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Published on 1 April 2003

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Patient-Oriented Evidence that MattersTM

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POEM stands for Patient-Oriented Evidence that Matters – a concept developed by David Slawson MD and Allen Shaughnessy PharmD, educators in family practice in the United States.

The majority of studies published in medical journals focus on disease-orientated outcomes (DOEs), such as aetiology, pharmacology and pathophysiology. While these studies are of interest, the relevance to the patient is often less clear.

What is a POEM?
POEMs have to meet three criteria:

  • They address a question that we face as pharmacists and doctors.
  • They measure outcomes that we and our patients care about – symptoms, morbidity, quality of life and mortality.
  • They have the potential to change the way we practise.

The difference between POEMs and DOEs is best illustrated using a recently published POEM(1) as an example – the POEM critically appraises a paper discussing the safety of COX-2 inhibitors.(2)

The POEM states that there are definite differences between COX-2 inhibitors and conventional NSAIDs, mainly in the development of fewer endoscopically identifiable ulcers.

However, the POEM emphasises that these ulcers do not consistently translate into pain or more serious ulcers and are not indicators of harm. More importantly, the POEM draws attention to the possible harms mediated by the effect of COX-2 inhibitors on prostaglandins, which could include an increase in thrombotic events, worsening heart failure and impaired fracture healing.

The POEM suggests that it is these more important patient-oriented outcomes that require consideration by doctors and pharmacists, and in particular the effect of COX-2 inhibitors on all-cause mortality, and concludes by saying that COX-2 inhibitors have serious potential harms that have been minimised in drug company-sponsored research reports.

POEMs – the “bottom line”
POEMs are selected by searching the current issues of 102 premier medical journals looking for relevant studies, potential POEMs, which are then evaluated for validity These POEMs are then synopsised in 200–300 words.

The POEM is written in a no-nonsense conversational style that breaks with medical convention, but in a style designed to have maximum impact on the reader. The following is copied from the website:(3)

“We try to put the most important nuggets in the bottom line, with additional information in the body of the synopsis. Research on our synopses has shown that most people read the bottom line first and then the synopsis, but only if they are interested in knowing the details. In the bottom line we occasionally refer to other studies and pull this particular study into context with the other evidence out there. We wish to avoid ‘medical gossip’ whereby a clinician will act on information from only one study, not being aware of the entire ‘conversation’ of other studies, and actually harm a patient with inappropriate information.”

InfoRetriever & DailyPOEMs
InfoRetriever (http://www.infopoems.com) simultaneously searches the complete POEMs database along with seven additional evidence-based databases, including the complete set of Cochrane abstracts, the Five-Minute Clinical Consult (including photos), plus clinical calculators and NNT tables. DailyPOEMs are delivered daily by email as a clinical awareness service to ensure the clinician is alert to new information that will affect patient care.

InfoRetriever therefore provides the busy clinician with the best available information – whether it be a meta-analysis of RCTs, a systematic review of studies related to a topic, a summary of a single, recent well-designed study or simply expert opinion, to which the clinician can then apply his or her own knowledge, abilities and judgement to ensure the best-quality care is delivered to his or her patient.

InfoRetriever is available via desktop, laptop, tablet PCs, Internet or PDA (Pocket PC and Palm OS). Demonstrations of all formats are available via the website.

References

  1. Harms outweigh benefits of COX-2 for many patients. InfoPOEM synopsis of: Wright JM. The double-edged sword of COX-2 selective NSAIDs. CMAJ 2002;167:1131-7. Available from URL: http://www.InfoPOEMs.com (accessed 3 February 2003).
  2. Wright JM. The double-edged sword of COX-2 selective NSAIDs. CMAJ 2002;167:1131-7.
  3. Available from URL: http://www.Info POEMs.com (accessed 3 February 2003).


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