General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey

McColl, Alastair; Smith, Helen; White, Peter; Field, Jenny

doi:10.1136/bmj.316.7128.361

Cited by 646 publications

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“…In the past decade few studies have analysed the impact of clinical practice guidelines and EBM among GPs [8,10,12]. Some reviews have suggested headache evidence-based diagnostic and therapy evaluation [5,7] and optimal strategy for managing acute headache [4,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have assessed general practitioners' (GPs) perceptions of EBM and its influence on health care decisions [8][9][10], but to the best of our knowledge no information is available about its evaluation on migraine and information on this topic is needed because patients with migraine headaches often present family physicians with diagnostic and therapeutic challenges. Therefore, the purpose of the present study is to identify if GPs in Italy are aware of technical terms used in EBM and what their behaviour is in terms of treating patients with migraine.…”

Section: Introductionmentioning

confidence: 99%

“…However, it should be noted that in several areas of the medical sciences the lack of good evidence for clinical decision-making remains an issue and the availability of good evidence does not necessarily get applied to patient care [3]. Moreover, as clinicians deal with patients, there is a continuing increase in the need for clinical information, but for many reasons clinicians often do not obtain that vital evidence.Previous studies have assessed general practitioners' (GPs) perceptions of EBM and its influence on health care decisions [8][9][10], but to the best of our knowledge no information is available about its evaluation on migraine and information on this topic is needed because patients with migraine headaches often present family physicians with diagnostic and therapeutic challenges. Therefore, the purpose of the present study is to identify if GPs in Italy are aware of technical terms used in EBM and what their behaviour is in terms of treating patients with migraine.…”

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Study on management of headache by general practitioners in South Italy

et al. 2005

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IntroductionEvidence-based medicine (EBM) promotes the use of current best evidence in making decisions about the health care of individual patients. Its practice means integrating individual clinical expertise with clinical evidence from systematic research and its main principle is that clinical decisions should be based on the best available scientific evidence of previous experience and the conclusions based on such evidence should stimulate quality improvements in patient care [1,2]. However, it should be noted that in several areas of the medical sciences the lack of good evidence for clinical decision-making remains an issue and the availability of good evidence does not necessarily get applied to patient care [3]. Moreover, as clinicians deal with patients, there is a continuing increase in the need for clinical information, but for many reasons clinicians often do not obtain that vital evidence.Previous studies have assessed general practitioners' (GPs) perceptions of EBM and its influence on health care decisions [8][9][10], but to the best of our knowledge no information is available about its evaluation on migraine and information on this topic is needed because patients with migraine headaches often present family physicians with diagnostic and therapeutic challenges. Therefore, the purpose of the present study is to identify if GPs in Italy are aware of technical terms used in EBM and what their behaviour is in terms of treating patients with migraine. Abstract The impact of migraine headaches is one of the major public health problems in several industrialised countries, with many patients reporting frequent and significant disability. Previous studies have assessed general practitioners' (GPs) perceptions towards evidence-based medicine (EBM) and its influence on health care decisions. Of 500 questionnaires distributed, responses were received from 455 for a response rate of 91%. Respondents' awareness of technical terms used in EBM indicated that only 27.2% of GPs agreed that clinical trials are needed to evaluate the efficacy of treatments and this awareness was higher in those who learned about migraine from scientific journals or continuing education courses and who attended courses on epidemiology or EBM. Training and continuing educational programmes on EBM and guidelines in terms of treatments of headache for GPs are strongly needed.J Headache Pain (2005) 6:312-314 DOI 10.1007/s10194-005-0218-6 Study on management of headache by general practitioners in South Italy H E A D A C H E A N D C O N T I N U I T Y I N H E A L T H C A R E R. Iannacchero (౧)

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confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Study on management of headache by general practitioners in South Italy

et al. 2005

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“…Sin embargo, la práctica de un cuidado de salud basado en la evidencia, con sus "clásicas etapas" (formulación de la pregunta, búsqueda de la información, análisis crítico, aplicación), parece no ser la alternativa preferida por muchos profesionales de la salud debido, en gran parte, a limitaciones en el tiempo para practicarla [7][8][9] . Por esta razón es que muchos profesionales de la salud, en especial en la atención primaria, prefieren utilizar resúmenes basados en evidencia generados por otros y Guías de Práctica Clínica (GPC) para la aplicación de los principios de la MBE 7,10,11 .…”

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Guías de práctica clínica: una introducción a su elaboración e implementación

Pantoja

Soto

2014

Rev. méd. Chile

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“…Despite the promotion of NNT as easier for clinicians to understand, when presented with a range of measures of treatment effects, most found NNTs no easier to understand or explain to others than relative risk. 2 …”

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The ‘number need to treat’: does it help clinical decision making?

Ebrahim

Smith

1999

J Hum Hypertens

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The number needed to treat (NNT) is an increasingly popular way of presenting the effects of treatment. However, the NNT varies markedly depending on the baseline risk of patients, the outcome considered, and the clinical setting. Furthermore geographic and secular trends make the NNT unstable between places and over time. Particular caution is needed in deriving the NNT Keywords: meta-analysis; hypertension; randomised controlled trials Eight hundred and thirty-three. This is the number of mildly hypertensive people who must be treated with antihypertensives for a year to avoid one stroke 1 and is widely quoted as an argument for not bothering to detect and treat hypertensive people. Why has the number needed to treat (NNT) become so popular recently? Is it because it can be used to highlight the workload and cost implications of treatments? Is it because the trade off between benefits and risks of treatment is made more obvious? Or is it just the novelty value of a new(ish) method of expressing the effects of treatment? Despite the promotion of NNT as easier for clinicians to understand, when presented with a range of measures of treatment effects, most found NNTs no easier to understand or explain to others than relative risk. 2 Describing the effects of treatmentThe effects of treatment are conventionally expressed in relative terms-the ratio of the event rate in the treatment group divided by the event rate in the control group. Ratios greater than one imply that treatment is harmful, less than one, that treatment is beneficial. This hides the fact that a small relative benefit applied to patients at very high risk will generate more lives saved (and non-fatal events avoided) than the same relative benefit applied to much lower risk patients. However, the relative treatment effect may be dependent on the baseline level of risk in the control group. For example, surgery for carotid endarterectomy is effective for high risk tight stenosis but not for low risk smaller degrees of stenosis. 3 It cannot be assumed that treatCorrespondence: Shah Ebrahim, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK Received 18 May 1999; accepted 22 May 1999 from pooled absolute risk differences in meta-analysis. In general, the NNT should be calculated by applying the relative risk reduction on treatment estimated by trials or meta-analysis to populations of specified absolute high, average or low risk to illustrate a range of possible NNTs. ment effects are constant across a wide range of baseline levels of risk.The absolute effects of treatment take account of baseline level of risk and are simply the difference between intervention and control group rates. From a clinical and public health standpoint it is useful to have some idea of the amount of effort required to avoid one adverse event. This is given by the reciprocal of the absolute risk difference-the number needed to treat. 4 The absolute effect and the NNT will vary-often greatly-according to the baseline leve...

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General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey

Abstract: Objectives: To determine the attitude of general practitioners towards evidence based medicine and their related educational needs. Design: A questionnaire study of general practitioners. Setting: General practice in the former Wessex region, England.

Cited by 646 publications

References 18 publications

Study on management of headache by general practitioners in South Italy

Study on management of headache by general practitioners in South Italy

Guías de práctica clínica: una introducción a su elaboración e implementación

The ‘number need to treat’: does it help clinical decision making?

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