New Feature to Help Physicians Implement AHRQ Effective Health Care Reviews
Am Fam Physician. 2012 May 1;85(9):863.
How do you decide which treatments to recommend to your patients? Every day, family physicians must evaluate the benefits and harms of dozens of tests and treatments for which reliable practice guidelines are often lacking.1 In 2003, the Agency for Healthcare Research and Quality (AHRQ) established its Effective Health Care Program to provide patients, physicians, and policy makers with more information to compare the effectiveness of health care interventions.2 This program supports a national network of Evidence-Based Practice Centers that produce systematic reviews of the evidence for commonly used interventions ranging from drugs for type 2 diabetes mellitus3 to treatments for localized prostate cancer.4
To date, the track record of translating comparative effectiveness research findings into clinical practice has been mixed, at best. For example, several years after a landmark randomized controlled trial demonstrated the superiority of thiazide diuretics compared with other first-line medications for hypertension, prescribing of thiazide diuretics had increased only modestly.5 An evaluation of diabetes practice guidelines produced after the publication of an Effective Health Care review of oral treatments found numerous inconsistencies between guideline recommendations and evidence-based conclusions.6 Despite extensive evidence that initial coronary stenting provides no advantages over optimal medical therapy for stable coronary artery disease,7 more than one-half of patients who undergo stenting in the United States have not had a prior trial of medical therapy.8
To more effectively disseminate the results of comparative effectiveness research into practice, AHRQ's Effective Health Care Program produces concise summaries of its reviews for patients, policy makers, and physicians, which are available at http://www.effectivehealthcare.ahrq.gov. American Family Physician has partnered with AHRQ to introduce a new journal feature, “Implementing AHRQ Effective Health Care Reviews,” which includes key evidence-based conclusions from AHRQ's clinician guides, with practice pointers from an experienced physician whom we solicit to put the evidence into clinical perspective. In this issue, Corey D. Fogleman, MD, interprets the evidence from a recent Effective Health Care review of behavioral, medical, and educational interventions for children with autism spectrum disorders.9 We hope that this new feature will provide you with additional tools to make the best treatment decisions for your patients.
editor's note: Kenneth W. Lin, MD, is the associate deputy editor for AFP Online.
1. Lin KW, Slawson DC. Identifying and using good practice guidelines. Am Fam Physician. 2009;80(1):67–70.
2. Slutsky JR, Clancy CM. AHRQ's Effective Health Care Program: why comparative effectiveness matters. Am J Med Qual. 2009;24(1):67–70.
3. Bennett WL, Maruthur NM, Singh S, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations [published correction appears in Ann Intern Med. 2011;155(1):67–68]. Ann Intern Med. 2011;154(9):602–613.
4. Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer [published correction appears in Ann Intern Med. 2008;148(11):888]. Ann Intern Med. 2008;148(6):435–448.
5. Stafford RS, Bartholomew LK, Cushman WC, et al. Impact of the ALL-HAT/JNC7 Dissemination Project on thiazide-type diuretic use. Arch Intern Med. 2010;170(10):851–858.
6. Bennett WL, Odelola OA, Wilson LM, et al. Evaluation of guideline recommendations on oral medications for type 2 diabetes mellitus: a systematic review. Ann Intern Med. 2012;156(1 pt 1):27–36.
7. Stergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(4):312–319.
8. Borden WB, Redberg RF, Mushlin AI, Dai D, Kaltenback LA, Spertus JA. Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention [published correction appears in JAMA. 2011;305(23):2418]. JAMA. 2011;305(18):1882–1889.
9. Fogleman CD. Therapies for children with autism spectrum disorders. Am Fam Physician. 2012;85(9):878–880.
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