Aims and Activities

The overall aim and mission statement of the Cochrane Primary Care Field is as follows:

"To promote the quality, quantity, dissemination, accessibility, applicability and impact of Cochrane systematic reviews relevant to people who work in primary care".

The specific objectives are:

  1. To ensure proper representation in the interests of primary care clinicians and consumers in Cochrane reviews and Cochrane Review Groups, and in other Cochrane entities.

  2. To develop a network of potential users of Cochrane reviews: consumers, professionals, and organizations.

  3. To disseminate Cochrane reviews to primary care clinicians via a Cochrane Primary Care website as a means of implementing evidence from Cochrane reviews.

  4. To communicate interests and expertise from Field members to Cochrane Review Groups.

  5. To identify and develop a register of clinical prediction rules (CPRs) relevant to Primary Care, in keeping with the Cochrane Screening and Diagnostic Methods Group. (Contact will occur after the transfer of administration - this will initially be conducted by the Dublin arm.)

  6. To identify potential authors and peer referees with a primary health care perspective who can contribute to existing Cochrane Review Groups.

  7. To develop and promote a specialized database of Cochrane reviews relevant to primary care.

  8. To promote liaison between Cochrane and key primary health care organizations at national and international levels.

  9. To identify funding to support the production of Cochrane reviews with relevance to primary health care.

  10. To develop and disseminate 'Primary care pearls' which will be mini POEMS (Patient oriented evidence that matters) and consist of minimum clinical information from primary care relevant Cochrane reviews. This will initially be conducted by the Auckland arm.

Elaboration of Clinical prediction rules work

Clinical prediction rules are clinical tools that quantify the contribution of the history, physical examination and diagnostic tests and stratify patients according to the probability of having a target disorder. Clinical prediction rules can be used to estimate the probability of diagnosis, prognosis or response to therapy in a wide range of disease specific areas. The objective of clinical prediction rules is to reduce the uncertainty inherent in medical practice by defining how to use clinical findings to make predictions. Every rule should assist the clinician in making a decision based on a combination of factors drawn from the history, physical examination or available diagnostic tests. There are many examples of clinical prediction rules that have improved clinician practice, either in the form of appropriate diagnostic testing or treatment. For example, the Ottawa ankle rule has improved appropriate investigation in the form of x-rays and reduced costs for people presenting to accident and emergency departments with injuries to their ankle, whilst a clinical prediction rule has been developed to stratify patients according to their risk of stroke in patients with atrial fibrillation.

In the primary care setting there is, as yet, no easily accessible resource of relevant clinical prediction rules. It is proposed that the Dublin arm of the Cochrane Primary Care Field develops a register of clinical prediction rules relevant to primary health care. Though not directly related to conventional Cochrane activities in terms of systematic reviews of therapeutic interventions, there is an increasing emphasis and focus on the development of methods for systematic reviews of diagnostic test accuracy studies. It is envisaged that the clinical prediction rule register would relate to Cochrane's plan to extend systematic reviews to diagnostic test accuracy studies. A register would also provide added value in terms of linkage between the evidence-based therapy resource of the Cochrane Library with evidence-based diagnostic and prognostic clinical prediction rules.

It is acknowledged that methods for producing systematic reviews of clinical prediction rules are less advanced, and not all of the methods for carrying out diagnostic test accuracy systematic reviews apply to clinical prediction rules. In particular, studies of clinical prediction rules involve different quality issues to standard diagnostic test accuracy studies, different methods of analysis, and methods for identifying relevant clinical prediction rules require further development. For these reasons, it is planned that a register of clinical prediction rules is the first step in producing systematic reviews in this process.

Elaboration on the Diet and Nutrition Subfield

Roles for the subgroup include the following:

  • Promote the conduct of Cochrane reviews of the effects of diet and nutrition on health outcomes

  • Identify primary studies of diet and nutrition and ensure that these are included in Cochrane databases

  • Raise awareness of Cochrane in the nutrition and primary care communities

  • Communicate and collaborate with individual CRGs

  • Collaborate with Cochrane Methods Groups to develop appropriate methods for including nutrition related studies into Cochrane reviews

  • Assist in the provision of evidence-based nutritional guidance in the clinical practice

Leadership in this effort was provided by:
Prof Jaap van Binsbergen (who will serve as co-ordinator for the group)
Prof Chris van Weel, Department of General Practice/Family Medicine Radboud University Nijmegen Medical Centre, The Netherlands
Prof Pieter van 't Veer, Division of Human Nutrition, Wageningen University, The Netherlands.

Since the exploratory meeting, approximately 25 Nutritionists, General Practitioners, Epidemiologists, and Methodologists from: The Netherlands, United Kingdom, Australia, Japan, Canada, United States, Finland and New Zealand have signed on as members of the new group. A stable funding source for the subgroup is currently being sought.