TABLE 2
Few drug therapy articles are POEMs
| Journal | Articles published in 6 months, n | Drug therapy articles, n | Drug therapy articles that are POEMs, n (%) |
|---|---|---|---|
| Arch Intern Med | 123 | 24 | 8 (33) |
| BMJ | 127 | 23 | 4 (17) |
| JAMA | 85 | 20 | 4 (20) |
| Lancet | 92 | 33 | 1 (3) |
| N Engl J Med | 128 | 39 | 4 (10) |
| 0bstet Gynecol | 115 | 24 | 2 (8) |
| Pediatrics | 325 | 50 | 1 (2) |
| Arch Intern Med, Archives of Internal Medicine; BMJ, British Medical Journal; JAMA, Journal of the American Medical Association; N Engl J Med, New England Journal of Medicine; Obstet Gynecol, Obstetrics and Gynecology; POEMs, Patient-Oriented Evidence that Matters. | |||
Discussion
Our study findings are consistent with the relevance data from a previous study published in 1999.8 After more than a decade, medical journals still are not publishing drug therapy POEMs.
A disturbing scarcity of useful information. The paucity of drug therapy POEMs with clinically useful information is alarming. Based on our data we estimate that a physician would have to read on average 36 drug therapy articles to find one clinically helpful drug therapy POEM. This finding suggests that the medical literature is not helping clinicians provide the best patient care or, when it does, the busy clinician is forced to spend what little time is available in calculations to determine what can actually affect practice in positive ways.
Study limitations. Our study has a number of limitations. The study settings in the articles we reviewed ultimately determined what information was important and could potentially change clinical practice. Some studies, for example, were performed in developing countries, where the therapy being tested was not commonly used and would alter practice. In the United States, however, the same treatment would not affect clinical practice because it was either common practice or standard of care.
We reviewed only 7 major medical journals. Our results cannot necessarily be extrapolated to other major journals, although they do suggest that the findings are not limited to a few publications. Moreover, we reviewed only 2 specialty journals. It is possible that other such journals are publishing more POEMs than we observed and providing more concrete numbers that specialists can use to quickly and easily adjust their practice patterns than general journals.
We did not analyze any family medicine journals for the following reasons: American Family Physician publishes only review articles; The Journal of Family Practice does not routinely publish original research; and Annals of Family Medicine (the research journal of the discipline) is less well established than the other journals we selected for this review, having been launched in 2003.
In addition, 6 months may not have been long enough to accurately calculate the percentage of POEMs or clinically useful information in the journals we reviewed. During the pilot study, in which we analyzed a full year of JAMA, only one POEM was published in the second 6 months, and it did not contain clinically useful information. Moreover, we reviewed most journals over 6 consecutive months rather than 6 randomly chosen months.
Finally, we reviewed only drug therapy articles. Future studies could examine surgical, diagnostic, or prognostic studies.
Toward more, and more useful, POEMs
Despite the scarcity of POEMs that provide clinically useful information in major medical journals, it is important that physicians continue to practice evidence-based medicine, sifting through the available information and even calculating ARR, NNT, and NNH themselves, which most busy clinicians do not have the time or inclination to do.
How can we improve the clinical usefulness of published data? One way is for journal editors to require that authors provide ARRs and NNTs or NNHs. Another is for authors to include these calculations on their own initiative. Either way, the goal is better clinical practice and optimal patient care.
CORRESPONDENCE Adrienne Z. Ables, PharmD, Edward Via College of Osteopathic Medicine, Carolinas Campus, 350 Howard Street, Spartanburg, SC 29303; aables@carolinas.vcom.edu