Lc. Kleinman, PREVENTION AND PRIMARY-CARE RESEARCH FOR CHILDREN - THE NEED FOR EVIDENCE TO PRECEDE EVIDENCE-BASED, American journal of preventive medicine, 14(4), 1998, pp. 345-351
Citations number
18
Categorie Soggetti
Medicine, General & Internal","Public, Environmental & Occupation Heath
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.