A search for the evidence supporting community paediatric practice
The
Academic Unit of Paediatrics and Child Health, University of Leeds,
Leeds LS2 9NP, UK
Correspondence to: Dr M Rudolf, Community Paediatrics, Belmont House, Leeds General Infirmary, 3-5 Belmont Grove, Leeds, LS2 9NP, UK.
Accepted 19 October
1998
AIM
Controversy exists
regarding the evidence base of medicine. Estimates range from 20% to
80% in various specialties, but there have been no studies in
paediatrics. The aim of this study was to ascertain the evidence base
for community paediatrics.
METHODSTwelve
community paediatricians working in clinics and schools in Yorkshire,
Manchester, Teesside, and Cheshire carried out a prospective review of
consecutive clinical contacts. Evidence for diagnostic processes,
prescribing, referrals, counselling/advice, and child health promotion
was found by searching electronic databases. This information was
critically appraised and a consensus was obtained regarding quality and
whether it supported actions taken.
RESULTSTwo hundred
and forty seven consultations and 1149 clinical actions were performed.
Good evidence was found from a randomised controlled trial or other
appropriate study for 39.9% of the 629 actions studied; convincing
non-experimental evidence for 7%; inconclusive evidence for 25.4%;
evidence of ineffectiveness for 0.2%; and no evidence for 27.5%.
Prescribing and child health promotion activities had the highest
levels of quality evidence, and counselling/advice had the lowest.
CONCLUSIONSAn
encouraging amount of evidence was found to support much of community
paediatric practice. This study improved on previous research in other
specialties because actions other than medications and surgery were included.
© 1999 by Archives of Disease in Childhood
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