the level of evidence utilized to answer general practitioners’ questions

The level of evidence utilized to answer general practitioners’ questions

Karen Davies

Evidence Based Medicine

2 Karen Davies, 2010

Clinical Expertise

Patient Preferences

Research Evidence

Haynes et al., 1996

EBM - Levels of Evidence


Meta analysisSystematic Reviews

Randomized Controlled Clinical Trials

Cohort StudiesCase Control StudiesCase Series / Reports

Anecdotal

Level One

Level Two

Research Objectives

• To determine the highest level of evidence per question

• To determine the number of questions not answered due to a lack of evidence

• To determine the number of times a guideline was used to answer a question

• To determine the type of websites used to answer questions


EBM Levels Used in This Study


(Meta analysis)Systematic Reviews

Randomized Controlled Clinical Trials

Cohort StudiesCase Control StudiesCase Series / Reports

Anecdotal

Guidelines

Websites

Level One

Level Two


Methodology

• Two national primary care answering services - ATTRACT and NLH Primary Care Answering Service

• Clinical questions

• Identified the type of evidence used to answer the question

• Data was collected for four months, from 1st March to 30th June 2008

•

Highest Level of Evidence

• 11 of the 57 ATTRACT questions answered by level 1 or 2 in the evidence hierarchy – 19%

• 74 of 724 Primary Care Answering Service questions answered by level 1 / 2 evidence – 10%

• Average 11%


Questions Not Answered

• 2 out of 57 ATTRACT questions – 3.5%

• 125 out of 724 NLH Primary Care Answering Service questions – 17%

• Average 16%


Guidelines Used

• 24 of the 57 questions from ATTRACT - 42%

• 301 of the 724 questions from NLH Primary Care Answering Service – 42%


Type of Websites

• 14 (18%) websites were used by ATTRACT and 116 (25%) by Primary Care Answering Service

• Not for Profit

• NHS (National Health Service)

• Average – 17%


Evidence for the Questions

11 KarenDavies, 2010

Leve

l 1

Leve

l 2

Guid

eline

s

Web

sites

Oth

er

Not A

nswer

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10

20

30

40

50

NLHATTRACT

Questions and Their Evidence I

• What evidence is there for the use of light boxes in the treatment of SAD?

• Are there any alternative /complimentary therapies recommended for IBS?

• Are there benefits from mindfulness therapy?

• What is the evidence for the use of statin in secondary prevention in the over 80's?


Questions and Their Evidence II

• In a 36 year old, hysterectomy and not eligible for HRT, how do we manage osteoporosis risk?

• What are the potential causes of foot numbness, spreading to both legs?

• Can a tens machine be used by a patient who is 20 weeks pregnant?

• Is there any evidence of an interaction between warfarin and litozin?


Why Is This Research Useful?

• NLH Primary Care Answering Service closed

• Useful service

• Guidelines may answer 40% of questions

• 10% of questions were answered using level 1 or 2 evidence


the level of evidence utilized to answer general practitioners’ questions

Documents