Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review

被引:2
作者
Chan, Vincy [1 ,2 ,3 ,7 ]
Estrella, Maria Jennifer [4 ]
Hanafy, Sara [1 ,3 ]
Colclough, Zoe [4 ]
Joyce, Julie Michele [4 ]
Babineau, Jessica [5 ,6 ]
Colantonio, Angela [1 ,2 ,3 ,4 ]
机构
[1] Univ Hlth Network, KITE Res Inst, Toronto Rehabil Inst, Toronto, ON, Canada
[2] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[3] Univ Toronto, Rehabil Sci Inst, Toronto, ON, Canada
[4] Univ Toronto, Dept Occupat Sci & Occupat Therapy, Toronto, ON, Canada
[5] Univ Hlth Network, Lib & Informat Serv, Toronto, ON, Canada
[6] Univ Hlth Network, Inst Educ Res, Toronto, ON, Canada
[7] 550 Univ Ave, Toronto, ON M5G 2A2, Canada
基金
瑞典研究理事会;
关键词
Clinical practice guideline; Concussion; Disadvantaged populations; Evidence-based practice; Health; inequity; Homeless; Knowledge synthesis; Traumatic brain injury; INCOG; 2.0; GUIDELINES; POSITION STATEMENT; HOUSED INDIVIDUALS; HEALTH EQUITY; CARE; VICTIMIZATION; PREVENTION; MANAGEMENT;
D O I
10.1016/j.eclinm.2023.102152
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs.Methods For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696).Findings Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI.Interpretation Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations.
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页数:9
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