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ROY M. POSES MD
BROWN UNIVERSITY CENTER FOR PRIMARY CARE AND PREVENTION
MEMORIAL HOSPITAL OF RI
111 BREWSTER ST.
PAWTUCKET, RI 02860
USA
401 729-2383
FAX: 401 729-2494
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----------------------------Original message----------------------------
At first glance, it appearrs to me that much of the variation, cannot be
explained by patient differences. My hope is that much of variation is due
to not knowing where the best evidence is. This way, we should be able to
improve outcomes and reduce costs via education. One study that highlights
variation, in the setting of similar patients is: Variations among Family
Physicians' Management Strategies for Lower Urinary Tract Infection in
Women: A report from the Washington Physicians Collaborative Research
Network. Journal of the American Board of Family Practice, Sept-Oct, 1991;
327-330. In this survey, 82 respondent family physicians came up with 137
different treatments, for the same scenario. Any comments, or thoughts?
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My first question is: what was the scenario? If the scenario was well-written
and included sufficient patient data, this suggests that the variation was
not due to patient characteristics. (But if the scenario was very sparse and
telegraphic, some physicians might have inferred patient characteristics that
were not mentioned in the scenario in order to make their decisions.)
If the scenario also was of a clinical problem for which the very good
evidence suggests that a certain treatment is superior, this result is
worrisome, because it suggests that the physicians are unaware of the
evidence or not convinced by it. On the other hand, if the scenario was
of a clinical problem for which the evidence suggests multiple treatments
are equivalent, then this response is an appropriate response to the state
of the evidence.
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