|How Often Are Ineffective Interventions Still Used in Clinical Practice? A Cross-Sectional Survey of 6,272 Clinicians in China|
|Luo, Xiao-Min1,3; Tang, Jin-Ling1,2; Hu, Yong-Hua3; Li, Li-Ming3; Wang, Yan-Ling1; Wang, Wei-Zhong4,5; Yang, Li6; Ouyang, Xiao-hui7; Duan, Guang-cai8|
|WOS标题词||Science & Technology|
|研究领域[WOS]||Science & Technology - Other Topics|
|关键词[WOS]||MYOCARDIAL-INFARCTION ; DISEASE|
Background: The World Health Organization reported in 2011 that irrational use of medicines was a serious global problem that is wasteful and harmful. The worst is use of ineffective or harmful interventions which should not be used at all. However, little is known about the changes that 20 years of evidence-based medicine has made particularly in reducing use of ineffective interventions. We surveyed clinicians in China to show how often ineffective interventions were still used in practice.
Methods: 3,246 clinicians from 24 tertiary hospitals were surveyed in person and another 3,063 through an online survey between 2006-2007. 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. 129 ineffective interventions for 68 diseases were identified from the BMJ Clinical Evidence and included 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 intervention.
Results: The mean prescription rate by clinicians is 59.0% (95% confidence interval (95% 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 as compared with that of matched effective interventions is 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% ineffective interventions were still routinely used in practice.
Conclusions: Ineffective interventions were still commonly used. Efforts are necessary to further reduce and eventually eliminate ineffective interventions from practice.
|作者单位||1.Peking Univ, Hlth Sci Ctr, Ctr Evidence Based Med, Beijing 100871, Peoples R China|
2.Chinese Univ Hong Kong, Sch Publ Hlth & Primary Care, Div Epidemiol, Hong Kong, Hong Kong, Peoples R China
3.Peking Univ, Hlth Sci Ctr, Sch Publ Hlth, Beijing 100871, Peoples R China
4.Chinese Acad Med Sci, Inst Pathogen Biol, Beijing 100730, Peoples R China
5.Peking Union Med Coll, Beijing 100021, Peoples R China
6.Guangxi Med Univ, Sch Publ Hlth, Nanning, Guangxi Zhuang, Peoples R China
7.Inner Mongolia Med Coll, Hohhot, Inner Mongolia, Peoples R China
8.Henan Univ Sci & Technol, Luoyang, Henan Province, Peoples R China
|Luo, Xiao-Min,Tang, Jin-Ling,Hu, Yong-Hua,et al. How Often Are Ineffective Interventions Still Used in Clinical Practice? A Cross-Sectional Survey of 6,272 Clinicians in China[J]. PLOS ONE,2013,8(3).|
|APA||Luo, Xiao-Min.,Tang, Jin-Ling.,Hu, Yong-Hua.,Li, Li-Ming.,Wang, Yan-Ling.,...&Duan, Guang-cai.(2013).How Often Are Ineffective Interventions Still Used in Clinical Practice? A Cross-Sectional Survey of 6,272 Clinicians in China.PLOS ONE,8(3).|
|MLA||Luo, Xiao-Min,et al."How Often Are Ineffective Interventions Still Used in Clinical Practice? A Cross-Sectional Survey of 6,272 Clinicians in China".PLOS ONE 8.3(2013).|