Article type
Year
Abstract
Background: One of the important impacts systematic reviews and evidence-based medicine can make is to facilitate the elimination of proven ineffective interventions from practice, which is one of the worst uses of health interventions. However, little is known about the changes that evidence-based medicine has made in reducing such inappropriate use of medicine.
Objectives: We surveyed clinicians in China to establish how often ineffective interventions were still used in practice.
Methods: A total of 3246 clinicians from 24 tertiary hospitals were surveyed in person and another 3063 through an online survey. The main outcomes are prescription by a clinician, and use in a patient of, an ineffective intervention and of a matched effective intervention in patients with the same disease. We identified 129 ineffective interventions for 68 diseases from the BMJ Clinical Evidence and included these in the survey. One effective intervention was identified for each disease and a total of 68 effective interventions were thus also included. The frequency of use of effective interventions was used as a reference for that of ineffective interventions.
Results: The mean prescription rate by clinicians was 59.0% (95% confidence interval (CI) 58.6% to 59.4%) and 81.0% (95% CI 80.6% to 81.4%), respectively for ineffective and effective interventions. The mean frequency of use in patients is 31.2% (95% CI 30.8% to 31.6%) and 56.4% (95% CI 56.0% to 56.8%) for ineffective and effective interventions, respectively. The relative reduction in use of ineffective interventions compared with that of matched effective interventions was 27.2% (95% CI 27.0% to 27.4%) and 44.7% (95% CI 44.3% to 45.1%) for clinician's prescription and use in patients, respectively; 8.6% of ineffective interventions were still routinely used in practice.
Conclusions: Ineffective interventions were still commonly used. Efforts are necessary to reduce and eventually eliminate ineffective interventions from practice.
Objectives: We surveyed clinicians in China to establish how often ineffective interventions were still used in practice.
Methods: A total of 3246 clinicians from 24 tertiary hospitals were surveyed in person and another 3063 through an online survey. The main outcomes are prescription by a clinician, and use in a patient of, an ineffective intervention and of a matched effective intervention in patients with the same disease. We identified 129 ineffective interventions for 68 diseases from the BMJ Clinical Evidence and included these in the survey. One effective intervention was identified for each disease and a total of 68 effective interventions were thus also included. The frequency of use of effective interventions was used as a reference for that of ineffective interventions.
Results: The mean prescription rate by clinicians was 59.0% (95% confidence interval (CI) 58.6% to 59.4%) and 81.0% (95% CI 80.6% to 81.4%), respectively for ineffective and effective interventions. The mean frequency of use in patients is 31.2% (95% CI 30.8% to 31.6%) and 56.4% (95% CI 56.0% to 56.8%) for ineffective and effective interventions, respectively. The relative reduction in use of ineffective interventions compared with that of matched effective interventions was 27.2% (95% CI 27.0% to 27.4%) and 44.7% (95% CI 44.3% to 45.1%) for clinician's prescription and use in patients, respectively; 8.6% of ineffective interventions were still routinely used in practice.
Conclusions: Ineffective interventions were still commonly used. Efforts are necessary to reduce and eventually eliminate ineffective interventions from practice.