Introducing POEMs - Editorials - Patient-Oriented Evidence that Matters

Author: Allen F. Shaughnessy, Jay Siwek
Date: March 15, 2003

In this issue of American Family Physician, we are pleased to introduce an ongoing feature called POEMs, a series that may already be familiar to many of our readers. The acronym POEMs, which stands for Patient-Oriented Evidence that Matters, refers to summaries of valid research that are important to physicians and to their patients. Ideally, POEMs represent information that has the potential to change the way physicians practice medicine.

Many of us suffer from "information overload" because there simply is too much new medical information available to process. The POEMs concept provides a filtering system, screening out most research findings and leaving only information that is correct and relevant to everyday practice.

What type of study qualifies for a POEM? A POEM is valid research that answers "yes" to the following three questions:

* Did the research focus on an outcome that patients care about (e.g., morbidity, mortality, quality of life)?

* Is the problem that has been studied common and is the intervention feasible?

* Does the information have the potential to change the practice of many physicians?

The most important aspect of a POEM is that it provides information that matters to our patients. Patients come to us with the understanding that what we do for them, or what we ask them to do, will help them to live longer, better, or both. Our goal is to do just that.

However, much of the information available to us in medical journals is on the pathophysiology, etiology, and prevalence of disease, and on the mechanism of action of drugs. While this information is often helpful, it may or may not help us to do what is best for our patients. This information told us that hormone replacement therapy lowers low-density lipoprotein cholesterol levels in women, that short-acting calcium channel blockers lower blood pressure, and that the cyclo-oxygenase-2 (COX-2) inhibitors selectively inhibit inflammatory mechanisms of the COX-2 isoenzyme while preserving mucosal integrity. All of these intermediate findings were determined to be misleading when new, better-designed trials reported on patient-oriented outcomes. These POEMs contradicted the earlier information that focused on disease processes rather than relevant outcomes.

POEMs come from research published in more than 100 clinical journals. Each month a team of family physicians and educators comb through this literature looking for results that are relevant and immediately applicable to practice. Potentially relevant research findings are identified and evaluated for validity ( cfm). The valid POEMs are summarized, reviewed, revised, and compiled into InfoRetriever, part of the InfoPOEMs Clinical Awareness System (

POEMs are similar to AFP's "Tips from Other Journals" department in that they summarize research articles from other journals. Both share similar purposes, namely to update family physicians on important new developments in common clinical problems and provide information that physicians can use in day-to-day practice. But, how do they differ? For one thing, the criteria for "Tips" are somewhat broader than the criteria for POEMs. Tips may include tables and figures from the original article. On the other hand, POEMs are derived from a larger number of journals, they are more likely to cover the most clinically important, outcomes-oriented research findings, and they undergo strict validity assessment of the research. These findings are presented in a structured format, including a level-of-evidence score, and are always accompanied by an editorial commentary (see the accompanying table).

Each issue of AFP will feature four or more POEMs, some taking the place of Tips. If our readers find these useful, the number will increase. We hope you will read and enjoy the POEMs in each issue and will take a moment to give us your feedback.

Comparison of Tips and POEMsCriteria Tips POEMsDiscusses a common clinical problem in family practice Yes YesReports on a new development Yes YesProvides practical pointers for day-to-day practice Yes YesAllows focus on pathophysiology, etiology, basic science Yes NoAllows summary of review article Yes NoHas a rigorous methodology for article selection No YesSpecifies levels of evidence for the research design No YesFocuses on clinically important outcomes (e.g., morbidity, mortality, quality of life) Optional RequiredPresented in an explicit, structured format No YesIncludes tables, figures from the original article Occasionally RarelyProvides editorial commentary Occasionally AlwaysNumber of journals reviewed 30 to 60 100Written by family physicians and family practice educators Yes Yes

Allen F. Shaughnessy, Pharm.D., is a contributing editor to American Family Physician; senior medical editor, InfoPOEM, Inc.; director of research at Harrisburg Family Practice Residency in Harrisburg, Pa.; and director of medical education, Pinnacle Health System, Harrisburg.

Jay Siwek, M.D., is editor of American Family Physician and professor and chair in the Department of Family Medicine at Georgetown University Medical Center, Washington, D.C.

Address correspondence to Allen F. Shaughnessy, Pharm.D., Harrisburg Family Practice Residency, 2501 N. Third St., Harrisburg, PA 17110 (e-mail: Reprints are not available from the authors.

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