SELF-CARE FINAL

Explain the importance of EBP in pharmacy practice

Ensures accurate, current, and clinically relevant decision-making

Describe the 5As of the EBP procesS

ASK: Ask & frame the question

ACQUIRE: Acquire the evidence

APPRAISE: Appraise the evidence

APPLY: Apply & integrate the evidence with our clinical expertise and patient values and circumstances

ACT: Implement your plan, assess your own performance of EBP

Describe, identify and create a background and a foreground question

BACKGROUND QUESTION

☼ general knowledge about a medical condition or drug therapy

☼ pathophysiology, anatomy, biology, drug-related questions

☼ mostly able to answer by using tertiary resources

What causes hypertension?

FOREGROUND QUESTION

☼ specific knowledge to inform clinical decision or action

☼ mostly answer with primary resources

☼ 4 Essential Components: PICO

How does Lisinopril compared to Amlodipine affect BP control?

IV DRUG COMPATIBILITY / STABILITY

☼ Trissel’s (Gold Standard)

[through Lexi & Micromedex)

DRUG COMPOUNDING

☼ Remington

PREGNANCY & LACTATION

☼ Briggs (Gold Standard) [through Lexi]

☼ Micromedex & LexiComp

DRUG INTERACTIONS

☼ Micromedex & LexiComp

NATURAL / HERBAL

☼ Natural Medicines (NatMed Pro)

PEDIATRICS

☼ Harriet Lane Handbook

GERIATRICS

☼ Merck Manual of Geriatrics

☼ Geriatric Dosing Handbook

Best resources for background questions

Tertiary resources and textbooks

Best resources for foreground questions

Primary and secondary literature

PICO

Framework for developing focused clinical questions

P: Patient Population

I: Intervention or Exposure

C: Comparison Intervention

O: Outcome

EXAMPLE CASE

 A 55-yo woman with a history of type 2 diabetes mellitus and

hyperlipidemia, presents to your pharmacy. Her glycemic control is excellent on metformin, but her cholesterol level has been running high. She has been trying diet and exercise for the past 4 months, but that did not have a major impact on her cholesterol level. She is Interested in trying garlic instead and would like to get your opinion regarding that.

P: Adult patient with hyperlipidemia

I: garlic

C: Exercise and diet

O: Cholesterol level

Types of foreground questions

Therapy, harm, diagnosis, prognosis

Best study design for therapy questions

Randomized controlled trials

Best study design for harm questions

Observational studies

Best study design for prognosis questions

Cohort studies

Best study design for diagnosis questions

Diagnostic accuracy studies

EBP resources pyramid

Hierarchy of evidence from summaries to original studies

Summaries in EBP pyramid

UpToDate, DynaMed

Pre-appraised research

Systematic reviews and synopses

Non-preappraised research

Original research studies

Primary literature

Original clinical research studies

Secondary literature

Indexes and abstracts of primary literature

Tertiary literature

Summarized and synthesized information

PubMed

Type of resource: secondary literature database

 Results limited to EXACT keywords found in the title and the abstract

EMBASE

Type of resource: secondary literature database

MeSH terms

Standardized indexing terms used in PubMed

Boolean operators

AND, OR, NOT

Wildcard operator

Searches for multiple spellings

Patient-important outcomes

Outcomes reflecting how patients feel, function, or survive

5 Ds of outcomes

Death, Disease, Discomfort, Disability, Dissatisfaction

→ want to PREVENT, CURE, REDUCE

Surrogate endpoint

Laboratory or physical marker used instead of clinical outcome

Surrogate endpoints often DO NOT translate 

into positive clinical outcomes