Background:
Clinical 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 byindividuals with intellectual disabilities.
Methods:
Nine health problems relevant to the health inequities experienced by persons withintellectual disabilities were selected. Clinical guidelines on these disorders were identifiedfrom across the world. The INCLEN equity lens was used as the basis for a purposedesigned,semistructured data collection tool. Two raters independently examined eachguideline and completed the data collection tool. The data extracted by each rater werediscussed at a research group consensus conference and agreement was reached on a finalequity lens rating for each guideline.
Results:
Thirty-six guidelines were identified, one of which (2.8%) explicitly excluded persons withintellectual disabilities. Of the remaining 35, six (17.1%) met the first criterion of the equitylens, identifying persons with intellectual disabilities at high risk for the specific healthproblem. Eight guidelines (22.9%) contained any content on intellectual disabilities. Sixguidelines addressed the fourth equity lens criterion, by giving specific consideration to thebarriers to implementation of the guideline in disadvantaged populations. There were noguidelines that addressed the second, third, and fifth equity lens criteria.
Conclusions:
The equity lens is a useful tool to systematically examine whether clinical guidelines addressthe health needs and inequities experienced by disadvantaged groups. Clinical guidelines arelikely to further widen the health inequities experienced by persons with intellectualdisabilities, and other disadvantaged groups, by being preferentially advantageous to thegeneral population. There is a need to systematically incorporate methods to considerdisadvantaged population groups into the processes used to develop clinical guidelines.