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How good is the evidence to support primary care practice?
Mark H Ebell1, Randi Sokol2, Aaron Lee1
1Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA.
Evidence-Based Medicine
|May 31, 2017
Summary
Primary care practice recommendations are often not based on high-quality evidence. Only 18% of recommendations use consistent, high-quality patient-oriented evidence, impacting evidence-based practice.
Area of Science:
- Evidence-based medicine
- Primary care research
- Clinical practice guidelines
Background:
- Assessing the quality of evidence underpinning primary care recommendations is crucial for effective patient care.
- Essential Evidence provides a widely used online reference for general practitioners.
Purpose of the Study:
- To evaluate the extent to which primary care practice recommendations are supported by high-quality, patient-oriented evidence.
- To analyze the grading of recommendations using the Strength of Recommendations Taxonomy (SORT).
Main Methods:
- Systematic review of 721 chapters in Essential Evidence, encompassing 3251 recommendations.
- Application of the Strength of Recommendations Taxonomy (SORT) grading system (A, B, C).
- Analysis of recommendation quality based on patient-oriented outcomes versus surrogate outcomes.
Main Results:
- Only 18% of recommendations received a SORT 'A' grade (consistent, good quality patient-oriented evidence).
- 49% of recommendations were graded 'C', relying on expert opinion or surrogate outcomes.
- 51% of recommendations were based on studies reporting patient-oriented outcomes (e.g., morbidity, mortality).
Conclusions:
- A significant portion of primary care recommendations lack robust, high-quality patient-oriented evidence.
- Improvement in the evidence base for clinical practice guidelines is needed.
- Further research should focus on generating high-quality patient-oriented evidence for primary care.
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