How Often Are Ineffective Interventions Still Used in Clinical Practice? A Cross-Sectional Survey of 6,272 Clinicians in China

Xiao-Min Luo,Xiao-Hui Ouyang,Yong-Hua Hu,Wei-Zhong Wang,Yan-Ling Wang,Li Yang,Li-Ming Li,Jin-Ling Tang,Guang-Cai Duan,Lawrence Kazembe

doi:10.1371/journal.pone.0052159

Abstract

BackgroundThe World Health Organization reported in 2011that irrational use of medicines was a serious global problem that is wasteful and harmful. The worst is use of ineffective or harmful interventions which should not be used at all. However, little is known about the changes that 20 years of evidence-based medicine has made particularly in reducing use of ineffective interventions. We surveyed clinicians in China to show how often ineffective interventions were still used in practice.Methods3,246 clinicians from 24 tertiary hospitals were surveyed in person and another 3,063 through an online survey between 2006–2007. The main outcomes are prescription by a clinician, and use in a patient of, an ineffective intervention and of a matched effective intervention in patients with the same disease. 129 ineffective interventions for 68 diseases were identified from the BMJ Clinical Evidence and included in the survey. One effective intervention was identified for each disease and a total of 68 effective interventions were thus also included. The frequency of use of effective interventions was used as a reference for that of ineffective intervention.ResultsThe mean prescription rate by clinicians is 59.0% (95% confidence interval (95% CI): 58.6% to 59.4%) and 81.0% (95% CI: 80.6% to 81.4%) respectively for ineffective and effective interventions. The mean frequency of use in patients is 31.2% (95% CI: 30.8% to 31.6%) and 56.4% (95% CI: 56.0% to 56.8%) for ineffective and effective interventions respectively. The relative reduction in use of ineffective interventions as compared with that of matched effective interventions is 27.2% (95% CI: 27.0% to 27.4%) and 44.7% (95% CI: 44.3% to 45.1%) for clinician's prescription and use in patients respectively. 8.6% ineffective interventions were still routinely used in practice.ConclusionsIneffective interventions were still commonly used. Efforts are necessary to further reduce and eventually eliminate ineffective interventions from practice.

Highlights

In 1992, a seminal paper showed clinical practice could have a time lag of 10 or more years behind what the evidence would suggest [1]
Evidence based medicine was proposed and urged medical decisions to be made consistent with current best evidence [2], [3], [4], [5], [6]
Little is known whether 20 years of efforts in evidence-based medicine have made any difference in clinical practice in particular in developing countries where healthcare resources are sparse

Summary

Introduction

In 1992, a seminal paper showed clinical practice could have a time lag of 10 or more years behind what the evidence would suggest [1]. In the past 20 years, tremendous efforts, in particular in generating, synthesizing and delivering evidence, have been made to help and engage clinicians and policy makers in evidence-based decision making [7], [8], [9], [10]. It has been shown beyond reasonable doubt that many widely used interventions are ineffective and should be eliminated from practice [11]. Little is known whether 20 years of efforts in evidence-based medicine have made any difference in clinical practice in particular in developing countries where healthcare resources are sparse. We surveyed clinicians in China to show how often ineffective interventions were still used in practice

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