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