What proportion of dermatological patients receive evidence-based treatment?

Objective: To determine the proportion of dermatological patients who are o ffered evidence-based therapy in the routine dermatological practice. Methods: For every patient seen for the first time at one of our tertiary h ospital setting clinics between April and May 1999, the primary diagnosis a nd the primary intervention were recorded. For each primary diagnosis-prima ry intervention combination, evidence was searched for in electronic databa ses from January 1966 to December 1999. The proportion of patients who were offered evidence-based interventions was calculated as the main outcome me asure. Results: With a study sample of 136 patients, 61 different diagnosis-treatm ent couples were generated and 94 queries on electronic databases were perf ormed (to account for "primary interventions" including more than 1 drug or treatment modality). Eighty-seven (64%) of 136 patients received evidence- based interventions. Evidence from randomized controlled trials was found f or 69 patients (50.7% of the sample). Controlled studies lacking randomizat ion or double blinding or including fewer than 20 patients per treatment gr oup dealt with treatments offered to 14 patients (10.3%). The treatments of fered to 4 patients (2.9%) were judged to have self-evident validity tie, v ials unanimously judged unnecessary). Symptomatic and supportive measures a ccounted for most interventions lacking substantial evidence (36% of the pa tients), but we had to include in this class other important treatment regi mens, mainly for rare conditions. Conclusions: Most of the study patients received evidence-based care. Howev er, published trials should be carefully appraised, and relevance of clinic al end points should be evaluated together with methodological issues. More accessible, clinically oriented, evidence-based information sources are ne eded.