医生调查结果表明，需要开展更多结局更好的研究
WESTPORT, CT (Reuters Health) - Primary care physicians in the US see a need for more outcomes research and easier access to research findings, according to a presentation Tuesday at the second annual conference of the Health Legacy Partnership (HELP) in Washington, DC.
HELP, a project of the Kanter Family Foundation and the Agency for Healthcare Research and Quality (AHRQ), is working to develop a National Health Outcomes Database. As part of that effort, the Kanter Family Foundation sponsored a national Harris Interactive survey of 301 primary care physicians regarding the state of medical care in the US.
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The survey, conducted in early October, consisted of eight patient- and disease-specific vignettes for which physicians were asked to choose treatment options. For some of the conditions clear outcomes research results are available, including stroke, heart disease, dyslipidemia, diabetes, and asthma. The remainder--prostate cancer screening, dyspepsia, and chronic pain syndrome--were deemed as having "fairly little outcomes research."
Dr. Carolyn Clancy, of the AHRQ in Rockville, Maryland, told Reuters Health, "There's always a question about whether a move in the direction of evidence-based medicine is the view of the elite, leaving behind practicing physicians. I think the results of this survey confirm that typical primary care physicians are very interested in evidence, and want more of it to help them with their daily clinical decisions."
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Co-investigator Dr. David M. Eddy, of Kaiser Permanente in Pasadena, California, agreed, telling Reuters Health, "There was widespread general agreement that better outcomes research was needed for every [vignette]."
The survey also showed that "even when there was good research, the guidelines often did not reflect available research, and the actual practices of physicians did not necessarily match either the guidelines or the available research," Dr. Eddy added. "The proportion in which that was true varied from vignette to vignette, from about 10% of physicians where practice did not match evidence or guidelines, to as high as 50% or more."
, 百拇医药
Another finding, he said, is that practice varies widely, reflecting in some cases lack of good outcomes research or variations in interpretation.
Dr. Clancy, in describing an example of that variability, said, "One issue that struck me was whether to screen a 50-year-old man for prostate cancer. Responses were digital rectal exam, a PSA screening test, a transrectal ultrasound, or do nothing."
"If you look to what evidence we have, the right answer was to do nothing," she said. "However, over 85% of physicians said they would do both a rectal exam and PSA test."
, 百拇医药
She suggested that perhaps physicians consider that testing could not hurt anything. She pointed out that "there is the potential for downstream harm." Patients with false-positive test results could undergo surgery or radiation, and they may have "significant side effects for a disease that would never have done them any harm to begin with."
The upshot of the survey, according to the investigators, is that physicians need a centralized, easily accessible source of information regarding different management options for specific conditions. As Dr. Eddy said, "That way, physicians and patients could base their decisions on information that is as accurate as possible."
-Westport Newsroom 203 319 2700, http://www.100md.com
HELP, a project of the Kanter Family Foundation and the Agency for Healthcare Research and Quality (AHRQ), is working to develop a National Health Outcomes Database. As part of that effort, the Kanter Family Foundation sponsored a national Harris Interactive survey of 301 primary care physicians regarding the state of medical care in the US.
, http://www.100md.com
The survey, conducted in early October, consisted of eight patient- and disease-specific vignettes for which physicians were asked to choose treatment options. For some of the conditions clear outcomes research results are available, including stroke, heart disease, dyslipidemia, diabetes, and asthma. The remainder--prostate cancer screening, dyspepsia, and chronic pain syndrome--were deemed as having "fairly little outcomes research."
Dr. Carolyn Clancy, of the AHRQ in Rockville, Maryland, told Reuters Health, "There's always a question about whether a move in the direction of evidence-based medicine is the view of the elite, leaving behind practicing physicians. I think the results of this survey confirm that typical primary care physicians are very interested in evidence, and want more of it to help them with their daily clinical decisions."
, 百拇医药
Co-investigator Dr. David M. Eddy, of Kaiser Permanente in Pasadena, California, agreed, telling Reuters Health, "There was widespread general agreement that better outcomes research was needed for every [vignette]."
The survey also showed that "even when there was good research, the guidelines often did not reflect available research, and the actual practices of physicians did not necessarily match either the guidelines or the available research," Dr. Eddy added. "The proportion in which that was true varied from vignette to vignette, from about 10% of physicians where practice did not match evidence or guidelines, to as high as 50% or more."
, 百拇医药
Another finding, he said, is that practice varies widely, reflecting in some cases lack of good outcomes research or variations in interpretation.
Dr. Clancy, in describing an example of that variability, said, "One issue that struck me was whether to screen a 50-year-old man for prostate cancer. Responses were digital rectal exam, a PSA screening test, a transrectal ultrasound, or do nothing."
"If you look to what evidence we have, the right answer was to do nothing," she said. "However, over 85% of physicians said they would do both a rectal exam and PSA test."
, 百拇医药
She suggested that perhaps physicians consider that testing could not hurt anything. She pointed out that "there is the potential for downstream harm." Patients with false-positive test results could undergo surgery or radiation, and they may have "significant side effects for a disease that would never have done them any harm to begin with."
The upshot of the survey, according to the investigators, is that physicians need a centralized, easily accessible source of information regarding different management options for specific conditions. As Dr. Eddy said, "That way, physicians and patients could base their decisions on information that is as accurate as possible."
-Westport Newsroom 203 319 2700, http://www.100md.com