why use evidence based medicine? Flashcards
what is the primary purpose of the NHS?
‘… to secure, through resources available, the greatest possible improvement in the physical and mental health of the population.’
what us the carnwell definition of EBP?
carnwell= the systematic search for, and appraisal of, best evidence in order to make clinical decisions that might require changes in current practise, while taking into account the individual needs of the patient.
what are the key features of clinical decision making?
it should be informed, up to date, relevant and robust evidence rather than outdated primary training or over interpretation of individual patient experiences.
how is EBM the key to clinical effectiveness and decision making?
- production of evidence through scientific research and review
- production of evidence based clinical guidelines
- implementation of evidence based, cost effective practise through education and change management.
what are the 2 levels of impact of EBM?
strategic
implementation
strategic impact of EBM?
- NICE, Scottish medicine consortium, all Wales strategy group use EBM principles to formulate Health Technology Assessments which determine which treatment should be available within the NHS.
implementation impact of EBM?
primary care and hospital trusts formulate prescribing, care pathways and guidelines based on HTAs
why will the NHS 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 the 3 principles of evidence based medicine?
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 suffienct basis for making clinical decisions about individual patients.
how do you apply evidence based medicine?
use the best evidence in the scientific literature to provide the best care for an individual patient.
what 2 things have evidence based medicine Brough about changes for?
- iron deficiency anaemia
- SiptilSend (fasting before surgery)
why is EBM now essential?
daily requirement for correct answers to questions about:
- the effects of therapy
- the utility of diseases
- the prognosis of diseases
- the ethology of disorders
what are the 5 different opponents to EBM?
1- EBM is ‘old hat’. Clinicians have been using the literature to guide their decisions for a long time. The label is new.
2- EBM identifies statistically significant benefits which may be marginal in clinical practise.
3- EBM has generated a massive volume of evidence and guidelines which are unmanageable.
4- EBM is the mindless application of population studied to the treatment of the individual. it plays down sound clinical judgment.
5- Often there is no randomised controlled trial or gold standard trial in the literature to address the clinical question, especially where the patient has complex problems.
what are the 5 proponents of EBM?
1- the new focus on EBM ‘formalises’ that ‘old hat’ process and filters the literature so that descsions are made based on ‘strong’ evidence.
2- EB, should be one art of the process. Descisins are based on individual clinical expertise, patient references and, when available, good evidence.
3- EBM produces expert judgment in a format that clinicians can understand.
4- the last step in the EBM process is to decide whether or not the information and results are applicable to your patient and discuss there results with the patient.
5- clinicians might consider the ‘evidence pyramid’ and look for the next bed level of evidence. clinicians need to understand that there may be no good evidence to support clinical judgement.
what is the process if evidence based medicine in use?
1- patient dilema
2- ask
3- acquire
- appraise (hierarchy of evidence)
4- apply (principles of evidence based medicine)
5- act and assess
different part of evidence based pyramid.
