Abstract
Editors' Note: This month we continue the new featureSTEPped Care: An Evidence-BasedApproach to Drug Therapy. These articles are designed to provide concise answers to the drug therapy questions that family physicians encounter in their daily practice. The format of the feature will follow the mnemonic STEP: safety (an analysis of adverse effects that patients and providers care about), tolerability (pooled dropout rates from large clinical trials), effectiveness (how well the drugs work and in what patient population[sj), and price (costs of drug, but also cost-effectiveness of therapy).l Hence, the name STEPped Care. Since the informatics pioneers at McMaster University introduced evidence-based medicine,2 Slawson and ShaughnessyJ,4 have brought it to mainstream family medicine education and practice. This feature is designed to further the mission of searching for the truth in medical practice. Authors will provide information in a structured format that allows the readers to get to the meat of a therapeutic issue in a way that can help physicians (and patients) make informed decisions. The articles will discourage the use of disease-oriented evidence to make treatment decisions. Examples of diseaseoriented evidence include blood pressure lowering, decreases in hemoglobin A 1 ond so on. We will include studies thot provide POEMs-patient-oriented evidence that matters (myocardial infarctions, pain, strokes, mortality, etc)-with the goal of offering patients the most practical, appropriate, and scientifically substantiated therapies. Whenever possible, number needed to treat to observe benefit in a single patient will also be included as a way of defining advantoges in terms that are relatively easy to understand. 5,6 At times this effort will be frustrating. Even as vast as the
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