evidence based prescribing Flashcards
(8 cards)
what major problems exist for todays prescribers?
how is this solved?
- increasing morbidities
- complex therapies
- too much information
- too many formats
this is solved with evidence based prescribing
what is evidence based medicine?
the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients
outline the 5 step approach to using evidence based practice
- asking relevant questions
- finding the most robust evidence to answer the question
- using critical appraisal to review the evidence
- applying the findings to the realities of practice and the needs of the individual
- reviewing the first 4 steps and considering changes for next time
what is the golden rule of evidence based prescribing
maximise the benefits
minimise the harms
therefore minimise the harm:benefit ratio
what do you need evidence of in evidence based prescribing?
Effectiveness - usually through randomised control trials. You need to know how to interpret the evidence eg. number needed to treat (all in stats notes)
Safety - outcome trials tend to look at overall effects including a primary safety outcome but most trials are powered to look at efficacy and not safety and adverse effects only become apparent later.
Cost - if the NHS spends more on one thing it has to do less on something else. The opportunity cost is the value of the best alternative use of resources. You can see this through economic evaluation which is the comparative analysis of alternative courses of action in terms of both their costs and their consequences.
how do you apply evidence based prescribing to the patient sat in front of you?
you need to decide would the patient meet the inclusion criteria of the study and do they meet any of the exclusion criteria. if not, look at whether the results are generalisable and if there is any reason why they would not be applicable to your patient
where do you find the most detailed source of information about a drug?
The most detailed source of information about drugs is in the product characteristics which are data sheets containing all the data about drugs (but not evidence). This is an overwhelming amount of information which is summarised in sources such as the BNF and NICE guidelines so people have done the evidence based medicine work for you.
If you do not know the answer you can make the use of pharmacists.
what challenges are faced by evidence based prescribing ?
- availability of evidence
- time and availability to interpret evidence
- translation and knowledge into clinical practice
