If you have kept up with your journal reading lately, you might have noticed that AFP is enhancing its delivery of evidence-based clinical recommendations in a number of ways. This issue contains a special feature entitled, “How to Write an Evidence-Based Clinical Review Article” (page 251), by Jay Siwek, M.D., Margaret L. Gourlay, M.D., David C. Slawson, M.D., and Allen F. Shaughnessy, Pharm.D.
The article by Dr. Siwek and colleagues presents guidelines for authors writing evidence-based clinical reviews for AFP and was recently posted online (see www.aafp.org/afp/authors). In an accompanying editorial (page 175), Dr. Siwek explainsAFP's enhanced evidence-based approach, including the newly implemented system for labeling the strength of evidence supporting practice recommendations in clinical review articles.
AFP is further enhancing its emphasis on evidence-based medicine by introducing new evidence-focused departments. The recently launched BMJ Clinical Evidence series is the fourth in a series of esteemed systematic reviews of the evidence. “Cochrane for Clinicians: Putting Evidence into Practice” debuted last spring, and a series of reports and quizzes based on executive summaries from the U.S. Preventive Services Task Force (USPSTF) appeared in December. In this issue, you will find the second in a series of reports from the USPSTF: “Screening for Lipid Disorders in Adults: Recommendations and Rationale” (see page 273, with related CME questions on page 167).
So what's the buzz all about, anyway? If you turn to page 176, you will find another editorial, written by Leif I. Solberg, M.D., entitled “Guideline Implementation: Why Don't We Do It?” As Dr. Solberg notes in his editorial, there's a chasm between what we know about medical evidence and what we do in terms of implementing practice based on evidence. While everyone agrees that improvement of the quality of health care is a laudable goal, two significant barriers to achieving that goal exist. First, physicians don't always know what constitutes best practices. In addition, physicians don't always know how to implement best practices. These fundamental problems have, indeed, caused quite a buzz.
Drs. Siwek and Solberg address these global issues in complementary editorials. Dr. Siwek has acted on the challenge by making AFP a leader among medical journals in requiring authors to identify the strength of evidence behind clinical recommendations, incorporating the best evidence in its content, and reinforcing those concepts through structured CME activities. Dr. Solberg has taken the next step by asking family physicians to take responsibility in implementing evidence-based guideline care in their practices. The “quality chasm,” Dr. Solberg says, can be bridged by family physicians, but it will require willingness to remodel office systems.
Authors have clearly been given the mission to label the strength of evidence whenever possible in all future clinical review articles submitted to AFP. Authors should use the new guidelines as they focus on helping readers understand the importance of evidence-based clinical practice. AFP has also updated and reprinted its “Information for Authors” on page 337 of this issue (also available on the AFP Web site,www.aafp.org/afp/authors), along with links to new evidence-based medicine resources. While it will take some time for evidence-labeled articles to enter and pass through the publication process, the first article applying AFP's evidence-labeling system has already been published (Am Fam Physician 2001;64:75–8).