GPs' use and understanding of the benefits and harms of treatments for long-term conditions: a qualitative interview study.

BACKGROUND: To support shared decision making and improve the management of polypharmacy, it is recommended that GPs take into account quantitative information on the benefits and harms of treatments (QIRx). Quantitative evidence shows GPs' knowledge of this is low. AIM: To explore GPs' attitudes to and understanding of QIRx for long-term conditions. DESIGN AND SETTING: Qualitative interview study in UK general practice. METHOD: Semi-structured interviews were carried out with 15 GPs. Audiorecordings were transcribed verbatim and a framework approach was used for analysis. RESULTS: Participants described knowing or using QIRx for only a few treatments. There was awareness of this knowledge deficit coupled with low confidence in statistical terminology. Some GPs perceived an absence of this information as an important barrier to optimal care, while others were content to follow guidelines. In the absence of this knowledge, other strategies were described to individualise treatment decisions. The idea of increasing the use of QIRx appealed to most participants, with imagined benefits for patients and themselves. However, potential barriers were described: a need for accessible information that can be understood and integrated into real-world practice, system factors, and communication challenges. CONCLUSION: GPs were aware of their knowledge deficit with regard to an understanding of QIRx. Most participants were positive about the idea of increasing their use of QIRx in practice but described important challenges, which need to be considered when designing solutions.

GPs' understanding of the benefits and harms of treatments for long-term conditions: an online survey.

BACKGROUND: GPs prescribe multiple long-term treatments to their patients. For shared clinical decision-making, understanding of the absolute benefits and harms of individual treatments is needed. International evidence shows that doctors' knowledge of treatment effects is poor but, to the authors knowledge, this has not been researched among GPs in the UK. AIM: To measure the level and range of the quantitative understanding of the benefits and harms of treatments for common long-term conditions (LTCs) among GPs. DESIGN & SETTING: An online cross-sectional survey was distributed to GPs in the UK. METHOD: Participants were asked to estimate the percentage absolute risk reduction or increase conferred by 13 interventions across 10 LTCs on 17 important outcomes. Responses were collated and presented in a novel graphic format to allow detailed visualisation of the findings. Descriptive statistical analysis was performed. RESULTS: A total of 443 responders were included in the analysis. Most demonstrated poor (and in some cases very poor) knowledge of the absolute benefits and harms of treatments. Overall, an average of 10.9% of responses were correct allowing for ±1% margin in absolute risk estimates and 23.3% allowing a ±3% margin. Eighty-seven point seven per cent of responses overestimated and 8.9% of responses underestimated treatment effects. There was no tendency to differentially overestimate benefits and underestimate harms. Sixty-four point eight per cent of GPs self-reported 'low' to 'very low' confidence in their knowledge. CONCLUSION: GPs' knowledge of the absolute benefits and harms of treatments is poor, with inaccuracies of a magnitude likely to meaningfully affect clinical decision-making and impede conversations with patients regarding treatment choices.

Sobrediagnóstico e tratamento excessivo: Médicos generalistas - é hora de uma revolução na medicina / Sobrediagnóstico e tratamento excessivo: Médicos generalistas - é hora de uma revolução na medicina / Sobrediagnóstico e tratamento excessivo: Médicos generalistas - é hora de uma revolução na medicina

Práticas médicas ineficientes e prejudiciais sempre estiveram conosco, mas a escala e institucionalização do sobrediagnóstico e do tratamento excessivo se expandiram exponencialmente nas últimas décadas. Este tema tem sido articulado em movimentos mundiais, tais como as conferências para Prevenção de Sobrediagnóstico, e campanhas como "Medicina em Demasia" ("Too Much Medicine"), do BMJ, "Menos é Mais" ("Less is More") da JAMA, o movimento italiano "Desacelerem a Medicina" ("Slow Medicine") e o projeto "Escolhendo com Inteligência" ("Choosing Wisely"), dos EUA (e agora internacional). (...)