Chapter 2 Evidence-Based Practice

Chapter 2

Buzzword

•“new deity in clinical medicine: physicians worship it, managers demand it, and policy makers aspire towards it.”

–Implies that medical clinicians have heretofore not based their practice on evidence

•Not true!!!

Phrase is new, but concept is not.

Every clinical decision is based on evidence of some kind

But some of the evidence was/is:

False or

Inaccurate for the situation, so

Decisions were inaccurate

Direct correlation between:

Quality of evidence and

Quality of health care

Evidence-Based Medicine

Medicine based on the latest and most rigorous scientific evidence, integrated with clinical experience and patient preferences and circumstance

Evidenced Based Practice

The application of the principles of EBM to patient care; health care that is based on scientific evidence; and patient preferences. Its goal is to improve the quality and effectiveness of health care.

Evidence-Based Versus Patient Centered medicine

Powerful, different, somewhat contradictory philosophies of medical care

Developed independently at about the same time

Both accepted as important

Little in common

Focused on different aspects of medical care

Evidence-Based Versus Patient-Centered Medicine (cont.)

Approaches patient care from a biomedical perspective

Based solely on scientific facts

Is a cognitive-rational enterprise

is a doctor-oriented, disease-centered model

Aims to improve quality by standardizing medical care, through clinical guidelines and best practices.

Patients treated as a group, based on major signs and symptoms

Patient uniqueness, needs, preferences, and emotional status become irrelevant

Evidence-Based Versus Patient-Centered Medicine (cont.) 3

Not either–or, but both

In 2000, efforts to bring these separate worlds together intensified.

Both are needed; must be integrated.

External clinical evidence can inform, but can never replace, individual clinical expertise.

Science cannot be ignored under the guise of being patient centered.

Becoming an Evidence-Based Practitioner

Becoming an Evidence-Based Practitioner (cont.)

A complex philosophy that evolves and develops over time

Does not happen in a week, a month, or a year.

Requires a lifelong commitment

Becoming an Evidence-Based Practitioner (cont.)

Begins with understanding the vocabulary, philosophy, and complexity of EBP

Expand your use and application of EBP philosophy during future educational and clinical classes and experiences.

Apply EBM philosophy and critically question all aspects of your practice throughout your career.

Clinical Decision Making

Process of making a diagnosis, and

Determining how to treat patients

Begins with collecting evidence from a variety of sources

Ends with a specific plan for treating the patient

Involves:

Careful analysis of, and

Critical thinking about,

The collected data and treatment option

Clinical Decision Making (cont.)

Educated guess

Can range from totally accurate to totally wrong

Ideal is:

Accurate decisions that

Lead to full, speedy resolution of patient’s disability or disease

Unfortunately, not always the case

Clinical Decision making (cont.) 3

Based on interpreting and integrating:

Clinical data

Patient preferences and actions

Research evidence

Clinician’s expertise and experience

Overrides the other three

Best Practices

No practice that is best for everyone or in every situation

Good guidelines apply to only ~80% of patients.

A given best practice only applies to a specific condition or circumstance.

May be modified or adapted for similar circumstances

Protocols

A plan or a set of specific steps to be followed

A strict process for monitoring and caring for specific conditions

Often provides a practical, step-by-step framework for implementing guidelines

Clinical Practice Guidelines

Aka Best Practice Statements, Recommendation Statements, or Health Care Guidelines

Systematically developed statements that describe best and achievable practice in specific areas of care

Reflect current scientific knowledge of practices and expert clinical judgment on best ways to prevent, diagnose, treat, or manage diseases

Guide practitioners in providing a consistent and cohesive approach to health care, and therefore improve the quality of care