Primary care decisions often made without the best evidence

June 21, 2017 by Lauren Baggett, University of Georgia

As medicine continues to shift toward evidence-based practice, some primary care providers may have a difficult time finding quality evidence to support their clinical decisions, according to a new study from the University of Georgia.

An analysis of 721 topics from an online medical reference for generalists showed that only 18 percent of the clinical recommendations were based on high-quality, patient-oriented evidence.

This finding highlights the need for more research in and family medicine, said Mark Ebell, epidemiology professor at UGA's College of Public Health and lead author of the study.

"The research done in the primary care setting, which is where most outpatients are seen, is woefully underfunded," he said, "and that's part of the reason why there's such a large number of recommendations that are not based on the highest level of evidence."

The lack of funding stands in contrast to the use of primary care across the care system. According to the Centers for Disease Control, primary care visits account for over half of physician's office visits in the U.S. And while treat the occasional cough or fever, they also bear the brunt of .

High blood pressure, diabetes, heart disease and high cholesterol often fall on a primary care provider's plate, and there are many different approaches to treatment. Therefore, it's essential, Ebell said, to understand which approach "has the greatest chance of providing benefit and minimizing harm, and the only way to truly know that is from well-designed studies."

Ebell and his co-authors identified areas of care supported by high-quality studies and others that are not. Topics related to pregnancy and childbirth, cardiovascular health, and psychiatry had the highest percentage of recommendations backed by research-based evidence. Hematological, musculoskeletal and rheumatological, and poisoning and toxicity topics had the lowest percentage.

About half of the recommendations overall were based on studies measuring patient-oriented health outcomes, such as quality of life, improved symptoms and lower death rates, rather than laboratory markers like blood sugar or cholesterol levels.

Because the latter may or may not translate into how long or how well people live, Ebell said, "practice should wherever possible be guided by studies reporting patient-oriented health outcomes."

Filling in the gaps for evidence-based, patient-oriented primary care research should matter to patients as well as their , said Ebell. "You would want your care to be guided by studies that have demonstrated that what the physician recommends will help you live better or longer. We should all want that kind of information to guide care."

Explore further: Retail medical sites expanding to provide primary care

More information: Mark H Ebell et al. How good is the evidence to support primary care practice?, Evidence Based Medicine (2017). DOI: 10.1136/ebmed-2017-110704

Related Stories

Retail medical sites expanding to provide primary care

April 18, 2017
(HealthDay)—Pharmacy chains are continuing to develop primary care venues within their stores, according to an article published in Medical Economics.

Physician volume may have a negative impact on quality of diabetes care

December 12, 2016
Primary care physicians with busier outpatient practices may deliver lower-quality diabetes care. The findings of a population-based cohort study are published in Annals of Internal Medicine.

AAFP releases primary care-based payment proposal

May 7, 2017
(HealthDay)—The American Academy of Family Physicians (AAFP) has responded to a request for proposals from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) by submitting a detailed plan, according ...

United States has highest rate of poor primary care coordination among 11 high-income countries

March 13, 2017
Care coordination has been identified as a key strategy for improving the effectiveness, safety and efficiency of the U.S. health care system. In new research published in the March/April issue of Annals of Family Medicine, ...

ADA issues recs for management of diabetes in primary care

March 3, 2016
(HealthDay)—New recommendations have been developed for diabetes, focusing on areas of importance for primary care providers. The clinical guideline was published online March 1 in the Annals of Internal Medicine.

ACP provides guidelines for retail health clinics

October 13, 2015
(HealthDay)—Retail clinics have a place in health care and should encourage the longitudinal care relationship with primary care physicians, according to a position paper published online Oct. 12 in the Annals of Internal ...

Recommended for you

Sweet, bitter, fat: New study reveals impact of genetics on how kids snack

February 22, 2018
Whether your child asks for crackers, cookies or veggies to snack on could be linked to genetics, according to new findings from the Guelph Family Health Study at the University of Guelph.

The good and bad health news about your exercise posts on social media

February 22, 2018
We all have that Facebook friend—or 10—who regularly posts photos of his or her fitness pursuits: on the elliptical at the gym, hiking through the wilderness, crossing a 10K finish line.

Smartphones are bad for some teens, not all

February 21, 2018
Is the next generation better or worse off because of smartphones? The answer is complex and research shows it largely depends on their lives offline.

Tackling health problems in the young is crucial for their children's future

February 21, 2018
A child's growth and development is affected by the health and lifestyles of their parents before pregnancy - even going back to adolescence - according to a new study by researchers at the Murdoch Children's Research Institute, ...

Lead and other toxic metals found in e-cigarette 'vapors': study

February 21, 2018
Significant amounts of toxic metals, including lead, leak from some e-cigarette heating coils and are present in the aerosols inhaled by users, according to a study from scientists at Johns Hopkins Bloomberg School of Public ...

Why teens need up to 10 hours' sleep

February 21, 2018
Technology, other distractions and staying up late make is difficult, but researchers say teenagers need to make time for 8-10 hours of sleep a night to optimise their performance and maintain good health and wellbeing.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.