Editorials

AFP: Doing More to Help You Get the Best Evidence



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Am Fam Physician. 2004 Feb 1;69(3):483-486.

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What business are you in? If you are like most family physicians, you will probably say that you are in the healing business, the curing disease business, or maybe the keeping people well business. Another way to look at our profession is that we are in the information management business. We gather information when we interview a patient and order tests; we integrate those data with our personal knowledge base, what we know about the patient's family and community, information from consultants, and answers to clinical questions; and we communicate a treatment plan back to the patient, the chart, and our colleagues. This flow of information is critical to the delivery of quality patient care, yet most of us lack an organized framework for managing the torrent of medical information that we encounter every day in practice. The result is increasing frustration, a concern that we are not able to keep up to date, and the possibility that we may not be giving our patients the most current evidence-based care.

American Family Physician (AFP) contributing editor Allen Shaughnessy, Pharm.D., and colleague David Slawson, M.D., have identified several ways that we navigate the information jungle: foraging, hunting, and retracing.1 Foraging is the process of keeping up to date with new information, making sure that we are aware of relevant original research that could improve patient-oriented outcomes. Hunting is the process of asking and answering questions at the point of care. Research has shown that the typical primary care physician has 10 or 15 clinical questions per day of outpatient care but attempts to answer only a fraction of these questions, and then not always with the best available evidence. Retracing is the process of systematically reviewing our knowledge of common or important diseases and symptoms over time.

In this issue of AFP, we are introducing some new features that help round out our ability to meet all of your information needs: foraging, hunting, and retracing. “Tips from Other Journals” have always been a great way to keep up to date with new research, and we recently added “POEMs” (Patient-Oriented Evidence that Matters) to supplement that feature.2 POEMs are selected from a monthly survey of more than 100 clinical research journals and represent research that addresses a common or important primary care question, measures patient-oriented outcomes, and has the potential to change your practice. Each POEM takes the form of a structured summary that helps you determine if the research is of interest, if it is relevant to your practice, if it is valid and well designed, and what the bottom line is for patient care. Dr. Shaughnessy also is coordinating and editing the new “STEPS” (Safety, Tolerability, Efficacy, Price, Simplicity) feature that gives you a quick, evidence-based, independent overview of a new drug each month.3

To help you answer questions that arise during the care of patients, we have added excerpts from the Family Practice Inquiries Network's (FPIN) “Clinical Inquiries” feature. Each month, FPIN (www.fpin.org) identifies questions that arise in family practice and provides answers using the best available evidence.4 The “Cochrane for Clinicians” feature is expanding to include one long and two concise summaries of new reviews from this world-class source of evidence-based information. Each piece answers an important clinical question about treatment. “Point-of-Care Guides” is a new feature that provides practical tools to help you apply evidence in practice. Where appropriate, the Guides include an encounter form to help you build this approach into your care of patients. We will make these available in a format that you can download, so you can modify or adapt them as needed.

Finally, we will continue to give you highly readable and authoritative review articles to help you with the task of retracing: reviewing your knowledge about a common or important condition. Our editors will continue working with authors to ensure that their recommendations are based on the best and most recent evidence. To make it easier for you to find key recommendations, each article will eventually include a summary table, the references on which they are based, and the strength of evidence that underlies that recommendation. The evidence will be rated A, B, or C using the new Strength of Recommendation Taxonomy (SORT) developed by editors of family medicine journals.5

We will strive to maintain the same clearly written and well-illustrated format that you have come to expect from AFP. By adding these new features and building on our existing strengths, we will make sure that AFP remains the best place to meet all of your information needs.

The Authors

Mark H. Ebell, M.D., M.S., is associate professor at Michigan State University College of Human Medicine, East Lansing, Mich., and deputy editor of evidence-based medicine for American Family Physician.

Jay Siwek, M.D., is professor and chair of the Department of Family Medicine at Georgetown University Medical Center, Washington, D.C. He also is the editor of American Family Physician.

Address correspondence to Mark H. Ebell, M.D., M.S., 330 Snapfinger Dr., Athens, GA 30605 (e-mail: ebell@msu.edu). Reprints are not available from the authors.

REFERENCES

1. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39:489–99.

2. Shaughnessy AF, Siwek J. Introducing POEMs. [Editorial]. Am Fam Physician. 2003;67:1196,1199.

3. Shaughnessy AF. STEPS drug updates. [Editorial]. Am Fam Physician. 2003;68:2342,2346,2348.

4. Epling J, Ewigman B, Ebell MH. Clinical inquiries from the Family Practice Inquiries Network. [Editorial]. Am Fam Physician. 2003;68:2340,2342.

5. Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman J, Ewigman B, Bowman MA. Strength Of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69:548–56.


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