PREVENTION AND PRIMARY-CARE RESEARCH FOR CHILDREN - THE NEED FOR EVIDENCE TO PRECEDE EVIDENCE-BASED

Medical care in the United States continues to face tremendous financi al pressures. Public and private health policy claim to encourage prim ary care and preventive services, but also discourage services that ha ve not been demonstrated to be effective and/or cost-effective. This a rticle suggests a model to illustrate the conceptual relationship betw een traditional American medical care and ''evidenced-based'' medicine . It further examines how the lack of an adequate research base makes a move to purely evidence-based care premature for primary care and pr evention services. The paper defines a new conceptual statistic, the u ncertainty index, as the proportion of non-refuted current practice th at is also not corroborated by research evidence. The greater the unce rtainty index, the less appropriate is a clinical model restricted to evidence-based care. Specific theoretical barriers to outcomes researc h in prevention are discussed and simple criteria to determine the des irable components of care are suggested. The need for theoretical and empirical research into primary care and prevention, especially for ch ildren, is emphasized. Care that is of low risk, not of extremely high cost, and that is generally believed useful by the community of pract itioners is particularly desirable in the absence of data refuting its value.