The controlled clinical trial and decision making in family practice

This study attempts to measure the extent to which the family physician's therapeutic and strategic decisions in selected areas are in accordance with the findings of controlled clinical trials and cohort studies bearing on the decision problem. A questionnaire was designed to present a clinical problem and elicit a choice of therapy, test, or management for that particular clinical situation, the choice being capable of classification as concordant (in best agreement with the results of pertinent cohort studies) or nonconcordant. There were 70 respondents. Out of 8 possible responses, the number of concordant responses per individual ranged from 0 to 5, with a mean of 2.57 +/- 1.2. No significant difference in concordance of response per individual by years of clinical experience (as measured by age), region of practice location, or region of medical school attendance was found. Only 18 percent of the sample had ratios (concordant/all responses) greater than 0.50. Likewise, for only one clinical area did concordance of response exceed 50 percent. As a measure of the penetrance of the clinical trial and cohort study into the practice or primary care, these data suggest that they do not exert a major influence in clinical decision making.