Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an uppermiddle income country on the GRADE approach (vol 32, pg 1484, 2017)

被引：2

作者：

Eslava-Schmalbach, Javier

Mosquera, Paola

Alzate, Juan Pablo

Pottie, Kevin

Welch, Vivian

Akl, Elie A.

Jull, Janet

Lang, Eddy

Katikireddi, Srinivasa Vittal

Morton, Rachel

Thabane, Lehana

Shea, Bev

Stein, Airton T.

Singh, Jasvinder

Florez, Ivan D.

Guyatt, Gordon

Schunemann, Holger

Tugwell, Peter

机构：

[1] Faculty of Medicine, Clinical Research Institute, Universidad Nacional de Colombia, Cra 30 45-03, Bogota

[2] Technology Development Centre, Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), Carrera 15A 120-74, Bogota

[3] Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå

[4] Clinical Research Institute, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá

[5] Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Ottawa, K1R 7G5, ON

[6] School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON

[7] Ottawa Hospital Research Institute, Ottawa, ON

[8] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON

[9] Clinical Epidemiology Unit, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107

[10] Department of Emergency Medicine, Foothills Medical Centre, Calgary, AB

[11] MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow

[12] Sydney School of Public Health, University of Sydney, Sydney, 2006, NSW

[13] McMaster University, Hamilton, ON

[14] Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON

[15] Public Health Ufcspa, Ulbra, HTA of Conceicao Hospital, Porto Alegre

[16] Medicine Service, Birmingham VA Medical Center, Birmingham, AL

[17] Division of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL

[18] Department of Orthopedic Surgery, Mayo Clinic, College of Medicine, Rochester, MN

[19] Department of Pediatrics, Universidad de Antioquia, Medellin

[20] Department of Medicine, McMaster University, Hamilton, ON

[21] Clinical Epidemiology Program, Department of Medicine, University of Ottawa, Ottawa

来源：

HEALTH POLICY AND PLANNING | 2017年 / 32卷 / 10期

基金：

英国医学研究理事会;

关键词：

clinical; equity; Health inequalities; implementation; practice guidelines;

D O I：

10.1093/heapol/czx158

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines ('guidelines') can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation.

引用

页码：1492 / 1492

页数：1