For the past 24 years, a team of six clinicians has systematically reviewed more than 100 medical journals to find the research most likely to change and improve primary care practice. The team includes experts in family medicine, pharmacology, hospital medicine, and women's health.^1,2

The goal of this process is to identify POEMs (patient-oriented evidence that matters). A POEM must report at least one patient-oriented outcome, such as improvement in symptoms, morbidity, or mortality. It should also be free of important methodologic bias, making the results valid and trustworthy. Finally, if applied in practice, the results would change what some physicians do by adopting a new practice or discontinuing an old one shown to be ineffective or harmful. Of more than 20,000 research studies published in 2022 in the journals reviewed by the POEMs team, 253 met criteria for validity, relevance, and practice change. These POEMs are emailed daily to subscribers of Essential Evidence Plus (Wiley-Blackwell, Inc.).

The Canadian Medical Association purchases a POEMs subscription, and thousands of its members receive the daily POEM. These physicians can rate each one using a validated questionnaire.³ This process is called the Information Assessment Method (https://www.mcgill.ca/iam). POEM ratings address the domains of clinical relevance, cognitive impact, use in practice, and expected health benefits. In 2022, each of the 253 daily POEMs were rated by an average of 1,087 physicians. New for 2022, readers of the daily POEM saw an “overuse alert” for POEMs that align with a Choosing Wisely recommendation.⁴

In this article, the 12th installment of our annual series (https://www.aafp.org/pubs/afp/content/top-poems.html), we summarize the 20 most clinically relevant POEMs of 2022 as determined by Canadian Medical Association members. Although some of the most highly rated POEMs addressed COVID-19, rapid changes in management as the pandemic has evolved make many of them less relevant in 2023. Therefore, we briefly summarize these COVID-19 POEMs, as well as highly rated practice guidelines, separately. The full POEMs discussed in this review are available at https://www.aafp.org/pubs/afp/content/top-poems/2022.html.

Preventive Health Care

The first two POEMs relate to preventive medicine (Table 1).^5,6 Many patients take statins to reduce cardiovascular events. But how large is the benefit? A meta-analysis identified 19 studies that randomized 132,763 patients to statin therapy or placebo.⁵ Studies were typically three to six years in duration, and statins reduced the risk of overall death by 0.8%, myocardial infarction by 1.3%, and stroke by 0.4%. When statins were used as primary prevention, the reductions were smaller: 0.6% fewer deaths, 0.7% fewer myocardial infarctions, and 0.3% fewer strokes, for an overall number needed to treat of 63 to prevent one event over three to six years. The 95% CI around all-cause mortality alone was 88 to 250 over several years of treatment as primary prevention. Not bad, but this is probably a higher number needed to treat than most of our patients believe.

Screening for low vitamin D levels and recommending replacement in those who are deficient have become popular, although the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend screening in asymptomatic individuals.⁷ A trial randomized 25,871 men 50 years or older and women 55 years or older to receive 2,000 IU of vitamin D or placebo daily for a median of five years.⁶ There was no difference between groups in any type of fracture, even in patients with low baseline vitamin D levels (hazard ratio = 1.04; 95% CI, 0.80 to 1.36) or a previous fracture.

Behavioral Health

The first POEM in this group provides insight into what happens when a patient discontinues an antidepressant⁸ (Table 2^8–13). The study included primary care patients with at least two episodes of depression who had been taking an antidepressant for at least two years.⁸ Patients were randomized to continue the medication or taper it over two months to placebo. After one year, the likelihood of relapse was significantly higher in the discontinuation group (56% vs. 39%; hazard ratio = 2.1; 95% CI, 1.6 to 2.7). Symptoms in the discontinuation group were also more severe.