METHODOLOGY AND FIRST TWO YEARS OF EXPERIENCE WITH PURLS: A NEW

TERTIARY LITERATURE REVIEW SYSTEM

Kate Rowland, MDUmang Sharma, MD

University of Chicago Department of Family Medicine

Keeping up with the literature

• Challenges: volume, variable quality, feasibility• Incorporation of new research into practice

notoriously slow• Need an efficient system to stay up to date• Existing secondary systems still high volume– EvidenceUpdates (BMJ)– DynaMed weekly updates– InfoPoems

Origins of primary care research

• Where is research impacting primary care physicians done?

• Who funds such research?• Who are the researchers completing such

studies?• Where is such research published?

Introducing PURLs

• Priority Updates from the Research Literature• Tertiary system designed for efficiency and

completeness• Planned, developed, and tested between

2005-2007• First PURLs published in 2007

PURLs criteria

1. Scientifically valid2. Relevant to Family Medicine3. Applicable in a Medical Care Setting4. Immediately implementable5. Clinically meaningful6. Change in practice

PURLs processes

Nomination Decision to review

Critical appraisal

Discussion; criteria

checklist

Decision to submit

PURLs process: potential PURL review

• Standardized critical appraisal forms• Review of secondary literature sources• PURL criteria checklist• 1-3 potential PURLs per week• 1-3 hours for reviewer per article

Medical literature: July 07-August 09Entered in Medline: 1,636,215

Seen by nominators: 44,114

Nominated: 283

Reviewed: 81

Submitted: 34

Rejected: 3

Published: 31

Journal SourceJournal of the American Medical Association 6New England Journal of Medicine 5British Medical Journal 3Lancet 3Archives of Pediatric & Adolescent Medicine 2Obstetrics & Gynecology 2Annals of Internal Medicine 1American Journal of Psychiatry 1Archives of Otolaryngology 1Allergy 1Archives of Disease in Childhood 1Archives of Internal Medicine 1Academic Emergency Medicine 1Annals of Emergency Medicine 1Explore 1Journal of Bone and Joint Surgery: American volume 1

PURL characteristicsStudy type RCT 22

Meta-analysis/ systematic review

7

Cohort study 2Population Adults 25

Pediatrics 4Both 2

Setting Outpatient 26Both in- and outpatient

4

Inpatient 1

PURL timing (days)Time from article release to nomination

33 (0-281)

Time from nomination to review

21 (7-65)

Time from review to PURL publication

123 (72-348)

Time from article release to PURL publication

178 (72-440)

Characteristics of original articlesSite of original research

International 16United States 10Both 5

Affiliation of primary researcher

Specialist 14Primary care 7Health services 3Unsure 3Primary care/specialty

1

Physical therapy 1Psychology 1

Characteristics of original articlesFunding source International

government10

Pharmaceutical company

5

Not reported 5

US government 4

International foundation/university

4

US government and pharmaceutical company

1

Conclusions

• Most research that changes primary care practice is done outside of the US, mostly by specialists, and with funding from international governments and industry.

Future directions

• PURLs project continues– 24 PURLs published in 2009 and 2010

• Similar descriptive analyses as data pool grows• Development of nationwide physician panel– What is current practice?– How do PURLs affect practice?

• Policy implications

Acknowledgments

• Bernard Ewigman, MD, MSPH, PURLs editor• Cortni Cross, PURLs project manager• Joan Nashelsky, MLS, FPIN librarian• Family Physicians Inquiries Network• The PURLs nomination team• The PURLs working group