Top 20 Research Studies of 2014 for Primary Care Physicians

 


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Am Fam Physician. 2015 Sep 1;92(5):377-383.

  POEMs are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell, Inc. For more information, see http://www.essentialevidenceplus.com.

  The full text of the POEMs discussed in this article is available at http://www.aafp.org/afp/poems2014.

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Dr. Grad has no relevant financial affiliations. See Editor's Note.

A team of primary care clinicians with expertise in evidence-based medicine performed monthly surveillance of more than 110 English-language clinical research journals during 2014, and identified 255 studies that had the potential to change how family physicians practice. Each study was critically appraised and summarized, focusing on its relevance to primary care practice, validity, and likelihood that it could change practice. A validated tool was used to obtain feedback from members of the Canadian Medical Association about the clinical relevance of each POEM (patient-oriented evidence that matters) and the benefits they expect for their practice. This article, the fourth installment in this annual series, summarizes the 20 POEMs based on original research studies judged to have the greatest impact on practice for family physicians. Key studies for this year include advice on symptomatic management and prognosis for acute respiratory infections; a novel and effective strengthening treatment for plantar fasciitis; a study showing that varenicline plus nicotine replacement is more effective than varenicline alone; a network meta-analysis concluding that angiotensin-converting enzyme inhibitors are preferred over angiotensin II receptor blockers; the clear benefits of initial therapy with metformin over other agents in patients with diabetes mellitus; and important guidance on the use of anticoagulants.

For more than 20 years, a group of clinicians with expertise in primary care and evidence-based practice have performed monthly surveillance of more than 110 English-language research journals.1 Of more than 20,000 research studies published in these journals during 2014, 255 met our criteria for validity, relevance, and practice change. We considered a study to be valid if it avoided important biases such as failure to conceal allocation or failure to mask outcome assessment. Relevance is defined as a study that reports patient-oriented outcomes, such as morbidity, mortality, or quality of life. We also prioritize studies that would change practice over those that merely confirm existing practice (that is, they “matter”). Studies that meet these criteria are called POEMs, or patient-oriented evidence that matters.2

Since 2005, the Canadian Medical Association (CMA) has sponsored a subscription to POEMs for all of its members. Each member has the option to receive the daily POEM by e-mail. When members read the POEM, they can also rate it with a validated tool called the Information Assessment Method (IAM). The IAM tool addresses relevance to clinicians, cognitive impact, use in practice, and expected health benefits if the results of the POEM are applied.3 For this article, we identified the 20 POEMs that were rated highest for clinical relevance by CMA members for 2014. Each POEM was rated by at least 500 physicians. At least 70% of respondents rated each of these POEMs as “totally relevant for at least one of your patients,” whereas less than 15% rated each as “not relevant for at least one of your patients.”

In this fourth installment of this annual series,46 we summarize the clinical question and bottom-line answer for each POEM, organized by topic and followed by a brief discussion. The full POEMs are available online at http://www.aafp.org/afp/poems2014.

Respiratory Disease

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Table 1.

Respiratory Disease

Clinical questionBottom-line answer

1. In treating acute respiratory tract infections, is advice to use an analgesic “only as needed,” regular dosing of an analgesic, steam inhalation, or any combination effective in relieving symptoms?7

Advice regarding the use of steam inhalation, ibuprofen alone, acetaminophen alone, alternating ibuprofen with acetaminophen, and regular vs. as-needed use of analgesics did not show any improved effectiveness in treating symptoms of acute respiratory tract infections. Ibuprofen may be beneficial in patients with chest symptoms and in children. However, ibuprofen advice was associated with a slight increase in the number of patients seeking a second visit for the same illness.

2. Are delayed prescriptions for respiratory tract infections effective for decreasing antibiotic use?8

A delayed prescription approach in children and adults with acute respiratory tract infections, combined with explicit instructions for symptom control, is effective in decreasing antibiotic use, while not adversely affecting patient satisfaction or symptom duration or severity. Asking patients to call, pick up, or simply hold a prescription for a prescribed time resulted in less than 40% of patients receiving antibiotics.

3. For common respiratory tract infections in children, what is the best guidance we can give parents

The Authors

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MARK H. EBELL, MD, MS, is a professor of epidemiology in the College of Public Health at the University of Georgia in Athens....

ROLAND GRAD, MD, MSc, is an associate professor in the Department of Family Medicine at McGill University, Montreal, Quebec, Canada.

Address correspondence to Mark H. Ebell, MD, MS, University of Georgia, 233 Miller Hall, UGA Health Sciences Campus, Athens, GA 30602 (e-mail: ebell@uga.edu). Reprints are not available from the authors.

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Dr. Grad has no relevant financial affiliations. See Editor's Note.

REFERENCES

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