Representations of clinical practice guidelines and health equity in healthcare literature: An integrative review

AimThis paper reports an integrative review of international health literature that discusses health equity in relation to clinical practice guidelines (CPGs). BackgroundHealthcare professionals (HCPs), policy makers, and decision makers rely on sound empirical evidence to make fiscally responsible and appropriate decisions about the allocation of health resources and health service delivery. CPGs provide statements and recommendations that aim to standardize care with an implicit goal of achieving equity of care among diverse populations. Developers of CPGs must be careful not to exacerbate inequity when making recommendations. As such, it is important to determine how equity is discussed within the context of CPGs. DesignThis integrative review was conducted according to integrative review methods as outlined by Whittemore and Knafl (2005), and Toronto and Remington (2020). These authors outlined a systematic process for the identification of relevant literature across health disciplines to examine the state of knowledge pertaining to a phenomenon such as health equity. Search MethodsThe computerized databases PubMed, CINAHL, Cochrane, Embase, Medline, and Web of Science were searched using a combination of keywords. Search parameters included international peer-reviewed published, full-text, English language articles, editorials, and reports over the last decade (January 2011 to February 2022). A reference search of included articles was conducted to identify any additional articles. Dissertations and theses were not included. Search OutcomeA total of 139 peer-reviewed English language articles were identified. ResultsThe findings of this review revealed five main ways in which health equity is in context of CPGs including if they target or exacerbate inequity among disadvantaged populations, equity and CPG development, implementation, and evaluation, and checklists and tools to assist developers and users of CPG to consider equity. Although critical appraisal tools exist to assist users of CPGs assess and to evaluate how well CPGs address issues of equity, the definition of equity and how CPG development panels should incorporate and articulate it remains unclear and haphazard. As such, recommendations intended to be implemented by HCPs to optimize health equity remains diverse and unclear. ConclusionThe way equity is discussed within the reviewed health literature has implications for their uptake by and utility for HCPs. The ability of HCPs to implement CPGs may be hindered without an appreciation and integration of equity considerations across the various phases of CPG conceptualization, development, implementation, and evaluation, and their relevance and appropriateness to diverse geographic and socioeconomic contexts with variable access to health human resources and services. This situation could be improved if equity were more clearly articulated within all aspects of the CPG process. Clinical RelevanceUnderstanding how equity is discussed in the literature relative to CPGs has implications for their uptake by and utility for HCPs in their goal of providing equitable health care. Successful implementation of CPGs with consideration equity could be improved if equity were more clearly articulated within all aspects of the CPG process including conceptualization, development, implementation, and evaluation.

Automated summary

This paper presents an integrative review of international health literature, focusing on the discussion of health equity in relation to clinical practice guidelines (CPGs). The findings suggest that the way equity is discussed within the context of CPGs has implications for their uptake by healthcare professionals (HCPs) and their ability to provide equitable healthcare. The study identifies five main ways in which health equity is discussed in relation to CPGs, including targeting or exacerbating inequity among disadvantaged populations, equity considerations in CPG development, implementation, and evaluation, and the use of checklists and tools to address equity. However, the definition of equity and its incorporation within the CPG process remains unclear and inconsistent, leading to diverse and unclear recommendations for HCPs.