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Evidence based general practice
M M Suárez-Varela1, A Llopis-González, J Bell
1Unit of Public Health, Hygiene and Environmental Health, Valencia University, Spain. maria.m.morales@uv.es
Objectives:
To estimate the proportion of interventions in general practice that are based on evidence.
Design:
A one-year cross-sectional study involving all consultations by patients over age 15 years seen in 34 national primary health care centers.
Setting:
The rural Castellon provincial district within the Valencian Community in eastern Spain, with a total population of 21,155 inhabitants.
Subjects:
of 1990 case histories registered in the course of one year, 4800 consultations were identified; of these, 2341 (49%) distinct diagnosis-intervention pairs were identified and coded.
Main Results:
The evidence basis for the diagnosis-intervention pairs in the study was derived from a computerized search of the scientific literature published in 1992-1996. The quality of the evidence was classified according to the method of Ellis et al. Within the 2341 diagnosis-intervention pairs, there was positive evidence in support of the intervention used in 55%. The evidence basis was sound for 42%, with 38% being based on Type I (clinical trials) evidence and 4% on Type II evidence. The most frequently presenting diseases involved the circulatory (18.7%), respiratory (14.9%), nervous (14.2%), musculo-skeletal (12.5%) and nutrition and metabolism and digestive systems, with 12.1% each.
Conclusions:
Clinical practice was clearly supported by positive evidence of all Types (I-III) in a total of 55% of interventions, and by good positive evidence of Type I or II in 42% of interventions. The percentage of evidence-based interventions in general practice serving a substantial population in rural Spain was lower than had been reported by some authors.