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Assessing equity in clinical practice guidelines.

Antonio Miguel Dans1, Leonila Dans, Andrew David Oxman

  • 1Department of Medicine, Philippine General Hospital, Section of Adult Medicine, Taft Avenue, Manila, The Philippines. tdans@zpdee.net

Journal of Clinical Epidemiology
|May 12, 2007
PubMed
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Clinical practice guidelines (CPGs) increasingly focus on effectiveness and cost, but rarely on equity. This work proposes a framework to evaluate how well CPGs address fairness and social justice in healthcare recommendations.

Area of Science:

  • Health Policy
  • Clinical Practice Guidelines
  • Health Equity

Background:

  • Clinical practice guidelines (CPGs) are crucial for evidence-based healthcare.
  • Historically, CPG development has prioritized intervention effectiveness and cost-efficiency.
  • The focus on equity in CPGs remains underdeveloped, despite its importance.

Purpose of the Study:

  • To highlight the underemphasis on equity in current CPG development.
  • To introduce a framework for evaluating the equity considerations within CPGs.
  • To promote the integration of sociopolitical dimensions into guideline formulation.

Main Methods:

  • Review of the evolution and focus of CPG development over the past 20 years.
  • Analysis of the typical questions addressed by CPGs (effectiveness, cost-effectiveness).

Related Experiment Videos

  • Introduction of the Knowledge Plus Project's approach to incorporate equity and local appropriateness.

    • Main Results:

    • CPGs predominantly address 'does it do more good than harm?' and 'is it worth the cost?'.
    • The critical question 'are the recommendations fair?' is seldom explicitly addressed.
    • A proposed lens for evaluating equity in CPGs is discussed.

    Conclusions:

    • There is a critical need to systematically incorporate equity into CPG development.
    • The proposed framework offers a method to assess and improve the fairness of healthcare recommendations.
    • Integrating equity and local appropriateness enhances the sociopolitical relevance of CPGs.