Identifying inequitable healthcare in older people: systematic review of current research practice

International Journal for Equity in Health

Lynne Forrest¹  Kate Walters²  Stefanie Buckner³  Sarah L. Sowden⁴  Linda Sharp⁴  Martin White⁵  Jean Adams⁵  Melanie Rimmer⁶  Hannah Jordan⁶  Nick Payne⁶  Sarah M. Salway⁶  Mira Hidajat⁷  Yoav Ben-Shlomo⁷ 

[1] Administrative Data Research Centre, University of Edinburgh, Edinburgh Bioquarter;Centre for Ageing & Population Studies, Department of Primary Care & Population Health, University College London;Department of Public Health and Primary Care, University of Cambridge;Institute of Health and Society, Newcastle University;MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine;School of Health & Related Research, University of Sheffield;School of Social and Community Medicine, University of Bristol;

关键词: Equity;    Disparity;    Ageism;    Methodology;    Healthcare;   

DOI  :  10.1186/s12939-017-0605-z

来源: DOAJ

【 摘 要 】

Abstract Background There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair. Method A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability. Results Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were ‘inequitable’. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles. Conclusions Caution is needed among clinicians and other evidence-users in accepting claims of healthcare ‘ageism’ in some published papers. Principles for improved research practice are proposed.

【 授权许可】

Unknown