Health outcomes in primary care: a 20-year evidence map of randomized controlled trials

Abstract

Objective To quantify the different types of health outcomes assessed as primary outcomes in randomized controlled trials (RCTs) in the primary care (PC) setting during the last 20 years and identify whether potential gaps exist in specific types of health care and types of intervention. Methods We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, from January 2000 to September 2020 for published RCTs in PC. We recorded characteristics of eligible studies and mapped evidence by health outcome category (patient health outcomes, health services outcomes); and for each outcome category, by types of health care (preventive, acute, chronic, palliative), and by types of intervention (drug, behavioural, on structure, and on process). For RCTs assessing patient health outcomes as primary outcomes, we further mapped using the quality-of-care dimensions, that is, effectiveness, safety, and patient-centredness. Results Of the 518 eligible RCTs in PC, 357 (68.9%) evaluated a patient health outcome as the primary outcome, and 161 (31.1%) evaluated only health services outcomes as primary outcomes. Many focused on population with chronic illness (224 trials; 43.2%) and evaluated interventions on processes of health care (239 trials; 46.1%). Research gaps identified include preventive and palliative care, behavioural interventions, and safety and patient-centredness outcomes as primary outcomes. Conclusion Our evidence map showed research gaps in certain types of health care and interventions. It also showed research gaps in assessing safety and measures to place patient at the centre of health care delivery as primary outcomes.

Clinical trials in primary care: bridging the gap between evidence-based recommendations and clinical practice

“…The number of published RCTs in primary care has been increasing over the last two decades; several of them have evaluated interventions on structures, and on processes of care as well as behavioral interventions that may facilitate the adoption of high-quality care. 7 Modifying structures, processes or behavior requires complex interventions that may act at multiple levels, incorporating features aiming both directly at patients and indirectly, through professionals and services, and vice versa. For example, primary care interventions might aim at improved training for clinicians to provide more patient-centered consultations; other interventions aimed at patients may require some change in the behavior or decisions of clinicians, and these changes in professional conduct, in turn, will also require some form of intervention, for example, new guidance, protocols or training.…”