Evidence Based Practice

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Evidence Based Practice

Began developing and growing as a ‘movement’ in the late 80’s. Sacket et al (2000) definition: “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research”. The definition is carefully phrased it that it is trying to strike a balance between clinical evidence and clinical expertise.

The integration of the best available research evidence with clinical expertise and patient values. Health professionals need to be able to evaluate research evidence for its use in daily practice – this is an important part of the lifelong learning of any professional (evidence based practice is based on the self directed learning model).

The practice of evidence based practice :
Step 1: - convert the need for information into an answerable question
Step 2: - tracking down the best evidence with which to answer that question
Step 3: - critically appraise that evidence for its validity, impact, and applicability
Step 4: - integrating the critical appraisal with our clinical expertise and with our patient’s unique biology, values, and circumstances
Step 5: - evaluating our effectiveness and efficiency in executing steps 1 – 4 and seeking ways to improve them both for next time

Common misconceptions of evidence based medicine (adapted from Sackett et al, 2000):
1) Its what we’ve always done – (not well founded due to the more recent easy access to electronic databases; many practitioners take little or no time to review current evidence)
2) It will replace clinical judgment - (needs to be combined with good clinical judgment)
3) I don’t have time for it – (can be initiated with little work)
4) It will lead to ‘cookbook’ medicine -

Weakness of evidence based approach` approach:
• Ignores clinical experience
• Patient choices and wishes are not taken into account
• Can be time consuming
not enough valid RCT's (or systematic reviews)
clinical trials reflect the average effect of an intervention

 

Rationale for applying evidence based medicine to medical education and clinical practice :
• Increasingly available new evidence can and should lead to major advances in patient care
• practising physicians often do not obtain available relevant evidence
• medical knowledge and clinical performance deteriorate with time
• traditional continuing medical education is insufficient and generally does not improve clinical performance
• evidence based medicine can keep the physician up to date

Opposition to the concept of evidence based practice is often on ideological grounds

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