Evidence-Based Practice Flashcards
What should heatlh service delivery be based on?
The best available evidence
What is the best evidence based on?
The findings of rigorously conduced research
What does the evidence that health service delivery should be based on concern?
- Effectiveness
- Cost-effectiveness
What needs evidence regarding effectiveness?
- Drugs
- Practices
- Interventions
Why does the health service need best evidence regarding cost-effectiveness?
In a system with finite resources, should be considered where money can be spent ot gain maximum utility
What is the problem with ineffective and inappropriate interventions?
They waste resources that could be used more effectively
What do variations in treatment cause?
Inequities
What are practices influenced too much by?
- Professional opinion
- Clinical fashion
- Historical practice and precedent
- Organisational and social culture
What has research shown that clinicians often do regarding evidence-based practice?
- Persisted in using interventions that are ineffective
- Failed to take up other interventions known to be effective
- Tolerated huge variations in practice
What sets out the principles of evidence-based practice?
Archie Cochrane’s book, Effectiveness and efficiency; random reflections of health services
What did Archie Cochrane’s book say?
- Criticised medical profession for failing to take account of research
- Caller for register of all RCTs
What resulted from Archie Cochranes call for a register of all RCTs?
Group in Oxford lead by Iain Chalmers responeded to this, and produced a register of all RCTs in obstetrics and gynacology, becoming the first ‘Cochrane Centre’
What did Iain Chalmers Cochrange centre contain?
Systematic reviews and meta-analyses of data and evidence produced by RCTs
What followed from Iain Chalmers Cochrane Centre?
Other Cochrane Centres were set up elsewhere
What does evidence based practice involve?
The integration of individual clinical expertise with the best available external clinical evidence from systematic research
What is evidence based practice also known as?
Evidence-based healthcare and evidence-based medicine
Where have systematic reviews and meta-analyses become very important?
In informing evidence base
What do doctors need, regarding systemic reviews and meta-analyses?
Need to have an understanding of these methods and be able to critically appraise them
Why are systematic reviews and meta-analyses needed?
- Some traditional, ‘narrative’ literature reviews may be biased and subjective
- Not easy to see how studies were identified for review
- Quality of studies variable and sometimes poor
- Systematic reviews are useful to help address clinical uncertainty
- Systematic reviews can highlight gaps in research/poor quality research
Why are systematic reviews useful to clinicians?
- By appraising and integrating findings, they offer both quality control and increased certainty
- They offer authoritative, generalisable, and up-to-date conclusions
- They save clinicians from having to locate and appraise the studies for themselves
- They may reduce delay between research discoveries and implementation
- They can help prevent biased decisions being made
- They can be relatively easily converted to guidelines and recommendations
Why do doctors need to be able to access systematic reviews?
To appraise them and be satisfied about the quality of the evidence
How is assessment of the quality of evidence easiest and best done?
Using a ‘critical appraisal tool’ or instrument
What do critical appraisal tools do?
Suggest the things to took for, and the questions to ask of, research articles
Where can evidence be found?
- Medical journals
- Cochrane Collaboration
- Centre for Reviews and Dissemination
- NIHR Dissemination Centre
- NIHR Health Technology Assessment Programme
