以及过去十年(2011年1月至2022年2月)的报告。对所包含的文章进行参考搜索以识别任何其他文章。不包括论文和论文。
UNASSIGNED:总共发现了139篇同行评审的英语文章。
结果:本综述的结果揭示了卫生公平在CPG背景下的五种主要方式,包括它们是否针对或加剧了弱势群体之间的不平等,公平和CPG发展,实施,和评估,以及检查表和工具,以帮助CPG的开发人员和用户考虑公平性。尽管存在重要的评估工具来帮助CPG用户评估和评估CPG解决公平问题的程度,公平的定义以及CPG发展小组应如何纳入和阐明公平的定义仍不清楚和随意。因此,旨在由HCPs实施以优化健康公平的建议仍然多种多样且不清楚.
结论:在所审查的健康文献中讨论公平性的方式对HCPs的吸收和效用具有影响。如果不对CPG概念化的各个阶段的公平考虑进行赞赏和整合,则可能会阻碍HCP实施CPG的能力,发展,实施,和评估,以及它们与不同地理和社会经济背景的相关性和适当性,以及对卫生人力资源和服务的可变访问。如果在CPG进程的所有方面更清楚地阐明公平,这种情况可以得到改善。
结论:了解文献中如何讨论与CPG相关的公平性,对于HCPs在提供公平医疗保健的目标中的吸收和效用具有重要意义。如果在CPG过程的所有方面包括概念化更清楚地阐明公平性,则可以改善考虑公平性的CPG的成功实施。发展,实施,和评价。
This paper reports an integrative review of international health literature that discusses health equity in relation to clinical practice
guidelines (CPGs).
Healthcare professionals (HCPs), policy makers, and decision makers rely on sound empirical evidence to make fiscally responsible and appropriate decisions about the allocation of health resources and health service delivery. CPGs provide statements and recommendations that aim to standardize care with an implicit goal of achieving equity of care among diverse populations. Developers of CPGs must be careful not to exacerbate inequity when making recommendations. As such, it is important to determine how equity is discussed within the context of CPGs.
This integrative review was conducted according to integrative review methods as outlined by Whittemore and Knafl (2005), and Toronto and Remington (2020). These authors outlined a systematic process for the identification of relevant literature across health disciplines to examine the state of knowledge pertaining to a phenomenon such as health equity.
The computerized databases PubMed, CINAHL, Cochrane, Embase, Medline, and Web of Science were searched using a combination of keywords. Search parameters included international peer-reviewed published, full-text, English language articles, editorials, and reports over the last decade (January 2011 to February 2022). A reference search of included articles was conducted to identify any additional articles. Dissertations and theses were not included.
A total of 139 peer-reviewed English language articles were identified.
The findings of this review revealed five main ways in which health equity is in context of CPGs including if they target or exacerbate inequity among disadvantaged populations, equity and CPG development, implementation, and evaluation, and checklists and tools to assist developers and users of CPG to consider equity. Although critical appraisal tools exist to assist users of CPGs assess and to evaluate how well CPGs address issues of equity, the definition of equity and how CPG development panels should incorporate and articulate it remains unclear and haphazard. As such, recommendations intended to be implemented by HCPs to optimize health equity remains diverse and unclear.
The way equity is discussed within the reviewed health literature has implications for their uptake by and utility for HCPs. The ability of HCPs to implement CPGs may be hindered without an appreciation and integration of equity considerations across the various phases of CPG conceptualization, development, implementation, and evaluation, and their relevance and appropriateness to diverse geographic and socioeconomic contexts with variable access to health human resources and services. This situation could be improved if equity were more clearly articulated within all aspects of the CPG process.
Understanding how equity is discussed in the literature relative to CPGs has implications for their uptake by and utility for HCPs in their goal of providing equitable health care. Successful implementation of CPGs with consideration equity could be improved if equity were more clearly articulated within all aspects of the CPG process including conceptualization, development, implementation, and evaluation.