Do Cochrane reviews drive clinical decision-making at the point of care?

Background:“Without Cochrane Reviews, people making decisions are unlikely to be able to access and make full use of existing healthcare research”, the Cochrane Collaboration website reports. Although systematic reviews (SR) are increasingly popular as a form of convenient synthesis of evidence to support clinical decision-making, it is difficult to measure to what extent may back practitioners up in their daily practice. A proxy of this achievement is whether Cochrane Reviews are utilized at the point of care. Point-of-care summaries provide physicians with comprehensive, condensed evidence in easily digestible formats. Objectives: We compared Cochrane and non-Cochrane SR citations in point-of-care summaries. Our null hypothesis was that the citation hazard of a relevant sample of Cochrane and non-Cochrane reviews did not differ. Methods: We selected the top five point-of-care summaries for coverage of medical conditions, editorial quality and evidence-based methodology. As samples of relevant non-Cochrane SRs, we selected all the SRs signalled by two literature surveillance journals (ACP Journal Club and Evidence-Based Medicine Primary Care and Internal Medicine). For Cochrane SRs we selected those labelled as “Conclusion changed” in the Cochrane Library. Parallel sampling ran from April to December 2009. We measured the occurrence and timing of Cochrane and non-Cochrane SR citation in point-of-care summaries from June 2009 to May 2010. We assessed the updating cumulative rate using Kaplan-Meier survival analyses. Cox model was used to calculate hazard ratios (HR) between the non- and Cochrane review citation. Results: The analysis included 128 SRs, 68 non-Cochrane (53%) and 60 Cochrane (47%). The difference between the non- and Cochrane review citation speeds was not significant (HR 1.13, IC 95% 0.87 to 1.46, p=0.36). Both were cited with similar patterns by point-of-care summaries. Conclusions: This finding belies down the criticism that Cochrane reviews are undervalued as a source of evidence for bedside clinical decision making.