EBM and Audit Flashcards
What is 5 step process of EBM
Ask - an answerable question Acquire - best evidence Appraise - critically Apply - high quality evidence to patient care Assess - how you perform
How do you form a question
PICO Patient/ population Intervention Comparison Outcome
What categories do PICO questions come under and what study is used to assess
Diagnosis - cross-sectional
Prognosis - cohort
Therapy - RCT
Harm - cohort or case control
Look at type of questions
OK
Quantitative (numerical) = PICO model
Qualitative
Diagnosis - cross sectional
Prognosis - cohort
Therapy - RCT
Harm - cohort or case control
What are observational studies
Case control
- Compare people with and without disease and look at exposure to RF
Prospective Cohort
- People without disease and follow up to see if they develop and compare exposure
Retrospective cohort
- People with disease and look back at exposure
Cross sectional
- Measures prevalence of disease and exposure in given point in time and compare to gold standard
What are interventional studies
Controlled clinical trial
- Effects of specific intervention against a control
Where can you get evidence
Textbook
SIGN guidelines
Cochrane - RCT + systematic review
Pubmed
What are sign guidelines and what are best levels of evidence to worst
Evidence based clinical guidelines
Put medical knowledge into practice
Reduce variation in practice and outcome
Based on critical appraisal of scientific literature
- SIGN provide checklist to critically appraise
Rates level of evidence
Different checklist for different studies
Best to worst
High quality meta-analysis or systematic review of RCT
Well conducted
High quality systematic review of cohort or cast control
Well conducted
Non-analytic studies
Expert opinion
What are determinants of health and health inequality
Lifestyle - smoking / diet / exercise / alcohol Socio-cultural environment Poverty and social deprivation Psychological Biological and conventional healthcare
What is socio-cultural environment
Health related behaviour linked to underlying social and economic circumstance - poverty / unemployment / poor housing
What is destitution
Absence of minimum basic resources for physical survival
What is an audit
Systematic approach to reviewing provision of healthcare and quality
Highlight area of improvement
What is audit cycle
Set standard Measure current practice Compare results with current standards Reflect, plan and change Re-audit
What are Scottish health survey’s
Provide info about lifestyles and health in Scotland
Monitor trends in RF / health behaviour
Annual
Representative of population
What do surveys collect info
General / mental health Recent Dx Prescribed medication Smoking Alcohol Fruit / veg Activity BP BMI Education Employment Ethnicity
What is data used for
Measure prevalence of RF
Compare health differences with different countries
Monitor trends
What are routine data collection in primary care
Scottish Primary Care Information Resource (SPIRE)
Prescribing Information System for Scotland (PRISM)
Data from Quality Outcomes Framework (QOF)
Data from uptake of immunisation and cervical screening
What is SPIRE
Info about consultations representative of population in terms of age, gender, deprivation, urban, rural
What is PRISM
Data on prescribed medicines dispensed into community
Used to enhance safe prescribing and reduce poly pharmacy
What is data from QOF used for
Pay GP practices for care they provide
Measure achievement of practice against evidence based indicate
What is clinical governance
A framework through which NHS organisation responsible for improving quality of services and safeguarding high standards of care
Providing high quality NHS care
Maintain high standards and continuously improve services patients receive
Identify and response to poor practice
What does clinical governance include
Clinical effictiveness
Clinical audit
Guidelines e.g. SIGN
Use of routine info about patient outcomes
Progressional development
Profressional regulation and revalidation
What is clinical effectiveness
Ensuring individual patients are offered treatment based on best available evidence
Also equity
Patients should have equal access according to need
NO postcode prescribing
What is SMC
Advises Scottish health boards about the effectiveness of all newly licensed medicines
Type of bias
Recall
- Answer questions that happened in the past
Selection
- Under-represent or over groups of population
Observational
- Aware being observed by scientists which alters answers
Confirmation
- Look for information in data that confirms ideas or opinions
Publishing
- Studies with - ve findings less likely to be published
What is discrimination
Unjust or prejudicial treatment of different categories of people
What is inequity
Lack of fairness
What is prejudice
Opinion not based on experience or reason
What is stereotype
Views of every person of group
