Methods for considering equality and equity implications in horizon scanning for medicines and healthcare innovations: a scoping review

Background

There is an increasing focus on inequity in healthcare and health outcomes. Early awareness of potential sources of inequity in access to and outcomes from innovative health technologies can support system preparedness and allow implementation of mitigations.

They may also be used to improve research inclusion.

Objective

To explore methods used to integrate equality and equity into horizon scanning for healthcare innovations, focusing on acceptability, polypharmacy, and multiple long-term conditions (MLTC).

Design

A scoping review followed Joanna Briggs Institute (JBI) guidelines to identify relevant methodologies for integrating equity into horizon scanning.

Data sources

Searches were conducted in MEDLINE, Embase, ProQuest, and WHO Global Index Medicus up to May 24, 2024.

Eligibility criteria

Studies were eligible if they presented methodologies for integrating equity and equality considerations into horizon scanning in health and care. Primary outcomes related to equity or equality, and secondary outcomes addressed acceptability, polypharmacy, and MLTC.

Data extraction and synthesis

Data were extracted on study characteristics, equity frameworks, and the integration of equity-related factors, including socioeconomic status, gender, and geographic location. A narrative synthesis was used to present the findings.

Results

Out of 951 records screened, three studies were included. The studies used varied horizon scanning methods, including scenario-building and foresight methodologies, and spanned multiple healthcare contexts such as precision oncology and complex paediatric care. Each study incorporated equity/equality by addressing the impact of emerging innovations on clinically vulnerable populations. Acceptability was found to be crucial for equitable implementation, particularly in precision oncology. However, managing complex health needs, especially in disadvantaged groups, is complicated by significant challenges such as polypharmacy and the presence of multiple long-term conditions.

Conclusions

Limited evidence highlighted a lack of consistent approaches to integrating equity into horizon scanning. While methods such as stakeholder engagement and scenario analysis showed promise, further research is needed to refine frameworks that better detect early indicators of inequity in healthcare innovation.

Article summary