Evidence Based Medicine

In the information age, clinicians are presented with a daunting number of diseases and possible treatments to consider as they care for patients each day. As knowledge increases and as the technology

for accessing information becomes widely available, healthcare professionals or pharmacists are expected to stay current in their fields of expertise and to remain competent throughout their careers. In addition, the number of information sources for the typical practitioner has ballooned, and clinicians must sort out information from many sources: college courses and continuing education (including semi-
nars and journals), pharmaceutical representatives, and colleagues,
as well as guidelines from committees of healthcare facilities, governmental agencies, and expert committees and organizations.

How does the healthcare professional find valid information from such a cacophony?

Increasingly, clinicians are turning to the
principles of evidence-based medicine (EBM) to identify the best course of action for each patient. EBM strategies can help healthcare professionals or pharmacists to ferret out these gold nuggets, enabling them to integrate the best current evidence into their pharmacotherapeutic decision making. 

These strategies can help physicians, pharmacists, and other healthcare professionals to distinguish reliably beneficial pharmacotherapies from those that are ineffective or harmful.

Also, EBM approaches can be applied to keep up-to-date and to make an overwhelming task seem more manageable.
This chapter describes the principles of EBM, offers guidance for finding EBM sources on the World Wide Web, provides a model for applying EBM in patient care, and explains how EBM strategies can help a pharmacist stay current.

WHAT IS EVIDENCE-BASED MEDICINE?

EBM is an approach to medical practice that uses the results of patient care research and other available objective evidence as a
component of clinical decision making. Similarly, evidence-based pharmacotherapy, defined by Etminan is an approach to
decision making whereby clinicians appraise the scientific evidence and its strength in support of their therapeutic decisions.

Although few will argue against the necessity for basing clinical decisions on the best possible evidence available, considerable controversy actually surrounds the practice of EBM. Critics note that not all questions relevant to the care of a patient are of a scientific nature and that EBM favors a “cookbook” approach. In fact, EBM integrates knowledge from research with other factors affecting clinical decision
making.

EBM does not replace clinical judgment. Rather, it informs clinical judgment with the current best evidence. The expertise and
experience of the clinician who understands the disease are crucial in determining whether the external evidence applies to the patient and whether it should be integrated in the therapeutic plan. Also, nonmed-
ical factors affect decision making, such as the patient’s preferences and readiness and the healthcare delivery system’s characteristics.

Other critics state that EBM considers randomized controlled trials (RCTs) as the only evidence to be used in clinical decision making. Actually, EBM seeks the best existing evidence, from basic science to
clinical research, with which to inform clinical decision.

For example, a decision about the accuracy of a diagnostic test is best informed by evidence from a cross-sectional study, not a RCT. A cohort study, not a RCT, best answers a question about prognosis.

However, in selecting a treatment, the RCT is the best study design to provide the most
accurate estimate of treatment efficacy and safety.

www.wildadmire.wordpress.com
Medicoadmire.blogspot.com
Wildadmire.blogspot.com