How accurate are GPs at integrating evidence into prescribing decisions?

EVIDENCE IN THE CONSULTATION

A 56-year-old attends his GP to discuss his newly diagnosed hypertension and asks the GP about the benefits and harms of taking long-term hypotensive medication … How accurate are we (GPs, healthcare professionals and other specialists) in providing this information?

GPs are unlikely to have fingertip evidence knowledge for management decisions, but if we don’t, should we? Treadwell et al ¹ highlight GP inaccuracy in numerical assessment of benefits and harms of long-term medications used in several long-term conditions. The General Medical Council’s Good Medical Practice ² states that doctors should: ‘… keep up to date … [and] prescribe drugs or treatments, including repeat prescriptions, only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.’

Also, to: ‘… provide effective treatments based on the best available evidence.’

Within consultations we commonly find two opportunities for evidence consideration. One is at diagnosis; for instance, calculating the probability of deep vein thrombosis using Wells score, risk assessment for primary prevention of coronary heart disease and stroke (for example, QRisk3³), or arranging investigations. The second is in the discussion of management decisions including prescribing, for example, benefits and harms of anticoagulation in atrial fibrillation and heart attack, and ischaemic stroke prevention using CHA₂DS …