STEPPED CARE: AN EvIDENCE-BASED APPROACH TO DRUG THERAPY

Editors' Note: This month we continue the new featureSTEPped Care: An Evidence-BasedApproach to Drug Therapy. These articles are designed to provide concise answers to the drog therapy questions that family physicians encounter in their daily practice. The format of the feature will follow the mnemonic STEP: safety (an analysis of adverse effects that patients and providers care about), tolerability (pooled dropout rates from large clinical trials), effectiveness (how well the drogs work and in what patient population[s]), and price (costs of drog, but also cost-effectiveness of therapy). 1 Hence, the name STEPped Care. Since the informatics pioneers at McMaster University introduced evidence-based medicine,2 Slawson and Shaughnessy3,4 have brought it to mainstream family medicine education and practice. This feature is designed to further the mission of searchingfor the truth in medical practice. Authors will provide information in a stroctured format that allows the readers to get to the meat of a therapeutic isSlle in a way that can help physicians (and patients) make informed decisions. The articks will discourage the use of disease-uriented evidence (DOE) to make treatment decisions. Exampks of Doer include blood pressure lowering, decreases in hemoglobin Ale> and so on. We will include studies that provide POEMspatient-oriented evidence that matters (myocardial infarctions, pain, strokes, mortality, ete)-with the goal of offering patients the most practical, appropriate, and scientifically substantiated therapies. Number needed to treat to observe benefit in a single patient will also be included as a way of defining advantages in terms that are relatively easy to understand. 5,6 At times this effort will be frustrating. Even as vast as the