Reducing Health Inequalities through General Practice: A Realist Review (EQUALISE)

The EQUALISE Study is a realist review that explores which interventions and aspects of routine general practice increase or decrease inequalities for the main drivers of inequalities in life expectancy: cardiovascular disease, cancer, diabetes or Chronic Obstructive Pulmonary Disease (COPD). The study undertakes a theory-driven review of the existing evidence and aims to develop guidance which can be used in general practice to reduce inequalities and improve services for patients.

Research question
What types of interventions or aspects of routine care in general practice increase or decrease inequalities in outcomes of cardiovascular disease, cancer, diabetes or COPD, for whom, why, in what circumstances and how?

Methods

• We are conducting a review of the literature using what is called a realist review. This type of review helps us understand the different contexts or settings in which interventions work or not, rather than taking a one-size-fits-all approach.
• At the first stage of the realist review, expert doctors, health care professionals and commissioners inform us about what they think increases or decreases health inequalities in their services
• Later, building on experts’ feedback, we do literature searches; there are a lot of published literature reviews about general practice which may or may not include information about health inequalities. We use the existing reviews to identify the original studies and explore whether they report their results by measures of inequality. We primarily focus on socio-economic status (e.g. income, occupation, education), but also we collect data on other categories of inequality (e.g. ethnicity). We are interested in a range of outcomes including prevention, diagnosis, follow-up and treatment.
• At the final stage, based on our findings and through a workshop with a diverse group of patients, carers, GPs, health care managers and researchers, we will develop guidance and a toolkit for the NHS.

The results will provide us with guidance about how the NHS can reduce health inequalities through doctors’ surgeries and PCNs. We will work with NHS England and Cambridgeshire and Peterborough Clinical Commissioning Group to ensure that the NHS can make best use of the findings. Moreover, we will work with the patients’ representatives among our team-members to ensure that our research is person-centred and its findings are effectively shared with the public.

Main Contact:Dr Anna Gkiouleka
PIs: Dr John Ford & Dr Geoff Wong
Research Team Members: Ms Isla Kuhn – University of Cambridge; Dr Sarah Sowden– University of Newcastle; Prof Clare Bambra – University of Newcastle; Dr Fiona Head– NHS Cambridgeshire and Peterborough CCG; Ms Rikke Siersbaek – Trinity College Dublin
PPI: Ms Annie Moseley; Ms Sukaina Manji; Ms Rebecca Harmston
Funder: NIHR HSDR