12:58pm Saturday 04 July 2020

Clinical prediction rules to aid patient management in primary care

A new study from RCSI (Royal College of Surgeons in Ireland) has defined an international register of clinical prediction rules (CPRs) for clinician use in a primary care setting. These CPRs will help inform clinicians in making decisions regarding diagnosis, management and prognosis of specific conditions in patients. In a separate study, RCSI researchers have also reviewed how such CPRs are being used in clinical guidelines and by general practitioners (GPs) in the United Kingdom (UK). These studies were conducted by researchers based at the Health Research Board (HRB) Centre for Primary Care Research at RCSI.
CPRs are clinical tools that take account of a patient’s history, clinical examination and diagnostic tests to predict a patient’s risk of a specific disease or outcome. Outcomes of CPRs can be presented as diagnosis, referral, treatment or prognosis. CPRs may be used in primary care to assist the overall diagnostic and prognostic process.
The first study, recently published in Annals of Family Medicine, developed an international register of CPRs for use in the primary care setting. The researchers, led by Dr Claire Keogh, created a search strategy which identified and retrieved CPRs relevant to primary care. From this they created an international register, consisting of 434 rules from a bank of 745 articles from 30 pre-specified medical journals. The study found that CPRs were most commonly published in the clinical areas of cardiovascular disease and musculoskeletal conditions. This register may help inform clinical decision making and will be available as a web-based resource through the Cochrane Primary Healthcare field later this year.
Speaking on this publication Professor Tom Fahey, Principal Investigator of the HRB Centre of Primary Care Research, said, ‘This register will assist with the knowledge transfer of evidence based medicine in clinical practice, at the point of patient care. The register will also be of use to researchers in planning future studies.’
The second study, co-led by Dr Emma Wallace, HRB Research Fellow and GP lecturer in the RCSI Department of General Practice, in conjunction with European collaborators, was published in the British Journal of General Practice. This study sought to focus on reviewing CPR recommendations in clinical guidelines and to survey GPs’ use of CPRs in the UK. Researchers explored the usefulness of CPRs in the opinions of experts and at the use at the point of care in selected clinical areas. The study screened 7,637 records, 243 clinical guidelines met the inclusion criteria and were included in the review. Speaking on this study Dr Wallace said, ‘We found that CPRs were most commonly recommended in guidelines regarding primary prevention of cardiovascular disease and depression, but there was little consensus across various clinical guidelines as to which CPR to use preferentially. Our research also found that the most common reasons for GPs using CPRs were to guide management and to conform to local policy requirements.’ This research was conducted with international collaborators in the UK based at the University of Oxford, and Keele University and the Instituto di Ricerche Farmacologiche ‘Mario Negri’ in Italy.
RCSI is headquartered in Dublin and is a recognised College of the National University of Ireland. In 2010, RCSI was granted independent degree awarding status by the State, which enables the College to award degrees alongside its traditional powers to award licentiates.


Editors Notes

Clinical Prediction Rules (CPRs) should pass through three stages of development before widespread implementation:
i. Derivation;
ii. Validation; and
iii. Impact analysis


Journal References:
Ann Fam Med. 2014 Jul;12(4):359-66. doi: 10.1370/afm.1640


• Br J Gen Pract. 2014 Apr;64(621):e233-42. doi: 10.3399/bjgp14X677860

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