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  • 1.
    Acosta, Naydú
    et al.
    Universidad Industrial de Santander .
    Pollard, Jennifer
    National University of Colombia.
    Mosquera, Paola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reveiz, Ludovic
    National University of Colombia.
    Equidad en el desarrollo de guias de practica clinica: [The concept of equity when developing clinical practice guidelines]2011In: Revista de Salud Pública, ISSN 0124-0064, Vol. 13, no 2, p. 327-38Article in journal (Refereed)
    Abstract [en]

    This systematic literature review sought to identify methodologies and technical strategies emphasising healthcare services and outcomes when incorporating the concept of equity into Clinical Practice Guidelines (CPG). 940 references were identified, of which 20 fulfilling the inclusion criteria were selected. While no reports were found describing or evaluating an explicit methodology for incorporating considerations of equity into CPG, some studies revealed related strategies or processes, summarised as follows: 1. Target population involvement during all phases of designing, implementing and evaluating CPG; 2. "Cultural capacity" seen as being necessary in CPGs' "cultural translation" for interventions to have less disparity regarding their application and results; 3. Considering psycho-social factors which could affect implementing CPG, and; 4. Considering system inequities so that any health intervention would also confront risks and obstacles to health care due to socioeconomic status. It was concluded that CPGs could be a potential route for promoting more equitable healthcare effects by standardising health interventions if, by incorporating some of the processes described above, they actively seek to avoid unjust differences in access to and/or the quality of the interventions that they prescribe.

  • 2. Eslava-Schmalbach, Javier H
    et al.
    Welch, Vivian A
    Tugwell, Peter
    Amaya, Ana C
    Gaitán, Hernando
    Mosquera, Paola
    Molina, Felipe
    Peralta, Fernando
    Romero-Vanegas, Sara
    Pardo, Rodrigo
    Alzate, Juan Pablo
    Incorporating equity issues into the development of Colombian clinical practice guidelines: suggestions for the GRADE approach2016In: Revista de Salud Pública, ISSN 0124-0064, Vol. 18, no 1, p. 72-81Article in journal (Refereed)
    Abstract [en]

    Objective To propose how to incorporate equity issues, using the GRADE approach, into the development and implementation of Colombian Clinical Practice Guidelines.

    Methodology This proposal was developed in four phases: 1. Included literature review and and the development of a preliminary proposal about how to include equity issues, 2. Involved an informal discussion to reach a consensus on improving the first proposal; 3. Was a survey of the researchers´acceptance levels of the proposal, and; 4. A final informal consensus was formed to adjust the proposal.

    Results A proposal on how to incorporate equity issues into the GRADE approach was developed. It places particular emphasis on the recognition of disadvantaged populations in the development and implementation of the suggested guideline. PROGRESS-Plus is recommended for use in exploring the various categories of disadvantaged people. The proposal suggests that evidence be rated differentially by giving higher ratings to studies that consider equity issues than those that do not. The proposal also suggests the inclusion of indicators to monitor the impacts of the implementation of CPGs on disadvantaged people.

    Conclusions A consideration of equity in the development and implementation of clinical practice guidelines and quality assessments of the evidence would achieve more in the participation of potential actors in the process and reflect on the effectiveness of the proposed interventions across all social groups. 

  • 3.
    Eslava-Schmalbach, Javier
    et al.
    National University of Colombia.
    Sandoval-Vargas, Gisella
    National University of Colombia.
    Mosquera Mendez, Paola
    Incorporating equity into developing and implementing evidence-based clinical practice guidelines2011In: Revista de Salud Pública, ISSN 0124-0064, Vol. 13, no 2, p. 339-351Article in journal (Refereed)
    Abstract [en]

    Clinical practice guidelines (CPG) are useful tools for clinical decision making, processes standardization and quality of care improvements. The current General Social Security and Health System (GSSHS) in Colombia is promoting the initiative of developing and implementing CPG based on evidence in order to improve efficiency and quality of care. The reduction of inequalities in health should be an objective of the GSSHS. The main propose of this analysis is to argue why it is necessary to consider the incorporation of equity considerations in the development and implementation of clinical practice guidelines based on the evidence. A series of reflections were made. Narrative description was used for showing the arguments that support the main findings. Among them are: 1. Differential effectiveness by social groups of interventions could diminish final effectiveness of CPG in the GSSHS; 2. To not consider geographical, ethnic, socioeconomic, cultural and access diversity issues within the CPG could have a potential negative impacts of the CPG; 3. Overall effectiveness of GPC could be better if equity issues are included in the quality verification checklist of the guideline questions; 4. Incorporating equity issues in the process of developing CPG could be cost effective, because improve overall effectiveness of CPG. Conclusions To include equity issues in CPG can help in achieving more equitable health outcomes. From this point of view CPG could be key tools to promote equity in care and health outcomes.

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