Many primary care doctors are shifting toward evidence-based practice, but they may have trouble finding the evidence they need to guide clinical decisions, according to a new study.
Researchers at the University of Georgia analyzed 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. Slightly more than half (51%) were based on patient-oriented evidence but from less quality research.
Patient-oriented outcomes, like quality of life, mortality rates and improved symptoms, translate directly into how well people live, so guidelines backed by research into those metrics are more useful than those based on laboratory markers, according to the study.
Topics related to pregnancy and childbirth, cardiovascular health and psychiatry had the highest percentage of clinical guidelines backed by research, while hematological, musculoskeletal, rheumatological, and poisoning and toxicity had the lowest percentage.
Mark Ebell, M.D., an epidemiology professor at UGA’s College of Public Health and the study’s lead author, said in an announcement that the findings highlight the need for further research into topics related to primary care and family medicine, especially as more than half of physician’s office visits are for primary care.
"The research done in the primary care setting, which is where most outpatients are seen, is woefully underfunded," Ebell 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."
Despite primary care’s value to the healthcare system, it is an often-forgotten piece of the puzzle. Investment in primary care can cut costs and reduce overuse; states like Rhode Island that have put the spotlight on primary care have seen significant return on that investment. The Agency for Healthcare Research and Quality is also examining ways to improve primary care to reduce hospital readmissions.
Plus, patients value having a relationship with their primary care doctors. A national survey found 89% of patients feel it’s important to have ties with a physician that knows their family and medical histories.