Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Rheumatologists Practise Evidence Based Medicine, an Observational Study.
Hall1, Stephen, Moreton4, Adam, Gibson2, Kathryn A., Kane2, Barry A., Thakkar2, Vivek, Hanrahan1, J., Romas1, Evange
Department of Medicine, Cabrini Health, Melbourne, Australia
Rheumatology Department, Liverpool Hospital, Sydney Australia
School of Clinical Sciences, University of Liverpool, Liverpool United Kingdom, Liverpool, United Kingdom
School of Clinical Sciences, University of Liverpool, Liverpool United Kingdom
Evidence-based medicine (EBM) is used to inform treatment guidelines and in decision-making about funding for medicines and procedures. The extent to which evidence exists and EBM is employed in clinical rheumatology practice is unclear.
To assess the extent to which rheumatologists in office practice follow EBM in their treatment recommendations.
The medical records of 190 patients attending rheumatology clinics with participating physicians (Liverpool Hospital, Sydney, Australia, private practices in Melbourne, Australia and University Hospital Aintree, Liverpool, UK) on or after 2nd July 2007 were reviewed and interventions were identified for each diagnosis made. A standardized search protocol was utilized to identify randomized controlled trials (RCT) in Medline (1950 present) and EMBASE (1980present) supporting these interventions. In addition the Cochrane Database of Systematic Reviews was searched. Where there was no RCT evidence to support a treatment recommendation a subsequent adjudication process was undertaken to assess if the recommendation was supported by expert opinion.
A total of 332 interventions were recommended. This generated 251 literature searches. Approximately 50% of interventions in clinical rheumatology were supported by EBM. The adjudication process supported 64% of non EBM based recommendations. Only 20% of interventions were neither supported by EBM or at adjudication. This occurred more often for soft tissue and non-inflammatory conditions compared to inflammatory conditions and osteoporosis. Adherence to EBM was similar in the private and public sector in Australia and across the public sectors of Australia and the United Kingdom.
Approximately 50% of rheumatology practice is supported by RCT data. Where RCT data does not exist, expert opinion supports 64 % of the recommended interventions, thus only 20% of all interventions in rheumatology office practice lack evidence. The extent to which evidence exists varies across the rheumatic diseases. There is no difference in the rate of EBM across the public and private sectors of rheumatology.
To cite this abstract, please use the following information:
Hall, Stephen, Moreton, Adam, Gibson, Kathryn A., Kane, Barry A., Thakkar, Vivek, Hanrahan, J., et al; Rheumatologists Practise Evidence Based Medicine, an Observational Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1560