Modalities Ch. 3 Flashcards
difference between EBM and EBP
EBP applies EBM
overarching goal of EBP
use best evidence possible to improve patient care
Evidence-Based vs. Patient-Centered Medicine
Powerful, different, somewhat contradictory philosophies
EBM
approaches patient care from a biomedical perspective
based solely on scientific facts
is a doctor-oriented, disease-centered model
aims to improve quality by standardizing medical, through clinical guidelines of best practice
patients treated as a group
_____
best practices
philosophy of action
specific techniques, methods, activities, or processes
good guidelines apply to only 80% of patients
a given best practice only applies to a specific condition or circumstance
-may be modified or adapted for similar circumstances
protocols
a plan or set of specific steps to be followed
a strict process for monitoring and caring for specific conditions
often provides a practical, step-by-step framework for implementing guidelines
patient-centered medicine
a humanistic, biophychosocial approach
focus on patient participation in clinical decision making, using in-depth patient communication to understand patients’ complaints, unique needs, and who they are
moves care from clinician control to_______
patients are experts in the experience of their symptoms
patients differ, even with same S/S
benefits of EBP and PCM
EBP -increased quality of care -proven to work PCM -patient-specific (not cookie cuter) -empowers the patient
detriments of EBP and PCM
EBP
-less personal
-might not work for everybody
-doesn’t account for patient differences
PCM
-giving patients too much control/power without knowledge
-can negate the expertise of the clinician
who one is best?
not either-or, but both
both are needed and must be integrated
-external clinical evidence can inform, but can never replace, individual clinical expertise
components of EBP
defining a clinically relevant question searching for the best evidence appraising the quality of the evidence applying the evidence to clinical practice evaluating the process
clinically relevant questions
what’s the best course of action?
components of clinical questions
patient population
intervention/treatment
outcome of interest
searching for the best evidence
technology is a blessing
what is evidence
anything used to establish a fact, or give a reason to believe something
seek “facts”
sources of medical evidence
tradition
experience
research
theory
types of research
laboratory
observational
clinical trials
laboratory
controlled
looks at
-physiological processes
-tissue response to intervention
laboratory pros and cons
pros
-easy to control
cons
-limited by tissue type (healthy, animals)
observational
observations in a natural environment
prospective or retrospective (before/after data collection)
observation pros and cons
pros
-natural
cons
-uncontrolled
clinical trials
observation + lab
clinical trials pros and cons
pros
- well controlled
- natural setting
narrowing the focus of your search
patient group
intervention
outcome
use studies within last 5-10 years
quality of evidence
there is a direct correlation between the quality of evidence and the quality of healthcare
levels of evidence
- systematic reviews or meta-analyses or randomized controlled trials and high-quality, single, randomized controlled trials
- well-designed cohort studies (observation)
- case-control studies
- comparison of two patients - case series and poor-quality cohort and case-control studies
- expert opinion, based not on critical appraisal, but on reasoning from physiology, bench research, or underlying principles
quality of evidence
relates to the credibility, clinical significance, and applicability of evidence
- how confident are you that it represents the “truth”
- can you trust the results?
things to consider when applying the intervention
what are the goals?
evidence
patient preference
clinical outcomes
end results of specific health care practices and interventions
examples of clinical outcome measures
objective measurements (ROM, strength) patient-based assessments (questionnaires, pain scales)
how to integrate EBP and PCM
adjust evidence-based intervention based on the patient -determined by --patient progress --outcome measures communication -what? -why?
