[Ethnicity in practice guidelines of the Dutch College of General Practitioners]

General practitioners (GP's) in the Netherlands increasingly see patients with differing ethnic backgrounds. A literature review has been published stating that too little attention was paid to ethnic differences in the references and recommendations of the practice guidelines of the Dutch College of General Practitioners (NHG). The recommendations in the guidelines often do not need adaptation to deal with the ethnic-specific problems that were identified. Looking at the references in the guidelines only is insufficient to make an appropriate weighing of evidence, because the acceptance of evidence is subject to several considerations pertaining to relevance and validity. In addition, extrapolation of research from other countries to the Netherlands is often difficult because of socioeconomic and behavioural differences. It was suggested that the composition of the guideline working group had a large influence on the amount of attention paid to ethnic-specific aspects. However, the guideline-setting process for Dutch GP guidelines includes a large number of internal and external review steps, as well as an open discussion afterwards. This should identify major flaws, if present. Guideline-setting organisations should be supported in the development of sensitive and specific search strategies for this subject. Researchers on ethnic differences in health care can identify and transfer existing evidence to guideline developers. They may also comment on (drafts of) guidelines. The emphasis should be on implementing the guidelines rather than on changing them in a marginal fashion, and on supporting the general practitioners working in lower-class districts where many patients are from different ethnic backgrounds.