A search for the evidence supporting community paediatric practice

Aim-Controversy exists regarding the evidence base of medicine, Estimates r ange from 20% to 80% in various specialties, but there have been no studies in paediatrics. The aim of this study was to ascertain the evidence base f or community paediatrics. Methods-Twelve community paediatricians working in clinics and schools in Y orkshire, Manchester, Teesside, and Cheshire carried out a prospective revi ew of consecutive clinical contacts. Evidence for diagnostic processes, pre scribing, referrals, counselling/advice, and child health promotion was fou nd by searching electronic databases. This information was critically appra ised and a consensus was obtained regarding quality and whether it supporte d actions taken. Results-Two hundred and forty seven consultations and 1149 clinical actions were performed. Good evidence was found from a randomised controlled trial or other appropriate study for 39.9% of the 629 actions studied; convincin g non-experimental evidence for 7%; inconclusive evidence for 25.4%; eviden ce of ineffectiveness for 0.2%; and no evidence for 27.5%. Prescribing and child health promotion activities had the highest levels of quality evidenc e, and counselling/advice had the lowest. Conclusions-An encouraging amount of evidence was found to support much of community paediatric practice. This study improved on previous research in other specialties because actions other than medications and surgery were i ncluded.