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In-patient interventions supported by results of randomized controlled trials in Japan
Hiroshi Koyama1, Kunihiko Matsui, Masashi Goto
1Department of General Medicine and Clinical Epidemiology, Kyoto University Hospital and Graduate School of Medicine, Kyoto City, Japan. hkoyama@kuhp.kyoto-u.ac.jp
Objective:
To determine to what extent the results of randomized controlled trials (RCTs) support medical interventions for in-patients at the department of general medicine of a university hospital in Japan.
Design:
Retrospective analysis. By reviewing discharge summaries, two physicians first independently decided on patients' respective primary problems at admission and up to two secondary problems. Next, up to five interventions for the primary problem and one intervention for each of the secondary problems were selected. Differences of opinion (if any) between the two physicians regarding these selected interventions were resolved by discussion. MEDLINE and/or the Cochrane Library were used as data sources for literature regarding the selected interventions.
Setting:
A ward of the department of general medicine of a Japanese university hospital, 1995-1997.
Main Measures:
The proportion of therapeutic interventions supported by RCT results and associated meta-analyses.
Results:
For the primary problems, 103 (48.8%) of the 211 most important interventions were supported by the results of RCTs, as were 47.8% of all the interventions including the most important and the adjunctive ones. Furthermore, 56.2% of the most important interventions for the secondary problems were also supported by the RCT results.
Conclusions:
Approximately half of the therapeutic interventions performed at an academic medical in-patient unit in Japan were RCT-supported. This was true not only for the most important interventions for primary problems but also for the adjunct interventions for the primary problems and the interventions for secondary problems.