Department of General Practice, University of Melbourne, Australia.
Ann Fam Med. 2010 Nov-Dec;8(6):533-41. doi: 10.1370/afm.1173.
We assessed whether existing guidelines for the primary care of lesbian, gay, and bisexual (LGB) people meet appropriate standards of developmental rigor, and whether they provide consistent recommendations useful for primary care clinicians.
We performed a systematic review of such guidelines using the Cochrane Collaboration method. The countries searched were Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. For sources, we used electronic databases, guidelines databases, primary care professional organizations, government departments of public health, LGB health care textbooks, and national LGB organizations. We assessed the quality of existing guidelines using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and compared the recommendations from all fully appraised guidelines.
Our search did not identify any previous systematic reviews on primary care of LGB people. Of 2,421 documents identified, we initially reviewed 30 and fully appraised 11, none of which completely satisfied the AGREE criteria for quality and only 2 of which were specifically designed for primary care. Developmental rigor was poor. Particular gaps were a lack of explicit inclusion criteria, independent reviewers, and updating procedures. Nonetheless, we did identify several consistent recommendations pertinent to primary care settings: guidance on inclusive clinical environments, standards for clinician-patient communication, sensitive documentation of sexual orientation, knowledge for cultural awareness, staff training, and addressing population health issues.
Currently available guidelines for LGB care are philosophically and practically consistent, and provide a degree of evidence-based clinical and systems support to primary care clinicians. There is a need, however, for evidence-based LGB guidelines that are more rigorously developed, disseminated, and evaluated specifically for the primary care setting.
我们评估现有的针对男同性恋、女同性恋和双性恋（LGB）人群的初级保健指南是否符合发展严谨性的适当标准，以及它们是否提供了对初级保健临床医生有用的一致建议。
我们使用 Cochrane 协作方法对这些指南进行了系统评价。搜索的国家包括澳大利亚、加拿大、爱尔兰、新西兰、英国和美国。对于来源，我们使用了电子数据库、指南数据库、初级保健专业组织、公共卫生政府部门、LGB 保健教科书和国家 LGB 组织。我们使用经过验证的评估研究和评估指南（AGREE）工具评估现有指南的质量，并比较了所有经过全面评估的指南的建议。
我们的搜索没有发现任何以前关于 LGB 人群初级保健的系统评价。在确定的 2421 份文件中，我们最初审查了 30 份，并对 11 份进行了全面评估，其中没有一份完全符合质量的 AGREE 标准，只有 2 份是专门为初级保健设计的。发展严谨性很差。特别缺乏明确的纳入标准、独立评审员和更新程序。尽管如此，我们确实确定了一些与初级保健环境相关的一致建议：指导包容性临床环境、临床医生与患者沟通标准、对性取向的敏感记录、文化意识知识、员工培训以及解决人口健康问题。
目前针对 LGB 护理的指南在哲学和实践上是一致的，为初级保健临床医生提供了一定程度的基于证据的临床和系统支持。然而，需要制定更具严谨性、更广泛传播和更具针对性的基于证据的 LGB 指南，以适应初级保健环境。
