S4) Evidence-based Practice
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What is the argument for evidence-based healthcare?
Health service delivery should be based on best available evidence which emerges from findings of rigorously conducted research
Which two factors should the evidence for healthcare consist of?
• Effectiveness (of drugs, practices, interventions) - Cost-effectiveness (in a system with finite resources where should money be spent to gain the maximum utility?)
Identify 4 factors which influence healthcare practices
• Professional opinion • Clinical fashion • Historical practice and precedent • Organisational and social culture
What is evidence based practice?
Evidence-based practice involves the integration of individual clinical expertise with the best available external clinical evidence from systematic research
Systematic reviews and meta-analyses have become very important in informing evidence base. Why are they needed?
• Traditional literature reviews may be biased and subjective • Quality of studies reviewed variable and sometimes poor • Help address clinical uncertainty • Highlight gaps in research/poor quality research
Provide 4 reasons as to why systematic reviews are useful to clinicians
• Offer quality control and increased certainty • Offer authoritative, generalisable and up-to-date conclusions • Reduce delay between research discoveries and implementation - Help to prevent biased decisions being made
What are the 3 practical criticisms of the evidence-based practice movement?
• An impossible task to create and maintain systematic reviews across all specialities - Challenging and expensive to disseminate and implement findings - Requires ‘good faith’ on the part of pharmaceutical companies
What are the 3 philosophical criticisms of evidence-based practice?
• ‘Does not align with most doctors’ modes of reasoning • Aggregate, population-level outcomes don’t mean that an intervention will work for an individual • Professional responsibility/autonomy