Between patient visits and paperwork, it can be a struggle for primary care physicians to keep up with the latest medical research and, more importantly, figure out which studies are relevant to their practice. That’s where family physician and University of Georgia researcher Dr. Mark Ebell and five colleagues stepped in to give family medicine practitioners some much-needed guidance.
Since 1998, they have been systematically tracking research related to primary care medicine and generating concise, structured summaries known as POEMs, which stands for “patient-oriented evidence that matters.” Selected studies address a primary care question, and recommend a change in practice that would improve patient-oriented outcomes like how long or how well a patient lives.
“Of the 20,000 or more studies published every year in the top 100 or so medical journals, what do you read? What do you pay attention to?” said Dr. Ebell, who studies clinical decision-making at UGA’s College of Public Health. “We filter out around 99 percent of the published research because it’s just not relevant to primary care physicians in practice, and we identify the 1 percent that would potentially change what they do and improve patient outcomes.”
In a recent paper for the Annals of Family Medicine, they describe the most important POEM for each of the last 20 years. The selected studies either recommended a new, effective intervention or to abandon an ineffective or potentially harmful practice. The authors identified over 5,600 POEMs for review. Four original POEM authors, which included Dr. Ebell, voted on the POEMs they thought had offered a “major and persistent change in practice that year.” The top POEMs include practice change recommendations for prostate and breast cancer screenings, treatment for diabetes, hormone replacement therapy for postmenopausal women, and the adoption of the HPV vaccine. Still, the appearance of a POEM doesn’t immediately result in practice change. The time it takes for “knowledge translation,” says Dr. Ebell, is highly variable. For example, a 2003 study – that year’s POEM — showed that self-breast exams were not effective in preventing breast cancer deaths, but self-exams still feature in some breast cancer awareness campaigns.
In contrast, when evidence became available showing that hormone replacement therapy for postmenopausal women did not prevent dementia, heart disease, or bone loss, and could even put some women at risk for cancer, practice changed relatively quickly.
Dr. Ebell says POEMs are necessary because the knowledge base for primary care medicine is broad, and it would be impossible for an individual physician to keep up with all of it. A systematic approach like POEM helps them keep up with the latest medical literature, even if the POEM didn’t appear in a family medicine or primary care journals.