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What is Evidence Based Medicine
It is the integration of:
- Best research
- Clinical expertise
- Patient values
It is used to stay current and involves the process of self-directed lifelong learning.
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Why use evidence based medicine
It improves quality care through determining:
- Practices that work and promoting them
- Practices that are ineffective and eliminating them
It helps health care professionals to find, appraise and use new research in their clinical practice.
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5 step EBM model
- Formulate answerable questions
- Find the evidence needed
- Critically appraise evidence
- Apply the research
- Evaluate the results
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Step 1: Formulate answerable clinical questions
Use the PICO format to structure questions:
- P -> Identify the patient or problem
- I -> What intervention do you want to try
- C -> What other alternative intervention are you comparing yours to?
- O -> How will you measure the outcome? Ex. time spent in hospital
An example of a PICO-question:
- P - In baby with viral bronchiolitis at the age of four months
- I - does giving corticosteroids
- C - compared to not administering corticosteroids
- O - better clinical score and make the length of the hospital stay shorter?
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Step 2: Finding the evidence
Traditional sources like textbooks are usually out-of-date and too disorganized. Experts can be consulted. Secondary sources that can be used are "Archimedes", "Clinical evidence" and "BestBets". They give reliable summaries of evidence. You can also consult online electronic bibliographic databases. They search thousands of journals in a short time.
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Basic Search Principles
- Formulate a question using the PICO format.
- Generate keywords - use the PICO format to generate a keyword for the problem, intervention, comparison and outcome.
- Chose a bibliographic database:
- Cochrane has systematic reviews
- Medline is administrated by die National Library of Medicine in the USA. The version, PUBMED, is available cost-free.
- Secondary sources named under step 2 can also be used
4. Conduct the search using the boolean operators "AND" or "OR"
- AND = only articles containing both terms
- OR = articles containing either term
If too many papers are found, use PUBMED to limit the results.
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Step 3: Appraising the evidence
3 main areas to appraise:
- Validity
- Importance
- Applicability to patient
The Critical Appraisal Skills Program (CASP) can be used to appraise research articles.
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Step 4: Apply the evidence
Consider the following:
- Can evidence be applied to the specific patient?
- What is patient's personal values and circumstances?
- What are the efficiency and risks of the treatment?
- What is the cost and availability of the treatment?
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Step 5: Evaluating performance
- Evaluate your approach frequently
- Do you need to improve any of the first 4 steps?
- Is your approach a rational and acceptable management strategy?
- Is EBM improving patient care?
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