EVIDENCE BASED PRACTICE

DR. RICHA SINGH

PROFESSOR
DEPT. OF OBS. & GYNAE.
S. N. MEDICAL COLLEGE , AGRA
• Benefield defines Evidence based practices as
using the best evidence available to guide
clinical decision making.
• The conscientious, explicit and judicious use of
current best evidence in making decision
about the care of individual patient
- Dr. David Sackett
 DEFINITION

• The integration of clinical expertise, patient

values, and the best research evidence into
the decision making process for patient care.
History of Evidence Based Practice
• Evidence based practice has its roots in
Evidence based medicine (also referred to as
Evidence based Health Care)
• EBM was created in the 1980s
• Popularised in the early 1990s as a response
to medical textbooks being unable to keep up
with rapid changes in medicine and being
frequently based up on the interpretation of
small number of people in a respective field.
 Need for EBP
• EBP provides guidelines that help clinician make
intelligent choices.
• Helps the clinician to evaluate the mass of data
and choose in skilled manner, what to use and
what to discard.
• New evidence is constantly being generated
which might significantly change the way we care
for patients.
• Our knowledge and clinical performance
deteriorate with time ,so we should update it
timely.
 EBP provides
• High quality , clinically oriented and relevant
research which provides better information
for the clinician
• It will yield improved treatment for the
patient
• Personal satisfaction that patient is offered
the best treatment.
 Evidence
• Knowledge derived from a variety of sources that
was found to be credible
• Types of evidences
 Type I – At least one good systemic review
 Type II- At least one good RCT
 Type III-Well designed interventional studies
without randomisation
 Type IV-Well designed observational studies
 Type V-Expert opinion, influential reports and
studies
 Goals of EBP
• Introduce innovation
• Assists with efficient and effective decision-
making
• Resolve regulatory problems
• Achieve excellence in regulation
• Resolve problems in the clinical setting
• Reduce variations in care
 Evidence based approach
• The approach will emphasize-
 Precise definition of patient problems to
facilitate efficient literature search
Understanding rules of evidence to interpret
literature regarding correct prognosis and
therapeutic approach
Extraction of clinical message and its
application to patient problem
 Evidence based approach
High quality , clinically oriented and relevant
research which provides better information
for clinician
Improved treatment to patient
Personal satisfaction that our patients are
offered the best treatment
 Benefits from EBP
• For Patients
Saves time
No need to approach other clinicians when
treatment plan is based on evidence based
practice
Relatively low harm to patient
Patients needs and preferences are valued
• For Practitioners
Personal satisfaction
High quality of care rendered to patients
Greater confidence in treatment planning
Wastage of resources is minimized
Good rapport developed between patients
and practitioner
It also favors to take up new and better
treatments in practice
• For researchers
They are being called upon to do the clinical
testing necessary before new products are
introduced.
 Advantages of EBP
• Provide better information to practitioner
• Enable consistency of care
• Better patient outcome
• Provide client focused care
• Increases confidence in decision making
• Provide guidelines for future research
• Helps practitioners to provide high quality
patient care
 Disadvantages of EBP

• Not enough evidence for EBP

• Time consuming
• Suppress creativity
• Publication bias
 Key points of EBP
• EBP is a structured approach for clinical
decision making
• It assists the practitioner in finding and
applying the best evidence in clinical practice
• EBP manages the information overload and
uncertainty
 Barriers to implement EBP
• Lack of interest
• Lack of involvement
• Lack of time
• Lack of renumeration
 Potential barriers to change clinical
practice
1) Knowledge and attitude of practitioner
Information overload
Clinical uncertainty
Influence of opinion leaders
Outdated knowledge
2. Patient factors
 Demands for care
 Perceptions and belief about appropriate
care
3. Practice environment
 Time constraints
 Poor practice organization
4. Educational environment
Inadequate continuing education programs
Inadequate preparation of faculty for teaching
5. Wider health system
Inappropriate funding system
Lack of financial support for innovation
Failure to provide practitioners with access to
appropriate information
 Conclusion
• Evidence based practice is the most effective
approach for treating patient.
• Evidence based approach improves patient
care through decision making.
• Incorporates research evidence , along with
clinical expertise and patient preferences.
• Research evidence should help guide , rather
than dictate clinical decisions.