The Evidence Base for Interventions Delivered to Children in Primary Care: An Overview of Cochrane Systematic Reviews
Open Access
- 1 August 2011
- journal article
- review article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 6 (8), e23051
- https://doi.org/10.1371/journal.pone.0023051
Abstract
Background: 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; 385 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 based and the lack of trial evidence to demonstrate intervention effectiveness in substantial areas of primary care for children should be addressed.© 2011 Gill et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedKeywords
This publication has 36 references indexed in Scilit:
- Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?PLoS Medicine, 2010
- An international registry of systematic-review protocolsThe Lancet, 2010
- A descriptive analysis of child-relevant systematic reviews in the Cochrane Database of Systematic ReviewsBMC Pediatrics, 2010
- Updating Systematic Reviews: An International SurveyPLOS ONE, 2010
- Increasing Short-Stay Unplanned Hospital Admissions among Children in England; Time Trends Analysis ’97–‘06PLOS ONE, 2009
- Avoidable waste in the production and reporting of research evidenceThe Lancet, 2009
- Children Are Not Just Small Adults: The Urgent Need for High-Quality Trial Evidence in ChildrenPLoS Medicine, 2008
- What is missing from descriptions of treatment in trials and reviews?BMJ, 2008
- The coming of age of ICPC: celebrating the 21st birthday of the International Classification of Primary CareFamily Practice, 2008
- Epidemiology and Reporting Characteristics of Systematic ReviewsPLoS Medicine, 2007