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Recommendations for Primary Care Clinicians Often Lack Strong Evidence

Not enough high-quality, patient-oriented evidence is used to craft diagnosis and treatment recommendations for primary care physicians, a new study suggests.

The report in the journal Evidence-Based Medicine points out that, as a result of analysis of 721 topics from an online medical reference for generalists, only 18% of the clinical recommendations were based on evidence that met those standard; i.e., Strength of Recommendations Taxonomy (SORT) A. About half were based on expert opinion, usual care, or disease-oriented evidence SORT C.

"The research done in the primary care setting, which is where most outpatients are seen, is woefully underfunded, 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,” explained lead author Mark Ebell, MD, epidemiology professor at UGA's College of Public Health.

Funding might be low but use of primary care is not, according to the study, which cites national CDC data showing that primary care visits account for more than half of physician's office visits in the United States.

Results of the review indicate that topics related to pregnancy and childbirth, cardiovascular health, and psychiatry had the highest percentage of recommendations backed by research-based evidence. On the other hand, hematological, musculoskeletal and rheumatological, and poisoning and toxicity topics were least likely to be based on strong evidence.

OB-OBGYN Clinical Alert - hz

Overall, about half of the recommendations overall grew from studies measuring patient-oriented health outcomes — such as quality of life, improved symptoms, and lower death rates — instead of laboratory markers.

“Primary care physicians should be aware that only a minority of recommendations are based on high-quality, patient-oriented evidence,” study authors stated. “This highlights the need for regular literature surveillance by primary care physicians to identify stronger evidence as it is developed. More research is needed in the primary care setting that evaluates the impact of interventions on patient-oriented health outcomes. Progress could be measured by periodically re-evaluating the percentage of recommendations based on high-quality evidence.”