Cargando…
Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study
BACKGROUND: Many clinical practice guidelines are based on randomised controlled trials conducted in secondary or tertiary care setting and general practitioners frequently question their relevance for primary care patients. Our aim was to compare the intervention effect estimates between primary ca...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773496/ https://www.ncbi.nlm.nih.gov/pubmed/36550405 http://dx.doi.org/10.1186/s12874-022-01815-2 |
_version_ | 1784855204105027584 |
---|---|
author | Dugard, Amandine Tavernier, Elsa Caille, Agnès Dechartres, Agnès Hoang, Adeline Giraudeau, Bruno Dibao-Dina, Clarisse |
author_facet | Dugard, Amandine Tavernier, Elsa Caille, Agnès Dechartres, Agnès Hoang, Adeline Giraudeau, Bruno Dibao-Dina, Clarisse |
author_sort | Dugard, Amandine |
collection | PubMed |
description | BACKGROUND: Many clinical practice guidelines are based on randomised controlled trials conducted in secondary or tertiary care setting and general practitioners frequently question their relevance for primary care patients. Our aim was to compare the intervention effect estimates between primary care setting randomised controlled trials (PC-RCTs) and secondary or tertiary care setting randomised controlled trials (ST-RCTs). METHODS: Meta-epidemiological study of meta-analyses (MAs) of a binary outcome including at least one PC-RCT and one ST-RCT. PC-RCTs were defined as trials recruiting patients in general practices, primary care practices, family practices, community centers or community pharmacies. ST-RCTs were defined as trials recruiting in hospitals, including hospitalized patients, hospital outpatients and patients from emergency departments. For each MA, we estimated a ratio of odds ratio (ROR) by using random-effects meta-regression, with an ROR less than 1 indicating lower estimates of the intervention effect in PC-RCTs than ST-RCTs. Finally, we estimated a combined ROR across MAs by using a random-effects meta-analysis. We performed subgroup analyses considering the type of outcomes (objective vs subjective), type of experimental intervention (pharmacological vs non-pharmacological), and control group (active vs inactive) as well as analyses adjusted on items of the Cochrane Risk of Bias tool. RESULTS: Among 1765 screened reviews, 76 MAs with 230 PC-RCTs and 384 ST-RCTs were selected. The main medical fields were pneumology (13.2%) and psychiatry or addictology (38.2%). Intervention effect estimates did not significantly differ between PC-RCTs and ST-RCTs (ROR = 0.97, 95% confidence interval 0.88 to 1.08), with moderate heterogeneity across MAs (I(2) = 45%). Subgroup and adjusted analyses led to consistent results. CONCLUSION: We did not observe any significant difference in intervention effect estimates between PC-RCTs and ST-RCTs. Nevertheless, most of the medical fields in this meta-epidemiological study were not representative of the pathologies encountered in primary care. Further studies with pathologies more frequently encountered in primary care are needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-022-01815-2. |
format | Online Article Text |
id | pubmed-9773496 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-97734962022-12-23 Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study Dugard, Amandine Tavernier, Elsa Caille, Agnès Dechartres, Agnès Hoang, Adeline Giraudeau, Bruno Dibao-Dina, Clarisse BMC Med Res Methodol Research BACKGROUND: Many clinical practice guidelines are based on randomised controlled trials conducted in secondary or tertiary care setting and general practitioners frequently question their relevance for primary care patients. Our aim was to compare the intervention effect estimates between primary care setting randomised controlled trials (PC-RCTs) and secondary or tertiary care setting randomised controlled trials (ST-RCTs). METHODS: Meta-epidemiological study of meta-analyses (MAs) of a binary outcome including at least one PC-RCT and one ST-RCT. PC-RCTs were defined as trials recruiting patients in general practices, primary care practices, family practices, community centers or community pharmacies. ST-RCTs were defined as trials recruiting in hospitals, including hospitalized patients, hospital outpatients and patients from emergency departments. For each MA, we estimated a ratio of odds ratio (ROR) by using random-effects meta-regression, with an ROR less than 1 indicating lower estimates of the intervention effect in PC-RCTs than ST-RCTs. Finally, we estimated a combined ROR across MAs by using a random-effects meta-analysis. We performed subgroup analyses considering the type of outcomes (objective vs subjective), type of experimental intervention (pharmacological vs non-pharmacological), and control group (active vs inactive) as well as analyses adjusted on items of the Cochrane Risk of Bias tool. RESULTS: Among 1765 screened reviews, 76 MAs with 230 PC-RCTs and 384 ST-RCTs were selected. The main medical fields were pneumology (13.2%) and psychiatry or addictology (38.2%). Intervention effect estimates did not significantly differ between PC-RCTs and ST-RCTs (ROR = 0.97, 95% confidence interval 0.88 to 1.08), with moderate heterogeneity across MAs (I(2) = 45%). Subgroup and adjusted analyses led to consistent results. CONCLUSION: We did not observe any significant difference in intervention effect estimates between PC-RCTs and ST-RCTs. Nevertheless, most of the medical fields in this meta-epidemiological study were not representative of the pathologies encountered in primary care. Further studies with pathologies more frequently encountered in primary care are needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-022-01815-2. BioMed Central 2022-12-22 /pmc/articles/PMC9773496/ /pubmed/36550405 http://dx.doi.org/10.1186/s12874-022-01815-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Dugard, Amandine Tavernier, Elsa Caille, Agnès Dechartres, Agnès Hoang, Adeline Giraudeau, Bruno Dibao-Dina, Clarisse Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study |
title | Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study |
title_full | Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study |
title_fullStr | Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study |
title_full_unstemmed | Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study |
title_short | Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study |
title_sort | intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773496/ https://www.ncbi.nlm.nih.gov/pubmed/36550405 http://dx.doi.org/10.1186/s12874-022-01815-2 |
work_keys_str_mv | AT dugardamandine interventioneffectestimatesinrandomisedcontrolledtrialsconductedinprimarycareversussecondaryortertiarycaresettingsametaepidemiologicalstudy AT tavernierelsa interventioneffectestimatesinrandomisedcontrolledtrialsconductedinprimarycareversussecondaryortertiarycaresettingsametaepidemiologicalstudy AT cailleagnes interventioneffectestimatesinrandomisedcontrolledtrialsconductedinprimarycareversussecondaryortertiarycaresettingsametaepidemiologicalstudy AT dechartresagnes interventioneffectestimatesinrandomisedcontrolledtrialsconductedinprimarycareversussecondaryortertiarycaresettingsametaepidemiologicalstudy AT hoangadeline interventioneffectestimatesinrandomisedcontrolledtrialsconductedinprimarycareversussecondaryortertiarycaresettingsametaepidemiologicalstudy AT giraudeaubruno interventioneffectestimatesinrandomisedcontrolledtrialsconductedinprimarycareversussecondaryortertiarycaresettingsametaepidemiologicalstudy AT dibaodinaclarisse interventioneffectestimatesinrandomisedcontrolledtrialsconductedinprimarycareversussecondaryortertiarycaresettingsametaepidemiologicalstudy |