An interpretive description of health equity in chronic obstructive pulmonary disease (COPD) clinical practice guidelines
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.144 | 0.291 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.004 | 0.037 |
| Scholarly communication | 0.011 | 0.013 |
| Open science | 0.004 | 0.008 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".