L1 - EBM

Introduction to Evidence-Based Medicine (EBM)

• Lecture Overview: Introduction to EBM principles for therapeutic decision making.

• Learning Outcomes:

  • Describe principles of EBM and its application in decision making.

  • Identify strategies for integrating clinical research with patient values.

  • Explain significance and methods for conducting medication reviews.

  • Apply critical appraisal skills to evaluate evidence in case-based scenarios.

Definition of Evidence-Based Medicine

• Definition: EBM integrates research evidence, clinical experience, and patient preferences to optimize care and outcomes.

• Application in Pharmacy: Utilization of current, high-quality research to select appropriate drug therapies.

• Components of EBM:

  • Research Evidence: High-quality data from clinical trials, systematic reviews, and meta-analyses.

  • Clinical Experience: Knowledge of medications, interactions, and pharmacokinetics.

  • Patient Preference: Respecting cultural, personal, and health priorities to ensure adherence and optimal outcomes.

Clinical Decision Making

• Importance: Facilitates effective personalized care leading to improved patient outcomes.

• Five Main Steps of Applying EBM in Clinical Practice:

  1. Develop a clinically relevant question (PICO format).

  2. Explore reliable evidence sources (e.g., PubMed, national guidelines).

  3. Evaluate evidence for validity, relevance, and practicality.

  4. Apply evidence with clinical experience and patient preferences.

  5. Assess treatment impact and monitor patient outcomes.

PICO Format Explained

• P: Patient or population – Define the target group.

• I: Intervention – Specify the treatment being evaluated.

• C: Comparison – Identify alternative treatments.

• O: Outcome – Determine the desired effect of the intervention.

• Example: For patients with severe headache, compare ibuprofen to standard paracetamol in terms of pain intensity reduction.

Levels of Evidence

• Evidence Pyramid: Ranks evidence based on reliability and quality.

• Types of Evidence:

  • Secondary Evidence:

    • Filtered or pre-appraised evidence (systematic reviews, meta-analyses, evidence summaries).

  • Primary Evidence:

    • Original studies like RCTs, cohort studies, and case studies.

• Systematic Reviews vs. Meta-Analyses:

  • Systematic Reviews summarize and appraise existing research, whereas Meta-Analyses statistically combine study results for stronger conclusions.

  • Caution regarding potential misinterpretation if methods are flawed or data is too diverse.

Limitations of Meta-Analysis

• Publication Bias: Favorable outcome studies more likely to be published.

• Quality of Included Studies: Flaws in methodology can compromise reliability.

• Limited Generalization: Results may not apply universally across diverse demographics.

Other Types of Evidence

• Critically Appraised Topics (CATs): Brief summaries on best available evidence for focused questions.

• Randomized Controlled Trials (RCTs):

  • Design: Two groups (treatment vs control) with random assignment to reduce bias.

  • Blinding: Participant and/or researcher unaware of treatment status to prevent bias.

  • Limitations: High cost, potential ethical issues, and selection biases.

• Cohort Studies: Observational studies examining exposures and outcomes over time, can be retrospective or prospective.

• Case-Control Studies: Compare individuals with a disease to those without, to calculate odds ratios, useful for rare diseases.

• Case Series/Reports: Document unusual cases or unique presentations, serving as hypotheses for further research.

Application of Evidence

• Clinical Guidelines: Systematically formulated statements aiding practitioners and patients in healthcare decision-making, such as therapeutic guidelines.

• Integration: Apply best available evidence to individual patient care while considering clinical judgment and patient preferences.

• Goal of EBM: Enhance medical outcomes through valid scientific evidence, experienced application, and value considerations.

Challenges and Conclusion

• Barriers to EBM: Limited access to evidence, time constraints, and difficulty interpreting complex data may hinder implementation in practice.

• Role of EBM in Pharmacy: Empowering pharmacists to make informed decisions on medication management to improve patient care and minimize errors.