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Mastering medical information and the role of POEMS - Patient-Oriented Evidence that Matters.

To help busy clinicians manage the often overwhelming information explosion, The Journal of Family Practice (JFP) is continually updating to meet the needs of its readers. May 1994 marked the inauguration of the JFP Journal Club. Early efforts consisted of reviews of two articles per month aimed at facilitating an evidence-based approach to critical appraisal of the medical literature. Since January 1996, we have, with the invaluable help of over 50 expert reviewers, included reviews and analyses of eight articles for each issue of the Journal. These articles are selected from a structured review of over 90 journals in every clinical specialty. Beginning this month, we will also review the best of the alternative medicine literature and introduce some tools for the management of new information.

It is a daunting task to survey these journals and search out eight research studies that present new information of relevance to family physicians, but it is not enough! Other journals, newsletters, and abstracting services provide timely reviews of the medical literature, but without prioritizing them as to relevance. To better reflect the unique focus of the abstracts in JFP, we are changing the name of JFP Journal Club to POEMs -- Patient- Oriented Evidence that Matters. Our goal is to present medical information in a format that will require the least amount of time and energy to find the best information must is useful for practice. Useful information must have three attributes: it must be relevant to everyday practice, it must be correct, and it must require little work to obtain. These factors can be related in what we have dubbed the "Usefulness Equation":[1,2]

Usefulness of medical = relevance x validity/work

information

Relevance, the initial aspect of this equation, focuses on Patient-Oriented Evidence that Matters (POEMs) -- information from original research or systematic reviews that meets two criteria. First, a POEM is a study that evaluates an outcome that patients care about. Patients want to live long, healthy, functional, pain- and symptom-free lives, and POEMs tell us information that will help us assist our patients with these goals. POEMs are not Preliminary research that focuses on intermediate results, but instead give us direct information about outcomes that patients truly care about. No studies on rats or mice here!

The second criterion of a POEM is that the information matters: if valid, it will require that our readers change their practice. In other words, it is information that you can use. In addition, we focus on information about a disease or problem that is common to family practice. Although no two practices are exactly alike, we search for research findings that will be applicable to a majority of readers. Time limits all of us, and you do not want to work unnecessarily to learn to treat uncommon illnesses that may never occur in your practice.

Occasionally, we will include research findings that meet neither of the above criteria but instead present information that is either too preliminary to warrant a change in practice or is focused on intermediate outcomes (disease-oriented evidence, DOEs). These may be the kinds of studies your patients hear about on the network news and then ask your opinion. It is our intent to can attention to the weaknesses in design or execution of these studies so changes in practice are prevented instead of encouraged by this early research.

Once we have selected the articles that are POEMs or "dangerous DOEs," we will present the information in a manner that is easily understood and provides a thorough validity assessment of the research. Our reviewers write concise, structured reviews of articles and assessments of research designs using criteria developed by the Evidence-Based Medicine (EBM) Working Group.[3] Based on this evaluation, our reviewers provide "Recommendations for Clinical Practice" that place the new information into the context of our previous knowledge and offer concrete, clear guidance on how to use it. All of this is provided to reduce the work needed for you to keep up to date with important articles. Our goal is to publish our reviews within 3 to 4 months of publication of the original research.

With the increasing interest in EBM as a paradigm for all patient care, teaching, and research, and the growing reliance of managed care on using "outcomes-based" information for structuring clinical guidelines, we feel it is appropriate for The Journal of Family Practice to now give family physicians an expanded "tool kit" for the practice of evidence-based medicine. POEMs-Patient-Oriented Evidence that Matters is just one of these tools. Another tool -- access through the Internet -- will continue to be available for the collected reviews of JFP Journal Club and for future reviews of POEMs at the same address: http://jfp.msu.edu/.

The Journal is embarking on a new venture to help busy physician keep current with the vast array of literature. Borrowing a little from others and building on the success of the JFP Journal Club, we are launching a monthly newsletter cared Evidence-Based Practice: POEMs for Primary Care. This newsletter will contain structured synopses of research articles (in addition to those covered in the Journal) and other tools for the practice of evidence-based medicine. By regularly reviewing this supplement, readers can be confident that any information of potential relevance to family physicians will be noted. We will include methods for using other techniques of EBM, such as articles on useful clinical prediction rules, information on using the best test to rule in or rule out a particular disease, and evidence-based discussions of drug therapy for particular symptoms or diseases. A regular feature will be brief summaries of timely topics, such as "What's New in H pylori Detection and Treatment?"; "The New Asthma Drugs -- Where Do They Fit?"; and "Anticoagulation: Tips for Management." We will also regularly review the latest Cochrane Library databases relevant to practicing family physicians.[4]

The third tool in our EBM Tool Kit is a computer software version of the newsletter that will include all the POEM reviews. Available soon, this searchable database will be suitable for use on desktop and handheld (Newton MessagePad) computers. The software also will contain summaries of evidence-based practice guidelines, useful clinical prediction rules, and information to help you select and interpret diagnostic test.

It has been said that "the strength of a profession lies in its expert generation of information and better management of it than other social groups."[5] Answering yes to the following three questions will help us, as practicing clinicians, identify information of relevance (POEMs) requiring validation:

1. Will this information have a direct bearing on the health of my patients, ie, is it something they care about?

2. Is the problem common in my practice and is the intervention feasible?

3. If valid, will this information require me to change my current practice?

We hope you will find that the Journal is a valuable source of new medical research for clinical practice and that these new tools help in your management of this information.

REFERENCES

[1.] Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract 1994; 38:505-13.

[2.] Shaughnessy AF, Slawson DC, Bennett JH. Becoming and information master: a guidebook to the medical information jungle. J Fam Pract 1994; 39:489-99.

[3.] Oxman AD, Sackett DL, Guyatt GH. User's guides to the medical literature: I. How to get started. JAMA 1993; 270:2093-5.

[4.] Bero L, Rennie D. The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care. JAMA 1995; 274:1935-8.

[5.] Huth EJ. The underused medical literature. Ann Intern Med 1989; 110:99-100.
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Author:Slawson, David C.; Ebell, Mark H.; Barry, Henry C.
Publication:Journal of Family Practice
Article Type:Editorial
Date:Sep 1, 1997
Words:1271
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