17-11-22 - Why use evidence-based medicine? Flashcards
Learning outcomes
- Explain why evidence-based medicine is an important part of modern medicine
- Explain the principles of EBM
- Summarise the pros and cons of the EBM approach
- List the key steps in the process of applying EBM
What Is the primary purpose of the NHS?
Why is evidence-based medicine important for this?
- The primary purpose of the NHS is to secure, through resources available, the greatest possible improvement in the physical and mental health of the population
- Evidence based medicine (EBM) is important for this, as there is a limited number of resource so we need to ensures that we are making the most out of these resources and developing the most efficacious treatment
What is a definition for EBM/EBP (evidence-based practise)?
- Sackett et al (1996) define EBP as ‘ the conscientious, explicit and judicious use of current best evidence in making nursing decisions about the care of individual patients’
- Carnwell (2001) defines EBP as ‘[the] systematic search for, and appraisal of, best evidence in order to make clinical decisions that might require changes in current practice, while taking into account the individual needs of the patient.’
What should clinical decisions be informed by?
- ‘Clinical decisions should […] be informed by up-to-date, relevant and robust evidence rather than outdated primary training or over interpretation of individual patient experiences (Donald & Greenhalgh, 2000; Sackett et al., 2000)
What are 4 things that make good clinical research?
- 4 things that make good clinical research:
1) Production of evidence through scientific research and review
2) Production and dissemination of evidence based clinical guidelines
3) Implementation of evidence based, cost effective practice through education and change management
4) Evaluation of compliance with practice guidance through clinical audit
What are 2 stages of management of change?
- 2 stages of management of change:
1) Strategic
* NICE, Scottish Medicine Consortium, All Wales Medicine Strategy Group use EBM principles to formulate Health Technology Assessments (HTAs) which determine which treatments should be available within the NHS
2) Implementation
* Primary care and hospital trusts formulate prescribing, care pathways and guidelines based on HTAs
What is an example of when EBM was used to implement treatment into the NHS?
When is an example of when EBM was used to prevent treatment from being implemented into the NHS?
- Example of when EBM was used to implement treatment into the NHS:
- Wearable glucose monitors will be made available to tens of thousands more people with type 1 diabetes from April 2019, NHS England has announced
- Example of when EBM was used to prevent treatment from being implemented into the NHS:
- NHS will not pay for ‘life-changing’ migraine drug
- NICE confirmed a decision to reject the drug on the grounds that it was not cost-effective, citing concerns that the type of patients used in clinical trials did not fully reflect those seen in the NHS
What are 3 principles of EBM?
- 3 principles of EBM:
1) High quality health care rests on objective and clinically relevant information
2) There is a hierarchy of evidence where some types are stronger than others
3) Scientific data alone is not a sufficient basis for making clinical decisions about individual patients
Why do we apply EBM?
What is an example of a medication being prescribed more in the UK?
What did EBM find to be a side-effect off this medication?
How was this adjusted for?
- We apply EBM so we can use the best evidence in the scientific literature to provide the best care for an individual patient
- The medication methylphenidate (Ritalin) was also prescribed more in the UK between 1995 and 2012
- There was variation in prescribing rates between countries and within countries
- Consultant psychiatrist Professor Tim Kendall, who has compiled national guidelines on treating ADHD, on BBC Radio 4’s Today programme when asked if there are any dangers to people who take methylphenidate drugs over a long period,
- Prof Kendall said: ‘In children, without doubt. If you take Ritalin for a year, it’s likely to reduce your growth by about three-quarters of an inch. There is also increasing evidence that it precipitates self- harming behaviour in children In the long term we have absolutely no evidence that the use of Ritalin reduces the long-term problems associated with ADHD.’
- The retardation of growth was found to be true from EBM, so Ritalin is prescribed as an ADHD medication for those over the age of 6, and careful measurements are taken to try to prevent this growth stunting
- This also highlights how careful the medical community has to be when talking about evidence-based medications
Why is EBM now essential? (4 reasons)
- EBM is now essential because daily requirement for correct answers to questions about:
1) The effects of therapy
2) The utility of diagnostic tests
3) The prognosis of diseases
4) The aetiology of disorders
- E.g high blood pressure – how does this affect the prognosis for other conditions
What are 5 opponents and proponents of EBM (in picture)?
What are 5 opponents and proponents of EBM (in picture)?
What are the 6 steps in practising EBM?
- 6 steps in practising EBM:
1) Ask
* Craft a clinical question (PICO)
* Patient comes in with problem
* We need to ask a question to probe the literature
2) Search
* Look through the medical literature (medical informatics)
3) Acquire
* Find the study that will best answer the question
4) Appraise
* Perform a critical appraisal (check for validity and bias)
5) Apply
* Determine how the results will help you care for your patient
6) Act and assess
* Evaluate the results in your patient or population
What do we need to practise EMB?
- To practise EBM, we need understand what clinical evidence is stronger than others
- In an ideal world, we would use Metanalysis and systematic reviews
- In many situations, especially in the case of new treatment, these are not available
- We need to come further down the pyramid and see what we can learn from these resources
- Only after integrating all of this information, then we are in a place to apply EBM to clinical practise
