Qual Saf Health Care 12:353-358 doi:10.1136/qhc.12.5.353
  • Original Article

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

  1. D R Manna1,
  2. M A Bruijnzeels1,
  3. H G A Mokkink2,
  4. M Berg1
  1. 1Department of Health Policy & Management, Erasmus MC, Rotterdam, The Netherlands
  2. 2Centre for Quality of Care Research, UMC St. Radboud, University of Nijmegen, The Netherlands
  1. Correspondence to:
 D R Manna, PO Box 1738, 3000 DR Rotterdam, The Netherlands; 
  • Accepted 19 January 2003


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.


  • See editorial commentary, pp 328–9