Weinbrenner Susanne, Lönnfors Sanna, Babitsch Birgit
Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin.
Z Evid Fortbild Qual Gesundhwes. 2010;104(7):547-53. doi: 10.1016/j.zefq.2010.08.001.
Gender and diversity have a strong impact on health and illness as evidenced by sex and gender differences in the onset and progression of diseases as well as in diagnosis, therapy, and therapeutic outcome. The number of sex/gender-specific studies in medicine has increased steadily in recent years, indicating sex (biological) and gender (social) differences in numerous diseases. Despite this evidence, however, sex/gender differences are rarely considered in medical practice or in health systems, suggesting a delay in transferring such research into evidence-based medical treatment. Similarly, quality improvement guidelines in medical care do not systematically integrate the sex/gender perspective. Against this backdrop, this paper seeks to enumerate the necessary components of a guideline development and evaluation process that systematically integrates sex/gender differences in addition to providing a sex/gender-based methodological approach. The latter is illustrated by a pilot study in which four international guidelines on depression were selected. The sex/gender appropriateness of these guidelines was analysed using two methods: first, sex/gender-relevant words were counted; and second, relevant sex/gender differences were summarised based on a systematic literature review and then compared with the information given in the guidelines. The findings of the pilot study revealed that although strong evidence exists on sex/gender differences in depression, such research was rarely implemented in the guidelines. Given the scope and potential of guidelines to improve the quality of health care, it is essential that they consider the crucial role of sex/gender differences. To date, sex/gender differences have been insufficiently addressed in guideline development and evaluation when they should be an integral component of the process.
性别与多样性对健康和疾病有着重大影响，疾病的发病和进展以及诊断、治疗和治疗结果方面的性别差异就是明证。近年来，医学领域中针对性别特异性的研究数量稳步增加，这表明在众多疾病中存在性别（生物学）和社会性别（社会）差异。然而，尽管有这些证据，但在医疗实践或卫生系统中，性别差异很少被考虑，这表明将此类研究转化为循证医学治疗的进程有所延迟。同样，医疗质量改进指南也没有系统地纳入性别视角。在此背景下，本文旨在列举指南制定和评估过程的必要组成部分，该过程除了提供基于性别的方法外，还系统地纳入了性别差异。通过一项试点研究对此进行了说明，在该研究中选择了四项关于抑郁症的国际指南。使用两种方法分析了这些指南的性别适宜性：第一，统计与性别相关的词汇；第二，基于系统的文献综述总结相关性别差异，然后与指南中给出的信息进行比较。试点研究的结果表明，尽管在抑郁症的性别差异方面有确凿证据，但此类研究在指南中很少得到应用。鉴于指南对于提高医疗质量的范围和潜力，至关重要的是它们应考虑性别差异的关键作用。迄今为止，在指南制定和评估中，性别差异尚未得到充分解决，而它们应该是该过程不可或缺的一部分。
