Article Figures & Data
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PURL decision workflow.
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Criteria Question What Fulfills This Criterion? What Does Not Fulfill This Criterion? Relevance Are the results patient-oriented AND generalizable to patients cared for by family physicians? The study addresses a condition commonly encountered by family physicians and suggests a change in practice that would lead to an improvement in their ability to care for patients. Conditions that family physicians rarely encounter or are primarily taken care of by medical or surgical subspecialists are not relevant. Studies conducted on very narrow patient populations may not be relevant. Validity Are the methods and statistical analysis appropriate for the study being conducted with a minimal risk of bias? The methods of the study were appropriate to answer the question being addressed and the statistical analysis was conducted in an appropriate manner with a large enough patient population. There is minimal risk of bias in the presented evidence. Findings are not valid if the methods or statistical analysis were inappropriate for the study or if there were significant confounders present. Conflicts of interest or questionable funding sources can also limit the validity of the findings. Change in Practice Does the recommendation differ from a practice currently accepted by most family physicians? A change in practice refers to findings that, if adopted, would be a change in practice for a significant percentage of family physicians. A recommendation that directly contradicts current, widely followed, clinical guidelines would be a practice changer. A study that sufficiently adds to existing knowledge to tip the scales definitively in one direction would be a practice changer. If the proposed change is already wide-spread, it is not a practice changer. If the potential change would be on the part of specialists or midlevel providers only, then it is not a change in practice for family physicians. Medical Care Setting Would the recommended change occur in a setting where family physicians routinely work? The recommended changes can be made in a practice setting where many family physicians routinely work and have sufficient control over policies and procedures. If the proposed changes are in a setting where family physicians are unlikely to have sufficient control over, this criterion is not met. Implementable Are the recommendations easily implementable for the average family physician? The proposed change could be easily implemented by a family physician without significant additional resources. A change that requires unusual or expensive technology or large amounts of additional personnel would not be easily implementable. Changes that would not be covered by insurers are not implementable. Meaningful Should the average family physician incorporate this study’s findings into their practice based on this study? The change should be meaningful to the patient. On occasion it is meaningful to the provider by increasing satisfaction or simplifying a process. It may be meaningful to the medical system if costs are reduced or processes are imported. If the change would only result in disease-related, rather than patient-oriented, improvements with no clear improvement in outcomes would not be meaningful. Changes with negligible improvements with increased costs are not meaningful.
