AAFP Board Chair Urges Changes in Comparative Effectiveness Research

Public and private payers should fund comparative effectiveness research that seeks to bridge information gaps that currently exist with some treatment methods, said AAFP Board Chair Jim King, M.D., of Selmer, Tenn., during a May 7 congressional briefing on the topic.

"Most of the research done today deals with controlled trials," said King, one of five speakers who addressed the briefing convened by the Alliance for Better Health Care. These trials are very complicated, and they don't always find results that are useful in practice, said King.

For example, he said, as a practicing family physician, he needs to know why therapy A works better than therapy B. "Most of the time, the research just shows that both of them work," he said. "If one works 80 percent of the time and the other works 60 percent of the time, I need to know that."

However, King added, if the therapy that works 60 percent of the time costs four times less than the one that works 80 percent of the time, he might consider using the one that works 60 percent of the time first.

In addition, certain treatments may not be as effective for women and children. That data needs to be "teased out" by comparative effectiveness research, he said. It's also important to know why some patients don't adhere to their treatment regimens.

"You would think we would know about common things like diabetes and depression, but we don't," King said. Physicians need to know which drugs don't work, what regimens patients need to follow and how they need to follow them, he said. That type of information -- which is not captured in the research done today -- is very important as FPs work with their patients to determine various treatment options for individual patients, said King.

"That is why comparative effectiveness research is so important to (FPs)," he said. "We take care of common problems" and need the best information available to do so.

King pointed out that the AAFP has taken a leading role in the Distributed Network for Ambulatory Research in Therapeutics, a public/private consortium that uses electronic health records, practice-based networks and practical clinical trails to advance comparative effectiveness research.

"It is a group of practices -- primary care physicians from across the country who are tied together electronically," King explained. "What they are doing is sharing information on best practices -- what works -- and with that quality improves."

King also noted that the investment in comparative effectiveness research has to be ongoing. Researchers can't just do one study and determine that something is always going to work the way the study indicates it will. "Things change and people change," he said.

He stressed that physicians want to provide the highest quality care to their patients, making it essential to involve physicians in the effectiveness research process. One of the overriding goals is for patients and physicians to work together in making treatment decisions based on "good transparent information," he said.

"What we are looking for as we move forward is getting the data, not only what was paid for, but the results -- how things are working," said King.