Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
PLoS One. 2011;6(8):e23051. doi: 10.1371/journal.pone.0023051. Epub 2011 Aug 1.
As a first step in developing a framework to evaluate and improve the quality of care of children in primary care there is a need to identify the evidence base underpinning interventions relevant to child health. Our objective was to identify all Cochrane systematic reviews relevant to the management of childhood conditions in primary care and to assess the extent to which Cochrane reviews reflect the burden of childhood illness presenting in primary care.
METHODOLOGY/PRINCIPAL FINDINGS: We used the Cochrane Child Health Field register of child-relevant systematic reviews to complete an overview of Cochrane reviews related to the management of children in primary care. We compared the proportion of systematic reviews with the proportion of consultations in Australia, US, Dutch and UK general practice in children. We identified 396 relevant systematic reviews; 358 included primary studies on children while 251 undertook a meta-analysis. Most reviews (n = 218, 55%) focused on chronic conditions and over half (n = 216, 57%) evaluated drug interventions. Since 2000, the percentage of pediatric primary care relevant reviews only increased by 2% (7% to 9%) compared to 18% (10% to 28%) in all child relevant reviews. Almost a quarter of reviews (n = 78, 23%) were published on asthma treatments which only account for 3-5% of consultations. Conversely, 15-23% of consultations are due to skin conditions yet they represent only 7% (n = 23) of reviews.
CONCLUSIONS/SIGNIFICANCE: Although Cochrane systematic reviews focus on clinical trials and do not provide a comprehensive picture of the evidence base underpinning the management of children in primary care, the mismatch between the focus of the published research and the focus of clinical activity is striking. Clinical trials are an important component of the evidence base and the lack of trial evidence to demonstrate intervention effectiveness in substantial areas of primary care for children should be addressed.
作为制定评估和提高初级保健儿童护理质量框架的第一步，有必要确定与儿童健康相关的干预措施的证据基础。我们的目标是确定与初级保健中儿童疾病管理相关的所有 Cochrane 系统评价，并评估 Cochrane 评价在多大程度上反映了初级保健中儿童疾病的负担。
方法/主要发现：我们使用 Cochrane 儿童健康领域登记册中与儿童相关的系统评价，完成了与初级保健中儿童管理相关的 Cochrane 评价概述。我们比较了系统评价的比例与澳大利亚、美国、荷兰和英国普通实践中儿童就诊的比例。我们确定了 396 项相关的系统评价；其中 358 项包括针对儿童的原始研究，而 251 项进行了荟萃分析。大多数评价（n = 218，55%）侧重于慢性疾病，超过一半（n = 216，57%）评估了药物干预。自 2000 年以来，儿科初级保健相关评价的比例仅增加了 2%（从 7%增加到 9%），而所有儿童相关评价的比例增加了 18%（从 10%增加到 28%）。近四分之一的评价（n = 78，23%）发表在哮喘治疗上，而哮喘治疗仅占就诊的 3-5%。相反，15-23%的就诊是由于皮肤状况，但它们仅占评价的 7%（n = 23）。
结论/意义：尽管 Cochrane 系统评价侧重于临床试验，并没有提供初级保健中儿童管理证据基础的全面情况，但已发表研究的重点与临床活动的重点之间的不匹配引人注目。临床试验是证据基础的重要组成部分，应解决在儿童初级保健的大量领域缺乏试验证据来证明干预措施的有效性的问题。
