Evidence Based Practice Flashcards
What should health service be based on?
Health service delivery should be based on best available evidence.
What is the best available evidence?
Best evidence = findings of rigorously conducted research, evidence of effectiveness of drugs, practices and interventions and cost effectiveness.
What does variation in treatment create?
Variations in treatment create inequities.
What can influence practice that results in it not being evidence based?
Practice can be influecned too much by professional opinion, clinical fashion, histoiral practice and precedant and organisational and social culture.
Research suggests that clinicians have persisted to take up other interventions that are ineffective, failed to take up other interventions known to be effective and tolerated huge variations in practice.
What did Cochrane decide and what did it result in?
This book criticised medical profession for failing to take account of new research.
This resulted in the registration of all RCTs currently raking place or finished.
What is evidence based practice?
Evidence based practice involved the ingegration of individual clinical expertise with the best available external clinical evidence form systemic research.
Why do we need systematic reviews when we have traditional narrative reviews?
Traditional narrative literature reviews may be biased and subjective
Not easy to see how studies were identified for review
Quality of studies reviewed variable and sometimes poor
Sytematic reviews are useful – can help address clinical uncertainty
Systematuc reviews can also highlight gaps in research/poor quality research
Why are systematic reviews useful?
Systematic reviews are useful because:
• They offer both quality control and increased certainty
• Authoratative generalisable and up-to-date conclusions
• They save clinicans from having to locate and appraise the studies for themselves
• They may reducde delay between research discoveries and implementation
What do systematic reviews help prevent?
Systematic reviews help to prevent biased decisions being made, make new practices easily converted into guidelines and recommendations however, doctors need to be able to access systematic reviews and to appraise them to be satisfied about the quality of the evidence.
What are the main critiques of evidence based practice?
- Practical criticisms – around the possiblity of evidence base practice
- Is it practically possible to keep absolutely up to date?
- Is it possible to disseminate and implement the findings
- RCTs not always possible to complete due to ethical considerations
It also requires good faith by pharaceutical companies
What are the philosophical criticisms of evidence based practice?
Does not align with most doctor’s modes of reasoning
Aggregate populations level outcomes don’t mean they work for an individual
Potential to create un reflective rule followers (recipe following)
Might be understood as a means of legitimising rationing
Professional responsibility/autonomy
What are the main problems trying to achieve evidence based practice?
- Doctors don’t know about the evidence due to dissemination problems – doctors not incentivised to keep up to date
- Doctors know about the evidence but don’t use it – habit, organisational failure, professional judgement
- Organisational systems cannot support innovation – manager lack influence to invoke changes
- Commissioning decisions reflect different priorities – what if patients say they want something else
- Resources not available to implement change – financial or human resources: change management is a complicated and demanding process.
