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

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...

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Autores principales: Salway, Sarah M., Payne, Nick, Rimmer, Melanie, Buckner, Stefanie, Jordan, Hannah, Adams, Jean, Walters, Kate, Sowden, Sarah L., Forrest, Lynne, Sharp, Linda, Hidajat, Mira, White, Martin, Ben-Shlomo, Yoav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505033/
https://www.ncbi.nlm.nih.gov/pubmed/28697768
http://dx.doi.org/10.1186/s12939-017-0605-z
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author Salway, Sarah M.
Payne, Nick
Rimmer, Melanie
Buckner, Stefanie
Jordan, Hannah
Adams, Jean
Walters, Kate
Sowden, Sarah L.
Forrest, Lynne
Sharp, Linda
Hidajat, Mira
White, Martin
Ben-Shlomo, Yoav
author_facet Salway, Sarah M.
Payne, Nick
Rimmer, Melanie
Buckner, Stefanie
Jordan, Hannah
Adams, Jean
Walters, Kate
Sowden, Sarah L.
Forrest, Lynne
Sharp, Linda
Hidajat, Mira
White, Martin
Ben-Shlomo, Yoav
author_sort Salway, Sarah M.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12939-017-0605-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-55050332017-07-12 Identifying inequitable healthcare in older people: systematic review of current research practice Salway, Sarah M. Payne, Nick Rimmer, Melanie Buckner, Stefanie Jordan, Hannah Adams, Jean Walters, Kate Sowden, Sarah L. Forrest, Lynne Sharp, Linda Hidajat, Mira White, Martin Ben-Shlomo, Yoav Int J Equity Health Systematic Review 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12939-017-0605-z) contains supplementary material, which is available to authorized users. BioMed Central 2017-07-11 /pmc/articles/PMC5505033/ /pubmed/28697768 http://dx.doi.org/10.1186/s12939-017-0605-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Systematic Review
Salway, Sarah M.
Payne, Nick
Rimmer, Melanie
Buckner, Stefanie
Jordan, Hannah
Adams, Jean
Walters, Kate
Sowden, Sarah L.
Forrest, Lynne
Sharp, Linda
Hidajat, Mira
White, Martin
Ben-Shlomo, Yoav
Identifying inequitable healthcare in older people: systematic review of current research practice
title Identifying inequitable healthcare in older people: systematic review of current research practice
title_full Identifying inequitable healthcare in older people: systematic review of current research practice
title_fullStr Identifying inequitable healthcare in older people: systematic review of current research practice
title_full_unstemmed Identifying inequitable healthcare in older people: systematic review of current research practice
title_short Identifying inequitable healthcare in older people: systematic review of current research practice
title_sort identifying inequitable healthcare in older people: systematic review of current research practice
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505033/
https://www.ncbi.nlm.nih.gov/pubmed/28697768
http://dx.doi.org/10.1186/s12939-017-0605-z
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