Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities.

Lindsay Am Mizen,Sally-Ann Cooper,Linda Findlay,Marjorie L Macfie,Craig A Melville

doi:10.1186/1748-5908-7-42

Lindsay Am Mizen, Sally-Ann Cooper + Show 3 more

Open Access

https://doi.org/10.1186/1748-5908-7-42

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Abstract

BackgroundClinical 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.MethodsNine 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.ResultsThirty-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.ConclusionsThe 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.

Highlights

International health policy is focused on tackling health inequalities [1]
Measurements The International Clinical Epidemiology Network (INCLEN) supports the role that clinical guidelines can have in influencing practice and potentially reducing health inequities
We looked in more detail at the information provided on the guideline development process to identify potential means to address the health inequities experienced by individuals with intellectual disabilities and other disadvantaged groups

Summary

Introduction

International health policy is focused on tackling health inequalities [1]. the evidence suggests that public health interventions have not reduced inequalities [2], and the extent of health inequalities may be increasing [3,4].The terms inequalities, disparities, and inequities have been used differently across geographical settings and specialities. Since the terms inequalities and disparities are used interchangeably, we will use inequalities in this paper. We use the definitions of health inequalities and inequities provided by Whitehead [5]. Health inequalities is the term most commonly used in intellectual disabilities research. We will use the term inequalities when referring to previous intellectual disabilities research. Research and policy relevant to clinical guidelines most often refer to equity. The terms equity and inequity will be used when referring to clinical guidelines, and thereafter in the Methods, Results, and Discussion sections of this manuscript. 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

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