Comparative Effectiveness Research (CER)
“Measuring Physicians' Opinions of CER to Strengthen Its Role in Patient-Centered Care”
Study Description and Methods
Comparative Effectiveness Research (CER) can be an important tool for patients as well as those who care for them. Yet, in prior surveys, clinicians reported uneven use of CER findings to inform their patients of possible options. A research initiative is needed to explore the reasons for the gap between valuing and using CER.
To address this gap, the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), and the American Osteopathic Association (AOA) are collaborating to survey primary care physicians about comparative effectiveness research (CER) and its role in providing the best available evidence to help physicians and their patients make better informed health care decisions. Ultimately, our findings should improve the uptake of new knowledge and its translation into better decision-making by patients and their physicians by determining both the readiness and willingness of primary care physicians to integrate CER into clinical practice.
Specific Aims and Objectives
The survey is designed to:
1. Identify gaps in physicians’ familiarity with and factual knowledge about CER findings;
2. Determine physicians’ awareness and attitudes toward CER as well as its perceived value for educating patients;
3. Assess physicians’ confidence in applying CER findings to practice along with potential barriers;
4. Determine current and desired sources for both obtaining and disseminating information about the relative clinical benefits of various drugs, devices, and treatments to patients and providers;
5. Determine attitudes toward as well as current and desired role of physicians in shared decision-making (SDM);
6. Identify effective approaches to distribute CER results to health care providers, with the goal of sustained changes in clinical practice as well as the effective distribution of results to patients to enable changes in behavior;
7. Determine attitudes toward meeting both the individual needs and preferences of the patient in selecting treatment options; and
8. Identify unmet needs and steps that could be taken to improve the value of CER to both physicians and patients.
September 1, 2014-September 30, 2015
The project has been completed.
None at this time
Key Findings and Publications
Familiarity with the term CER Family physicians have only a low level of familiarity with the term CER, with a majority reporting that they are “slightly” or “not at all” familiar with it.
Although they lack familiarity with CER by name, most respondents are confident in their abilities that are needed to use such research, namely finding, assessing, discussing with patients, and applying research findings related to treatment options.
Attitude toward CER The majority agree that it can improve how patients make health care decisions, the relationship between physicians and patients, the quality of patient care, and that CER should be used to develop guidelines. A sizeable minority, about one in five, feel that CER will be used to restrict physician’s freedom to choose treatments for patients. Only a few are skeptical about the validity of most CER.
Barriers to using CER findings Most commonly cited as a major barrier is lack of time to find and read research evidence to inform clinical decision-making. Patients’/families’ inability to pay for recommended care is a sizable barrier to using CER. However, the vast majority of physicians do not consider lack of payment to physicians for applying CER findings as a major barrier.
Trusted sources of research findings Most physicians report a high level of trust in a clinical information reference tool (e.g., UpToDate, Smart Medicine, American Family Physician), research findings from systematic reviews, peer reviewed literature, their medical professional society. CME conferences/webinars and disease-specific associations were moderately reported as trustworthy. One’s employer/institution and websites of government health agencies are less trusted.
Preferred dissemination methods Overall, print is the most preferred way to obtain research findings, followed by live meetings or courses, websites, and email. Virtual and mobile technology had moderate interest, with social media being of little interest.
Medical societies’ roles in disseminating and translating research Most respondents think the AAFP should spend more time disseminating and translating research findings into health care practice for clinicians and, specifically, should use findings to set guidelines, direct physicians to sites where they can obtain research findings, provide direct access to research articles, provide guidance on research articles, provide tools to assist in using results in making decisions with patients, provide educational resources for certification and recertification.
Ways to improve the value of CER Respondents are more likely to value evidence from CER if it is linked to clinical practice guidelines, endorsed by the AAFP, included in the AAFP’s repository of resources, and published in a medical journal. Less than half of respondents reported Certification and CME as ways to increase value of CER and very few found monetary incentives valuable.
Brian Manning, MPH, CHES
Associate Research Director
AAFP National Research Network
This study is funded by grants from the Eugene Washington PCORI Engagement Award that was made to the American College of Physicians. This project is a collaboration of the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA).