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 3 Karen Davies, 2010 Meta analysis Systematic Reviews Randomized Controlled Clinical Trials Cohort Studies Case Control Studies Case 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 4 Karen Davies, 2010

EBM Levels Used in This Study 5 Karen Davies, 2010 (Meta analysis) Systematic Reviews Randomized Controlled Clinical Trials Cohort Studies Case Control Studies Case Series / Reports Anecdotal Guidelines Websites Level One Level Two

6 Karen Davies, 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% 7 Karen Davies, 2010

Questions Not Answered 2 out of 57 ATTRACT questions – 3.5% 125 out of 724 NLH Primary Care Answering Service questions – 17% Average 16% 8 Karen Davies, 2010

Guidelines Used 24 of the 57 questions from ATTRACT - 42% 301 of the 724 questions from NLH Primary Care Answering Service – 42% 9 Karen Davies, 2010

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% 10 Karen Davies, 2010

Evidence for the Questions 11 KarenDavies, 2010

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? 12 Karen Davies, 2010

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? 13 Karen Davies, 2010

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 14 Karen Davies, 2010