Notes on Evidence-Based Practice and Quality Medical Practice

Overview of Evidence-Based Practice (EBP) and Quality Medical Practice (QMP)
  • QMP Definition: Quality Medical Practice integrates Evidence-Based Practice and focuses on Quality and Safety in healthcare delivery.
  • Key Components:
    • EBP = Evidence Based Practice
    • Q&S = Quality and Safety
QMP Course Structure
  • Phases of QMP:
    • Phase 1: Focus on foundational knowledge of Evidence-Based Medicine (EBM) and data understanding.
    • Other activities: Lectures, tutorials, practical sessions focusing on research skills, critical appraisal, bias, and understanding statistical tests.
What is Evidence-Based Medicine/Practice (EBM)?
  • Definition: EBM integrates best research evidence, clinical expertise, and patient values.
    • Importance of strong empirical evidence versus weak opinions or beliefs.
  • Components of EBM:
    • Doctor
    • Patient
    • Literature
Importance of Patients in EBM
  • Patient Characteristics: Consider their needs, values, and preferences as integral to clinical decision-making.
Role of the Doctor in EBM
  • Doctors must use clinical expertise to evaluate patient states and tailor interventions considering risks and benefits.
Research and Evidence in EBM
  • EBM should be based on rigorous and relevant research, utilizing peer-reviewed sources to ensure validity and ethical standards.
Examples of EBM in Practice
  1. Cardiac Arrhythmias:
    • 1980s study on new anti-arrhythmic treatments revealed high mortality associated with some medications, highlighting the importance of evidence over assumptions.
  2. COVID-19:
    • Examination of alternative treatments when vaccines were not yet available, stressing the need for reliable sources of information.
Challenges in EBM
  • An overwhelming amount of information (e.g., hundreds of thousands of articles on a single topic) complicates the practice of EBM.
  • Continuous monitoring and appraisal of literature is necessary to ensure that new evidence is effectively integrated into practice.
The Five Steps of EBM
  1. Asking: Formulating clear, specific clinical questions.
    • Examples:
      • Magnitude: How common or serious is this issue?
      • Aetiology: What causes this condition?
      • Diagnosis: How should we best diagnose it?
      • Therapy: What is the most effective treatment?
      • Prognosis: What is the expected progression of this condition?
  2. Acquiring: Finding relevant data and research through databases like Medline and Cochrane reviews.
  3. Appraising: Evaluating the evidence found and determining its applicability to clinical practice based on safety and efficacy.
  4. Applying: Discussing treatment options with patients, integrating their values into the care plan.
  5. Assessing: Monitoring the patient’s response to treatment and making necessary adjustments.
PICO System for Clinical Questions
  • A structured approach to frame clinical questions effectively:
    • P: Population/Patient
    • I: Intervention
    • C: Comparison/Control
    • O: Outcome
  • Example Case:
    • Patient: 3-year-old with fever and cold.
    • Intervention: Suggest treatment options.
    • Comparison: Standard care advice.
    • Outcome: Improvement in symptoms.
Implementing Evidence-Based Practice
  • Despite knowing the best practices, challenges in effectively applying them in clinical settings arise. Continuous evaluation and adaptation of strategies are essential for successful implementation.
Summary
  • QMP's relationship to EBM: EBM is a foundation for QMP, aiming to provide safe, high-quality healthcare.
  • Five Steps of EBM: Asking, Acquiring, Appraising, Applying, and Assessing.
Homework and Additional Resources
  • Complete Adaptive Tutorial on EBP before the practical class.
  • Participation in practical sessions focusing on PICO methodology and statistical analysis.
  • All resources are available in the QMP Moodle.