• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of qualsafetyQuality and Safety in Health CareCurrent TOCInstructions for authors
Qual Saf Health Care. Oct 2003; 12(5): 353–358.
PMCID: PMC1743772

Ethnic specific recommendations in clinical practice guidelines: a first exploratory comparison between guidelines from the USA, Canada, the UK, and the Netherlands

Abstract

Objectives: To investigate whether clinical practice guidelines in different countries take ethnic differences between patients into consideration and to assess the scientific foundation of such ethnic specific recommendations.

Design: Analysis of the primary care sections of clinical practice guidelines.

Setting: Primary care practice guidelines for type 2 diabetes mellitus, hypertension, and asthma developed in the USA, Canada, the UK, and the Netherlands.

Main outcome measures: Enumeration of the ethnic specific information and recommendations in the guidelines, and the scientific basis and strength of this evidence.

Results: Different guidelines do address ethnic differences between patients, but to a varying extent. The USA guidelines contained the most ethnic specific statements and the Dutch guidelines the least. Most ethnic specific statements were backed by scientific evidence, usually arising from descriptive studies or narrative reviews.

Conclusion: The attention given to ethnic differences between patients in clinical guidelines varies between countries. Guideline developers should be aware of the potential problems of ignoring differences in ethnicity.

Full Text

The Full Text of this article is available as a PDF (96K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Berg M. Problems and promises of the protocol. Soc Sci Med. 1997 Apr;44(8):1081–1088. [PubMed]
  • Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct 20;282(15):1458–1465. [PubMed]
  • Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999 May 26;281(20):1900–1905. [PubMed]
  • Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H. Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ. 1998 Sep 26;317(7162):858–861. [PMC free article] [PubMed]
  • Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999 Feb 20;318(7182):527–530. [PMC free article] [PubMed]
  • Kaplan NM. Ethnic aspects of hypertension. Lancet. 1994 Aug 13;344(8920):450–452. [PubMed]
  • Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P. Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London. Heart. 1997 Dec;78(6):555–563. [PMC free article] [PubMed]
  • Khattar RS, Swales JD, Senior R, Lahiri A. Racial variation in cardiovascular morbidity and mortality in essential hypertension. Heart. 2000 Mar;83(3):267–271. [PMC free article] [PubMed]
  • Partridge MR. In what way may race, ethnicity or culture influence asthma outcomes? Thorax. 2000 Mar;55(3):175–176. [PMC free article] [PubMed]
  • Freeman HP, Payne R. Racial injustice in health care. N Engl J Med. 2000 Apr 6;342(14):1045–1047. [PubMed]
  • Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000 May 17;283(19):2579–2584. [PubMed]
  • Feldman RD, Campbell N, Larochelle P, Bolli P, Burgess ED, Carruthers SG, Floras JS, Haynes RB, Honos G, Leenen FH, et al. 1999 Canadian recommendations for the management of hypertension. Task Force for the Development of the 1999 Canadian Recommendations for the Management of Hypertension. CMAJ. 1999;161 (Suppl 12):S1–17. [PMC free article] [PubMed]
  • Boulet LP, Becker A, Bérubé D, Beveridge R, Ernst P. Canadian Asthma Consensus Report, 1999. Canadian Asthma Consensus Group. CMAJ. 1999 Nov 30;161(11 Suppl):S1–61. [PMC free article] [PubMed]
  • Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S, Yale JF, Zinman B, Lillie D. 1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association. CMAJ. 1998;159 (Suppl 8):S1–29. [PMC free article] [PubMed]
  • Ramsay L, Williams B, Johnston G, MacGregor G, Poston L, Potter J, Poulter N, Russell G. Guidelines for management of hypertension: report of the third working party of the British Hypertension Society. J Hum Hypertens. 1999 Sep;13(9):569–592. [PubMed]
  • Eccles M, Freemantle N, Mason J. North of England evidence based guidelines development project: methods of developing guidelines for efficient drug use in primary care. BMJ. 1998 Apr 18;316(7139):1232–1235. [PMC free article] [PubMed]
  • Fujimoto WY, Leonetti DL, Kinyoun JL, Shuman WP, Stolov WC, Wahl PW. Prevalence of complications among second-generation Japanese-American men with diabetes, impaired glucose tolerance, or normal glucose tolerance. Diabetes. 1987 Jun;36(6):730–739. [PubMed]
  • Zimmet PZ. Kelly West Lecture 1991. Challenges in diabetes epidemiology--from West to the rest. Diabetes Care. 1992 Feb;15(2):232–252. [PubMed]
  • Dean HJ, Mundy RL, Moffatt M. Non-insulin-dependent diabetes mellitus in Indian children in Manitoba. CMAJ. 1992 Jul 1;147(1):52–57. [PMC free article] [PubMed]
  • Delisle HF, Ekoé JM. Prevalence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance in two Algonquin communities in Quebec. CMAJ. 1993 Jan 1;148(1):41–47. [PMC free article] [PubMed]
  • Harris SB, Gittelsohn J, Hanley A, Barnie A, Wolever TM, Gao J, Logan A, Zinman B. The prevalence of NIDDM and associated risk factors in native Canadians. Diabetes Care. 1997 Feb;20(2):185–187. [PubMed]
  • Harris SB, Caulfield LE, Sugamori ME, Whalen EA, Henning B. The epidemiology of diabetes in pregnant Native Canadians. A risk profile. Diabetes Care. 1997 Sep;20(9):1422–1425. [PubMed]
  • Dean H. NIDDM-Y in First Nation children in Canada. Clin Pediatr (Phila) 1998 Feb;37(2):89–96. [PubMed]
  • Tuomilehto J, Knowler WC, Zimmet P. Primary prevention of non-insulin-dependent diabetes mellitus. Diabetes Metab Rev. 1992 Dec;8(4):339–353. [PubMed]
  • Berghout A, Dijkstra S. Diabetes mellitus type II bij Hindoestanen; nieuwe verschijningsvormen van oude ziektebeelden. Ned Tijdschr Geneeskd. 1995 Jan 7;139(1):3–7. [PubMed]
  • Bongers I, Westendorp RG, Stolk B, Huysmans HA, Vandenbroucke JP. Vroegtijdige coronaire hartziekten samengaand met diabetes mellitus type II bij personen van Hindoestaanse afkomst. Ned Tijdschr Geneeskd. 1995 Jan 7;139(1):16–18. [PubMed]
  • Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Stamler J. End-stage renal disease in African-American and white men. 16-year MRFIT findings. JAMA. 1997 Apr 23;277(16):1293–1298. [PubMed]
  • Fang J, Madhavan S, Alderman MH. The association between birthplace and mortality from cardiovascular causes among black and white residents of New York City. N Engl J Med. 1996 Nov 21;335(21):1545–1551. [PubMed]
  • Havas S, Sherwin R. Putting it all together: summary of the NHLBI Workshop on the Epidemiology of Hypertension in Hispanic American, Native American, and Asian/Pacific Islander American Populations. Public Health Rep. 1996;111 (Suppl 2):77–79. [PMC free article] [PubMed]
  • Hall WD, Ferrario CM, Moore MA, Hall JE, Flack JM, Cooper W, Simmons JD, Egan BM, Lackland DT, Perry M, Jr, et al. Hypertension-related morbidity and mortality in the southeastern United States. Am J Med Sci. 1997 Apr;313(4):195–209. [PubMed]
  • Townsend RR, DiPette DJ, Goodman R, Blumfield D, Cronin R, Gradman A, Katz LA, McCarthy EP, Sopko G. Combined alpha/beta-blockade versus beta 1-selective blockade in essential hypertension in black and white patients. Clin Pharmacol Ther. 1990 Dec;48(6):665–675. [PubMed]
  • Chen MF, Chen CC, Chen WJ, Wu CC, Liau CS, Lee YT. Dose titration study of isradipine in Chinese patients with mild to moderate essential hypertension. Cardiovasc Drugs Ther. 1993 Feb;7(1):133–138. [PubMed]
  • Chen MF, Yang CY, Chen WJ, Lee CM, Wu CC, Liau CS, Lee YT. A double-blind comparison of once-daily metoprolol controlled-release and atenolol in the treatment of Chinese patients with mild to moderate hypertension. Cardiovasc Drugs Ther. 1995 Jun;9(3):401–406. [PubMed]
  • Weinberger MH. Salt sensitivity of blood pressure in humans. Hypertension. 1996 Mar;27(3 Pt 2):481–490. [PubMed]
  • Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J. 1996 Jul-Aug;48(4):343–353. [PubMed]
  • Howard BV, Lee ET, Yeh JL, Go O, Fabsitz RR, Devereux RB, Welty TK. Hypertension in adult American Indians. The Strong Heart Study. Hypertension. 1996 Aug;28(2):256–264. [PubMed]
  • Winkleby MA, Kraemer H, Lin J, Jatulis D, Fortmann SP. Sociodemographic influences on Hispanic-white differences in blood pressure. Public Health Rep. 1996;111 (Suppl 2):30–32. [PMC free article] [PubMed]
  • Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991 Mar 9;302(6776):560–564. [PMC free article] [PubMed]
  • McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991 Feb 16;337(8738):382–386. [PubMed]
  • Williams B. Westernised Asians and cardiovascular disease: nature or nurture? Lancet. 1995 Feb 18;345(8947):401–402. [PubMed]
  • Woolcock AJ, Colman MH, Blackburn CR. Factors affecting normal values for ventilatory lung function. Am Rev Respir Dis. 1972 Nov;106(5):692–709. [PubMed]
  • Hsu KH, Jenkins DE, Hsi BP, Bourhofer E, Thompson V, Tanakawa N, Hsieh GS. Ventilatory functions of normal children and young adults--Mexican-American, white, and black. I. Spirometry. J Pediatr. 1979 Jul;95(1):14–23. [PubMed]
  • Wall MA, Olson D, Bonn BA, Creelman T, Buist AS. Lung function in North American Indian children: reference standards for spirometry, maximal expiratory flow volume curves, and peak expiratory flow. Am Rev Respir Dis. 1982 Feb;125(2):158–162. [PubMed]
  • Coultas DB, Howard CA, Skipper BJ, Samet JM. Spirometric prediction equations for Hispanic children and adults in New Mexico. Am Rev Respir Dis. 1988 Dec;138(6):1386–1392. [PubMed]
  • Crapo RO, Lockey J, Aldrich V, Jensen RL, Elliott CG. Normal spirometric values in healthy American Indians. J Occup Med. 1988 Jul;30(7):556–560. [PubMed]
  • Marcus EB, MacLean CJ, Curb JD, Johnson LR, Vollmer WM, Buist AS. Reference values for FEV1 in Japanese-American men from 45 to 68 years of age. Am Rev Respir Dis. 1988 Dec;138(6):1393–1397. [PubMed]
  • Coultas DB, Gong H, Jr, Grad R, Handler A, McCurdy SA, Player R, Rhoades ER, Samet JM, Thomas A, Westley M. Respiratory diseases in minorities of the United States. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 2):S93–131. [PubMed]
  • Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988 Dec;26(12):1119–1128. [PubMed]
  • Pachter LM, Weller SC. Acculturation and compliance with medical therapy. J Dev Behav Pediatr. 1993 Jun;14(3):163–168. [PubMed]
  • Pachter LM, Cloutier MM, Bernstein BA. Ethnomedical (folk) remedies for childhood asthma in a mainland Puerto Rican community. Arch Pediatr Adolesc Med. 1995 Sep;149(9):982–988. [PubMed]
  • Risser AL, Mazur LJ. Use of folk remedies in a Hispanic population. Arch Pediatr Adolesc Med. 1995 Sep;149(9):978–981. [PubMed]
  • Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978 Feb;88(2):251–258. [PubMed]
  • Woloshin S, Bickell NA, Schwartz LM, Gany F, Welch HG. Language barriers in medicine in the United States. JAMA. 1995 Mar 1;273(9):724–728. [PubMed]
  • Standardized lung function testing. Report working party. Bull Eur Physiopathol Respir. 1983 Jul;19 (Suppl 5):1–95. [PubMed]
  • Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:5–40. [PubMed]
  • Leape LL, Park RE, Kahan JP, Brook RH. Group judgments of appropriateness: the effect of panel composition. Qual Assur Health Care. 1992 Jun;4(2):151–159. [PubMed]
  • Naylor CD. Grey zones of clinical practice: some limits to evidence-based medicine. Lancet. 1995 Apr 1;345(8953):840–842. [PubMed]
  • Casparie AF. The ambiguous relationship between practice variation and appropriateness of care: an agenda for further research. Health Policy. 1996 Mar;35(3):247–265. [PubMed]
  • Grimshaw J, Eccles M, Russell I. Developing clinically valid practice guidelines. J Eval Clin Pract. 1995 Sep;1(1):37–48. [PubMed]
  • Wood AJ. Racial differences in the response to drugs--pointers to genetic differences. N Engl J Med. 2001 May 3;344(18):1394–1396. [PubMed]
  • Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Clinical guidelines: developing guidelines. BMJ. 1999 Feb 27;318(7183):593–596. [PMC free article] [PubMed]

Articles from Quality & Safety in Health Care are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...