Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity
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Review
Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity Andrew D Oxman*1, Holger J Schünemann2 and Atle Fretheim1 Address: 1Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway and 2INFORMA, S.C. Epidemiologia, Istitituto Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy Email: Andrew D Oxman* - [email protected]; Holger J Schünemann - [email protected]; Atle Fretheim - [email protected] * Corresponding author
Published: 05 December 2006 Health Research Policy and Systems 2006, 4:24
doi:10.1186/1478-4505-4-24
Received: 07 April 2006 Accepted: 05 December 2006
This article is available from: http://www.health-policy-systems.com/content/4/1/24 © 2006 Oxman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 12th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Objectives: We reviewed the literature on incorporating considerations of equity in guidelines and recommendations. Methods: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. Key questions and answers: We found few directly relevant empirical methodological studies. These answers are based largely on logical arguments. When and how should inequities be addressed in systematic reviews that are used as background documents for recommendations? • The following question should routinely be considered: Are there plausible reasons for anticipating differential relative effects across disadvantaged and advantaged populations? • If there are plausible reasons for anticipating differential effects, additional evidence should be included in a review to inform judgments about the likelihood of differential effects. What questions about equity should routinely be addressed by those making recommendations on behalf of WHO? • The following additional questions should routinely be considered: • How likely is it that the results of available research are applicable to disadvantaged populations and settings? • How likely are differences in baseline risk that would result in differential absolute effects across disadvantaged and advantaged populations? • How li
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