Preventive care recommendations to promote health equity.

Background: Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages.

Methods: The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders.

Recommendations: We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages.

Interpretation: Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.

Competing Interests: Competing interests: Nav Persaud reports receiving grants from the Canadian Institutes of Health Research (CIHR), the Canada Research Chairs Program, the Public Health Agency of Canada (PHAC), Physicians Services Incorporated Foundation, and the Ontario SPOR Support Unit, outside the submitted work; and support for travel expenses for a presentation at the Canadian Cardiovascular Congress. Dr. Persaud was a member of the Canadian Task Force on Preventive Health Care between 2018 and 2022 (travel expenses paid for by PHAC) and advisor to the pan-Canadian Advisory Panel on a Framework for a Prescription Drug List (no payment or compensation). Ambreen Sayani reports receiving a grant from CIHR as part of a Patient-Oriented Research Award–Transition to Leadership Stream, in support of the present manuscript (payments to institution). Dr. Sayani has also received consulting fees as a health equity expert advisor to the Canadian Partnership Against Cancer. Muna Chowdhury reports receiving an honorarium from CIHR. Somtochukwu Ibezi reports receiving honoraria as a keynote speaker at University of Saskatchewan College of Medicine’s Ninth Annual Global Health Conference (“Racism in Health Care”) in January 2021, and as a member of the scientific planning committee for a College of Family Physicians of Canada–accredited learning module related to the topic of racism in health care, in 2021. Dr. Ibezi is an executive board member and vice-president of Black Physicians of Canada, and a board member of Craig’s Cause Pancreatic Cancer Society. Alan Katz reports receiving research grants from CIHR, outside the submitted work. Dr. Katz is a member of the ICES scientific advisory board and the SAIL Databank International advisory board, past president of the Canadian Association for Health Services and Policy Research, a member of an advocacy group on research for College of Family Physicians of Canada, and Manitoba co-lead of OurCare. Trudy McFarlane reports holding unpaid positions with Black Physicians of Canada, Black Physicians’ Association of Ontario (and its subsidiary, the Black Health and Vaccine Initiative), VaxFax for Black Communities, and Black Physicians of Nova Scotia. Anjali Oberai reports receiving a speaker honorarium from Northern Constellations, Northern Ontario School of Medicine University. Yinka Oladele is executive director of the Oladele Foundation. Aisha Lofters reports receiving an institutional grant from Pfizer Canada related to the care of Black women living with metastatic breast cancer, outside the submitted work. No other competing interests were declared.

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