Evidence Based Practice Flashcards
What aspects are important when looking at evidence?
Effectiveness of the drug/practice/intervention
Cost-effectiveness
Before evidence-based practice (EBP), what factors influenced treatment?
Professional opinion
Historical practice and precedent
Clinical fashion
Organisational and social culture
Before EBP, what does research show that clinicians would often do?
Persist in using healthcare interventions that are ineffective
Fail to take up other interventions that are known to be effective
Tolerate huge variations in practice
What does EBP involve?
Integration of individual clinical expertise with best available external clinical evidence from systematic research
Why are systematic reviews needed?
Traditional, narrative literature reviews may be biased and subjective
Not easy to see how studies were identified for review
Quality of the studies reviewed was variable and sometimes poor
Useful to help to address clinical uncertainty
Can highlight gaps in research/poor quality research
Why are systematic reviews useful to clinicians?
Appraise and integrate findings - offer quality control and increase certainty
Offer authoritative, generalisable and up-to-date conclusions
Saves clinicians from having to locate and appraised studies themselves
May reduce delay between research discoveries and implementation
Helps to prevent biased decisions
Easily converted into guidelines and recommendations
How is assessing quality and evidence done?
Using a critical appraisal tool - suggests things to look for and questions to ask
Where can evidence be found?
Medical journals
EPB-specific journals
Cochrane collaboration
NHS centres for reviews and dissemination
NIHR Health Technology Assessment programme
What are the two categories of criticism of EBP?
Practical and philosophical criticisms
What are some practical criticisms of EBP?
Hard to create and maintain systematic reviews across all specialties
Challenging and expensive to disseminate and implement findings
RCTs are not always feasible
Choice of outcomes often very biomedical, may limit interventions which are trialled and therefore which are funded
Required good faith on part of pharmaceutical companies
What are some philosophical criticisms of EBP?
Population-level outcomes may not apply to an individual
Professional responsibility/autonomy
Might be seen as a means of legitimising rationing, with potential to undermine trust in the doctor-patient relationship and ultimately the NHS
Could create ‘unreflective rule-followers’ out of professionals
What are some difficulties of getting EBP into practice?
Resources not available to implement change
Evidence exists but Drs don’t know about it
Doctors know about evidence but don’t use it
Organisational systems cannot support innovation eg managers don’t have authority to invoke changes
Commissioning decisions reflect different priorities
