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

International Journal for Equity in Health

Systematic Review

Lynne Forrest¹  Kate Walters²  Stefanie Buckner³  Sarah L. Sowden⁴  Linda Sharp⁴  Martin White⁵  Jean Adams⁶  Nick Payne⁷  Sarah M. Salway⁷  Melanie Rimmer⁷  Hannah Jordan⁷  Mira Hidajat⁸  Yoav Ben-Shlomo⁸ 

[1] Administrative Data Research Centre, University of Edinburgh, Edinburgh Bioquarter, 9 Little France Road, EH16 4UX, Edinburgh, UK;Centre for Ageing & Population Studies, Department of Primary Care & Population Health, University College London, Rowland Hill Street, NW3 2PF, London, UK;Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK;Institute of Health and Society, Newcastle University, Baddiley-Clark Building, NE2 4AX, Newcastle upon, Tyne, UK;Institute of Health and Society, Newcastle University, Baddiley-Clark Building, NE2 4AX, Newcastle upon, Tyne, UK;MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, CB2 0QQ, Cambridge, UK;MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, CB2 0QQ, Cambridge, UK;School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK;School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK;

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

DOI  :  10.1186/s12939-017-0605-z

 received in 2017-01-09, accepted in 2017-06-13,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere 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.MethodA 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.ResultsForty 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.ConclusionsCaution 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】

CC BY   
© The Author(s). 2017