An interpretive description of health equity in chronic obstructive pulmonary disease (COPD) clinical practice guidelines

Abstract

Health equity is an increasing global phenomenon of interest among health care professionals (HCPs), researchers, and decision-makers. Clinical practice guidelines (CPGs) serve to promote standardized care and may have implications relative to health equity. Health care professionals rely on evidence including CPGs to be accountable, provide optimal care, and to advance advocacy efforts for people with chronic lung disease. However, CPGs for COPD may unintentionally exacerbate health inequities and health disparities experienced by those living in northern or rural areas where there may be decreased access to supports such as spirometry, pulmonary rehabilitation, and specialist care. The purpose of this study was to conduct an interdisciplinary analysis of COPD CPGs to understand the contribution and implications of these guidelines to health equity for individuals living with COPD. Different perspectives and representations of health equity across the guidelines may have problematic implications and challenges for patients, HCPs and decision-makers. The research question guiding this study is how do CPGs for COPD explicitly or implicitly address health equity? The study design, interpretive description, was guided by critical social theory. Using purposive sampling, publicly available international, national, and provincial English language CPGs for COPD were selected. Concurrent data collection and analysis was informed by five items of The Equity Lens instrument and the four items of Domain 5, outlined in the Applicability of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. The four stages of content analysis are decontextualization, recontextualization, categorization, and compilation. The results offer opportunities to engage multiple interdisciplinary knowledge users in dialogue about the implications of CPG adoption to move toward health equity and to best service individuals with COPD in Northeastern Ontario.