Mediocre Evidence Behind Many Primary Care Decisions

Only 18% of clinical recommendations were based on high-quality, patient-oriented evidence, a primary care research study shows.

Research-based evidence to help primary care physicians make decisions seems to be hard to come by, according to research from the University of Georgia.

Researchers, led by Mark Ebell, epidemiology professor at UGA’s College of Public Health, analyzed 721 topics from an online medical reference for generalists and found that only 18% of the clinical recommendations were based on high-quality, patient-oriented evidence. Their work appears in the journal BMJ Evidence-Based Medicine.

“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,” Ebell said in a statement.

The researchers used Essential Evidence, an online, evidence-based, medical reference for generalists to identify areas of care that are supported by high-quality studies and others that are not. Each of Essential Evidence’s topics are graded A, B, or C using the Strength of Recommendations Taxonomy (SORT), the study said.

They found that topics related to pregnancy and childbirth, cardiovascular health, and psychiatry had the highest percentage of recommendations backed by research-based evidence. Hematological, musculoskeletal and rheumatological, and poisoning and toxicity topics had the lowest percentage.

In addition, just 51% of the recommendations overall were based on studies reporting patient-oriented outcomes, such as morbidity, mortality, quality of life, or symptom reduction, instead of laboratory markers like blood sugar or cholesterol levels.

“Practice should wherever possible be guided by studies reporting patient-oriented health outcomes,” Ebell said. “You would want your care to be guided by studies that have demonstrated that what the physician recommends will help you live better or longer. We should all want that kind of information to guide care.”

The study authors also note that the lack of funding for primary care research stands in stark contrast to patients’ primary care usage: Primary care visits account for 53.2% of all physician office visits, according to the CDC.