Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, Los Angeles, California, USA.
Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, California, USA.
J Am Geriatr Soc. 2023 Dec;71(12):3874-3885. doi: 10.1111/jgs.18568. Epub 2023 Sep 1.
Inequities with regard to brain health, economic costs, and the evidence base for dementia care continue. Achieving health equity in dementia care requires rigorous efforts that ensure disproportionately affected populations participate fully in-and benefit from-clinical research. Embedding-proven interventions under real-world conditions and within existing healthcare systems have the potential to examine the effectiveness of an intervention, improve dementia care, and leverage the use of existing resources. Developing embedded pragmatic controlled trials (ePCT) research designs for nonpharmacological dementia care interventions involves a plethora of a priori assumptions and decisions. Although frameworks exist to determine whether interventions are "ready" for ePCT, there is no heuristic to assess health equity-readiness. We discuss health equity considerations, case examples, and research strategies across ePCT study domains of evidence, risk, and alignment. Future discussions regarding health equity considerations across other domains are needed.
在大脑健康、经济成本和痴呆症护理的证据基础方面仍然存在不平等现象。要实现痴呆症护理中的公平,需要做出严格的努力,确保受影响不成比例的人群充分参与并受益于临床研究。在实际条件下和现有医疗保健系统中嵌入经过验证的干预措施,有可能检验干预措施的有效性,改善痴呆症护理,并利用现有资源。为非药物性痴呆症护理干预措施开发嵌入式实用对照试验(ePCT)研究设计涉及大量的事先假设和决策。虽然存在确定干预措施是否“准备好”进行 ePCT 的框架,但没有评估健康公平准备情况的启发式方法。我们讨论了 ePCT 研究领域中的证据、风险和一致性的健康公平考虑因素、案例示例和研究策略。需要就其他领域的健康公平考虑因素进行未来的讨论。