Closing evidence gaps in general practice & family medicine

Dear colleagues and researchers,

Patients rightly expect us to provide them with the best possible medical treatment. Therefore, we increasingly used and refined the principles of evidence-based medicine over the past two to three decades in our research. During the recent past, the evidence published in scientific journals and elsewhere has started to grow at an unprecedented pace, now nearly doubling within only four years. On average, a new medical article today is published every 15 seconds. To an enlarging extent the evidence informing our clinical decision making comes from our very own setting. But there is not only a change in quantity: a growing number of today’s clinical trials also encompasses the patients' preferences and comprises relevant details needed for the implementation in clinical decision making.

However, increasing the quantity of evidence can in itself create a variety of new problems: health care professionals are challenged to remain up to date with new evidence like never before. Systematic reviews show that adherence to guideline recommendations in daily routine care varies widely from 20 to over 80%. Thus, despite the rapidly growing knowledge, a varying share of patients is still likely to receive suboptimal treatments, inappropriate diagnostics, unsafe medications, and costly but ineffective care. Incorporating new evidence into daily practice usually takes several years already. This “evidence to practice gap” might even get bigger the more evidence there is.

At the same time, we still face an ongoing lack of evidence in other domains. This is partly due to the characteristics of research in primary care, e.g., varying organizational structures, practice team compositions, or different contexts caused by the health care system and its legal boundaries. Besides these contextual factors, research in primary care often times deals with complex interventions and patients with very heterogeneous characteristics which leaves us with many potential sources of uncertainty when we try to put together guidelines based on evidence in our field of research.

Fortunately, in the wake of the digitisation new and promising ways of combining and integrating evidence e.g., learning health care systems, big data analysis and machine learning are at our disposal. Nonetheless, closing evidence gaps is an ongoing challenge that is only in part solved by creating new or more evidence or combining more and more information. In fact, we will still have to perform a constant assessment of evidence gaps, both in generating evidence and in translating evidence into practice. Ideally, this assessment is followed by a prioritisation of research questions and, in addition, existing evidence gaps should be addressed in trials in real-world conditions.

We cordially invite you to come to the 92th EGPRN meeting in Halle, Germany, to identify gaps of evidence and to discuss ways in which problems related to evidence gaps in general practice and family medicine could be researched and rectified.