Physicians Have Mixed Feelings About Comparative Effectiveness Research

October 19, 2010

October 19, 2010 — Most physicians believe that comparative effectiveness research (CER) — the science of comparing tests or therapies for the same condition — will improve the quality of care but limit their clinical freedom at the same time, according to a letter published in the October 19 issue of the Annals of Internal Medicine.

By one estimate, the federal government will spend $500 million a year on CER by 2014 as a result of the new healthcare reform law. The incongruent findings discussed in the letter, drawn from a 2009 national survey, suggest that reformers need to win over more medical hearts and minds.

Proponents of CER say it will steer physicians to the best drugs, medical devices, and tests and cut costs in the process. Critics, many of whom are physicians, are afraid CER will lead to ham-handed rationing of healthcare for the sake of balancing the federal budget.

Federal CER work will be focused in the Patient-Centered Outcomes Research Institute, created under the new healthcare reform law. Fears of rationing prompted Congress to draft the law so that the institute's findings may not be construed as mandates, guidelines, or recommendations for payment, coverage, treatment, or denial of care.

Southern Physicians Most Dubious About CER

All of this controversy is a backdrop for the survey, conducted by Salomeh Keyhani, MD, MPH; Mark Woodward, PhD; and Alex Federman, MD, MPH. The authors found that 56.5% of physicians agreed that national guidelines should be developed to influence clinical practice, and 77.8% affirmed that guideline writers should rely on CER. In addition, 55.2% said they believed that CER would improve the quality of care.

However, 65.7% also agreed with the statement, "Comparative effectiveness data will be used to restrict my freedom to choose treatments for my patients." Physicians who were more prone to express apprehension were osteopathic physicians, surgical and medical specialists, physicians who owned their own practices, and physicians in the south.

Southern physicians stood out in other ways. In contrast to their peers elsewhere, less than half of them favored the development of practice guidelines (48.8%) or thought that CER would improve patient care (48.7%).

Salomeh Keyhani, MD, MPH, and Alex Federman, MD, MPH, received grant support from the Robert Wood Johnson Foundation.

Ann Intern Med. 2010;153:551-552.

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