Is there an evidence base for children in primary care?
A recent article in PlosONE of Cochrane reviews relevant to children in primary care states there is a mismatch between the focus of published research and the clinical activity for children in general practice. Not only in the UK but in a number of countries: Australia, Netherlands, US and the UK.
What’s odd is that in a condition such as asthma despite representing 3-5% of consultations, it is the focus of nearly one-quarter of all reviews. On the other hand, despite the increasing burden of skin conditions which lead to one-quarter of all visits only 7% of reviews were relevant.
Non-drug interventions (such as counseling) are an important part of general practice yet they are virtually non-existent in evidence syntheses and research funding. Over half of the reviews studied drug interventions in children while 69% of all controlled trials in children assess drug products.
Whilst the number of systematic reviews published is skyrocketing (over 2,500 in 2007 alone) there continues to be avoidable waste in the production and reporting of research evidence (read more on cebmblog’s recent post). Yet, there has not been a similar increase in children reviews in primary care. Since 2000, the percentage of reviews on children nearly tripled compared to a much smaller increase in primary care reviews.
Why the mismatch? Likely due to multiple factors: absence of primary trials, lack of author interests, public funding poorly correlates with disease burden, more interventions in certain conditions (such as asthma) than others, lack of additional academic training in child health and lack of an overall map of the evidence.
Despite the reasons the mismatch is clear and needs to be addressed. Further work needs to be done to look at how the reviews inform clinical practice. Improving the evidence base for children in primary care is a no-brainer. So how and who should sort this out? Initial steps should include encouraging Cochrane Review Groups, funders, and other relevant organizations to prioritize topics.
The recently created PROSPERO international register of systematic reviews is a step forward to help minimize waste.
Is there an evidence base for children in primary care? Not yet.