Clinical prediction rules in primary care
Citation: Wallace E, Uijen MJ, Clyne B, Zarabzadeh A, Keogh C, Galvin R, Smith SM, Fahey T. Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review. BMJ Open 2016; 6(3): e009957
What is this? The COVID-19 pandemic is placing additional demands on primary care clinicians. Clinical prediction rules (CPRs) are intended to standardise clinicians’ approaches to diagnosis, management and prognostic assessment and existing research on them might provide information to help cope with these demands.
In this systematic review, the authors searched for comparative effectiveness studies of the use of CPRs in primary care. They restricted their search to articles published in 30 preselected journals from 1980 to 2013, with no restrictions on language of publication. They included four cluster randomized trials, eight individually randomized trials, one pilot RCT, three controlled before-after studies and two interrupted time series studies; across a variety of conditions.
What was found: Overall, 10 of the 18 included studies reported an improvement in primary outcome with CPR implementation compared to usual care.
For patients presenting with ankle, knee and neck musculoskeletal injuries, 5 of the 6 studies found that that use of the CPR altered targeted physician behaviour in the ordering of imaging compared to usual care.
Among the 4 studies of cardiovascular risk scores, 3 reported no impact on physician behaviour outcomes (such as prescribing and referral) or patient outcomes (such as reduction in serum lipid levels) compared to usual care.
Two studies examined CPRs in decision-making for patients presenting with chest pain and both found a reduction in inappropriate admissions compared to usual care.
Two of the 5 respiratory studies found the CPR to be effective at reducing antibiotic prescribing for sore throat compared to usual care.
What’s uncertain: The effects of combining CPR use with other decision aids or within wider protocols are uncertain.
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