Evidence-based Practice vs. Evidence-informed Practice:, Lecture notes of Medicine

Download Evidence-based Practice vs. Evidence-informed Practice: and more Lecture notes Medicine in PDF only on Docsity! 26 Wound Care Canada Volume 12, Number 1 · Spring 2014 M ost people agree that scientific evi- dence should be used to influence practice and that it will help clinicians provide “best” care for clients and fam- ilies. For many years the term evidence-based has been used freely by health-care profes- sionals—and more recently the term evidence-informed is used instead or as well. What do these terms really mean? Evidence-based medicine was defined by Sackett et al. as the following: “Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evi- dence-based medicine means integrating individual clinical expertise with the best avail- able external clinical evidence from systematic research. By individual clinical expertise we mean the pro- ficiency and judg- ment that indi- vidual clinicians acquire through clinical experience and clinical prac- tice.”1 Although the evi- dence-based pro- cess was defined for physicians, it has been adopted by many professionals who refer to it as evidence-based practice (EBP). Over the years, critics of EBP have argued that it will turn clinicians into technicians who follow a recipe and that there is a tendency to forget the client’s or patient’s values and circum- Qualitative studies and mixed methods studies that pose ques- tions from the client’s perspective are vitally important for informing practice, as they present informa- tion about patients’ perceptions and understanding that cannot be obtained in quantitative studies. Evidence-based Practice vs. Evidence-informed Practice: What’s the Difference? By M. Gail Woodbury, BScPT, MSc, PhD, and Janet L. Kuhnke, RN, BSN, MS, ET Research 101 Volume 12, Number 1 · Spring 2014 Wound Care Canada 27 stances with this approach. The EBP approach has become more overtly endorsing of clinical expertise and inclusive of client values, preferences and circum- stances. This updated explanation stresses the importance of patient factors, indicating that EBM or EBP requires: “. . . the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.”2 The meaning of best research evidence, clinical expertise, patient values, and patient cir- cumstances are more clearly and specifically indicated. What Is EBP? The evidence-based process consists of:2 answerable question - dence for validity (truth), size of effect and applicability in clinical practice - tion with clinical expertise and the patient’s unique circum- stances and values for next time What kind of evidence is needed to answer clinical questions? As indicated by the World Health Organization (WHO), “not all evidence is equally convincing. How convincing evidence is depends on what sorts of observations were made and how well they were made. Research evidence is generally more convincing than haphaz- ard observations because it uses systematic methods to collect and analyse observations.”3 Evidence comes from research studies that have investigated specific clinical circumstances. Often clinicians are interested in knowing if an intervention works or works better than another intervention. This is only one type of question that clin- icians might ask. Clinicians ask many different types of ques- tions, such as: condition or complication? means of assessment or risk assessment? clinically effective? Cost effective? the most likely to be followed? - ences or preferences? the most appropriate? Different types of clinical questions are answered best by different types of research stud- ies. Some examples of the best research design to address dif- ferent types of clinical questions are illustrated in Table 1. Since clinicians often want to know which therapy works best, this is the question topic that we will illustrate. The words therapy and intervention mean the same thing and will be used interchangeably. To help in searching for evidence to answer a clinical question, the question needs to be specific and frequently includes PICO and sometimes T elements.2,4 P Population or problem I Intervention C Comparison (if appropriate) O Outcome(s) of interest T Time Example: For persons over age 65 with type 2 diabetes who are in assisted living, does imple- mentation of a daily walking program compared with no walking program have an effect on weight and glycemic control over six months? Table 1. Clinical question topics are addressed best by different types of research studies. Question topics Research study type Treatment, therapy, intervention Systematic review, randomized controlled trial (RCT) Patient experiences/concerns Qualitative study Prevalence of condition or complication Cross-sectional study Cost effectiveness Economic study Disease course Longitudinal study