Equity-in-Health Group, Faculty of Medicine, Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Cra 30 45-03, University Campus, Bogota, Colombia.
Technology Development Centre, Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), Carrera 15A 120-74, Bogota, Colombia.
Health Policy Plan. 2017 Dec 1;32(10):1484-1490. doi: 10.1093/heapol/czx126.
The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines ('guidelines') can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation.
循证指南的可用性并不能确保其在临床实践或决策制定中的实施和使用。健康不平等被定义为人群内部或人群之间的那些可以避免、不必要且不公正和不公平的不平等。循证临床实践和公共卫生指南（“指南”）可用于针对弱势人群所经历的健康不平等问题，但指南可能会无意中加剧健康不平等。出于这个原因，需要循证临床实践和公共卫生指南有针对性地针对弱势人群所经历的健康不平等问题。当前的指南制定过程不包括针对公平为重点的指南实施的计划步骤。本文描述了九个步骤，为在指南实施过程中考虑公平性提供了指导。对文献进行批判性评估，然后建立专家共识的过程，旨在定义如何在特定的 GRADE 指南制定过程中纳入对公平问题的考虑。我们使用哥伦比亚的一个案例研究来描述九个步骤，这些步骤用于实施公平为重点的 GRADE 建议：（1）确定弱势群体，（2）量化当前的健康不平等，（3）制定公平敏感的建议，（4）确定实施公平为重点的建议的关键行为者，（5）确定实施公平为重点的建议的障碍和促进因素，（6）制定纳入实施计划的公平战略，（7）评估资源和激励措施，（8）制定支持公平重点的沟通策略，以及（9）制定监测和评估策略。本案例研究可作为在指南制定和实施过程中考虑公平问题的实施临床实践指南的模型。
