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The Evidence-Based Primary Care Handbook.
  1. Richard Baker
  1. Director, University of Leicester School of Medicine, Clinical Governallee Research & Development Unit, Faculty of Medicine, Leicester LES 4PW, UK

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    Mark Gabbay, editor. (Pp 314; £19.50). London: Royal Society of Medicine, 1999. 1 85315 415 6

    A flood of publications followed the introduction of evidence-based practice to this country in the mid 1990s and many of the books were concerned with explaining the subject in primary care. Perhaps this reflects particular interest in the topic in a discipline that had not previously believed it had an evidence base to justify its patterns of practice. Whatever the reasons for the initial interest, there has been an inevitable backlash. The criticisms of evidence-based practice now range from detailed technical points, through the difficulty of blending evidence and patient preferences within clinical decisions, to heated emotional reactions that are difficult to interpret. At the present stage of the natural history of evidence-based practice a balance is being struck as the methods are assimilated.

    The earlier books concentrated on methods, in particular those that an individual clinician professional would require. Book after book explained the process of seeking and appraising evidence and applying it in practice. The Evidence-Based Primary Care Handbook is the first of a second generation of publications on the topic and is therefore a welcome step forward in the debate about the place of evidence-based practice in daily health care.

    The first five chapters are perhaps the least helpful. These present a general introduction to the methods of evidence-based practice that can be found in more detailed form in earlier books. For example, guidance on or how to implement clinical guidelines can be found elsewhere. However, from chapter 6 onwards the situation changes. We are introduced to the role of evidence-based practice in learning and development, and issues such as patient consent and patient involvement are discussed. There is an excellent chapter on fundamental statistics. Then begins a section concerned with commissioning, health economics, and the use of evidence to make the best of limited resources. This is essential material for primary care groups and trusts. The book is rounded off by a series of practical examples of the use of evidence in primary care, including discussion of prostate screening illustrated with decision analysis, a chapter on whether or not to treat urinary tract infection, and an investigation of treatments for mastalgia.

    If you are already familiar with the concepts of evidence-based practice, miss the first five chapters and enjoy the rest. If you are new to evidence-based practice, you may find the first five chapters helpful although perhaps they do not contain as much detail as some of the earlier books concerned principally with methods. Either way, those leading primary care groups or trusts have much to gain from the later sections of the book.

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