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Open Access Highly Accessed Research

Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities

Lindsay AM Mizen1, Marjorie L Macfie2, Linda Findlay3, Sally-Ann Cooper4 and Craig A Melville4*

Author Affiliations

1 Psychiatry Training Scheme, South East Scotland Deanery, Edinburgh, Scotland, UK

2 Learning Disabilities Psychiatry Higher Training Scheme, West of Scotland Deanery, Glasgow, Scotland, UK

3 Department of Learning Disabilities Psychiatry, NHS Lanarkshire, Longdales, Kirklands, Bothwell, Scotland, UK

4 Mental Health and Wellbeing, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK

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Implementation Science 2012, 7:42  doi:10.1186/1748-5908-7-42

Published: 11 May 2012

Abstract

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 by individuals with intellectual disabilities.

Methods

Nine health problems relevant to the health inequities experienced by persons with intellectual disabilities were selected. Clinical guidelines on these disorders were identified from across the world. The INCLEN equity lens was used as the basis for a purpose-designed, semistructured data collection tool. Two raters independently examined each guideline and completed the data collection tool. The data extracted by each rater were discussed at a research group consensus conference and agreement was reached on a final equity lens rating for each guideline.

Results

Thirty-six guidelines were identified, one of which (2.8%) explicitly excluded persons with intellectual disabilities. Of the remaining 35, six (17.1%) met the first criterion of the equity lens, identifying persons with intellectual disabilities at high risk for the specific health problem. Eight guidelines (22.9%) contained any content on intellectual disabilities. Six guidelines addressed the fourth equity lens criterion, by giving specific consideration to the barriers to implementation of the guideline in disadvantaged populations. There were no guidelines that addressed the second, third, and fifth equity lens criteria.

Conclusions

The equity lens is a useful tool to systematically examine whether clinical guidelines address the health needs and inequities experienced by disadvantaged groups. Clinical guidelines are likely to further widen the health inequities experienced by persons with intellectual disabilities, and other disadvantaged groups, by being preferentially advantageous to the general population. There is a need to systematically incorporate methods to consider disadvantaged population groups into the processes used to develop clinical guidelines.

Keywords:
Intellectual disabilities; Clinical guidelines; Health inequalities