Background Disadvantaged populations in the United States experience disparities in the use of preventive health services. Purpose To examine effects of barriers that create health disparities in 10 recommended preventive services for adults, and to evaluate the effectiveness of interventions to reduce them. Data Sources English-language searches of Ovid MEDLINE, PsycINFO, SocINDEX, and the Veterans Affairs Health Services database (1 January 1996 to 5 July 2019); reference lists. Study Selection Trials, observational studies with comparison groups, and systematic reviews of populations adversely affected by disparities that reported effects of barriers on use of any of the 10 selected preventive services or that reported the effectiveness of interventions to reduce disparities in use of a preventive service by improving intermediate or clinical outcomes. Data Extraction Dual extraction and assessment of study quality, strength of evidence, and evidence applicability. Data Synthesis No studies reported effects of provider-specific barriers on preventive service use. Eighteen studies reporting effects of patient barriers, such as insurance coverage or lack of a regular provider, on preventive service use had mixed and inconclusive findings. Studies of patient-provider interventions (n = 12), health information technologies (n = 11), and health system interventions (n = 88) indicated higher cancer screening rates with patient navigation; telephone calls, prompts, and other outreach methods; reminders involving lay health workers; patient education; risk assessment, counseling, and decision aids; screening checklists; community engagement; and provider training. Single studies showed that clinician-delivered and technology-assisted interventions improved rates of smoking cessation and weight loss, respectively. Limitation Insufficient or low strength of evidence and applicability for most interventions except patient navigation, telephone calls and prompts, and reminders involving lay health workers. Conclusion In populations adversely affected by disparities, patient navigation, telephone calls and prompts, and reminders involving lay health workers increase cancer screening. Primary Funding Source National Institutes of Health Office of Disease Prevention through an interagency agreement with the Agency for Healthcare Research and Quality. (PROSPERO: CRD42018109263).

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在预防服务中实现健康平等：美国国立卫生研究院预防途径研讨会的系统综述。

背景技术美国的弱势人群在使用预防保健服务方面存在差距。目的研究在成人推荐的10种预防服务中造成健康差异的障碍的影响，并评估减少这些障碍的干预措施的有效性。数据源：Ovid MEDLINE，PsycINFO，SocINDEX和退伍军人事务健康服务数据库的英语搜索（1996年1月1日至2019年7月5日）；参考清单。研究选择试验，具有比较组的观察性研究，有系统地审查受差异影响的人群，这些差异报告了使用障碍物对选择的10种预防服务中的任何一种的影响，或报告了通过改善中间或临床结果来减少预防服务使用差异的干预措施的有效性。数据提取双重提取和评估研究质量，证据强度和证据适用性。数据综合尚无研究报道特定于提供商的障碍对预防性服务使用的影响。十八项研究报告了患者障碍（例如保险范围或缺乏正规医疗服务提供者）对预防性服务使用的影响，但结果并不确定。研究患者-提供者的干预措施（n = 12），健康信息技术（n = 11），卫生系统的干预措施（n = 88）表明患者导航的癌症筛查率更高；电话，提示和其他推广方法；提醒非专业卫生工作者；病人教育；风险评估，咨询和决策辅助；筛选清单；社区参与；和提供者培训。单项研究表明，临床医生提供的干预和技术辅助的干预分别提高了戒烟率和减肥率。局限性除大多数情况下，患者导航，电话和提示以及涉及非专业卫生人员的提醒之外，大多数干预措施的证据强度不足或适用性很低。结论在受到差异，患者导航，电话和提示不利影响的人群中，并提醒非专业卫生工作者增加对癌症的筛查。主要资金来源美国国家卫生研究院疾病预防控制办公室通过与医疗保健研究与质量机构的跨机构协议达成。（PROSPERO：CRD42018109263）。