Evidence-based practice (EBP) or evidence-based medicine is a relatively new discipline, defined at the end of the last century. It involves judicious use of current best evidence in making decisions about the care of individual patients. Using EBP, clinical decisions are made involving the integration of clinical expertise, current best research evidence and individual needs, as seen in the figure below.

Firstly, clinical expertise involves understanding the individual patient and knowing what works in a specific situation, as well as a talent for precise observation. Clinicians need access to the latest medical advances and the time to review these in relation to an individual patient. When clinicians are being trained they need to be exposed to role models who practice EBP and that have this expert clinical experience (Evidence-Based Medicine Working Group, 1992).

Secondly, it is important clinicians keep up to date with the latest research evidence to ensure they provide the best medical treatments. Evidence can come from the basic sciences, as well as medical and clinical research. One of the best sources of evidence is the combination of several well-designed clinical trials that have been strategically reviewed (meta-analysis). Clinicians must be able to critically appraise the evidence and exercise sound judgment as to what is reliable.

In recent times, there has been an increasing number of articles available to clinicians instructing them on how to access, evaluate and interpret medical literature. There has also been a growing demand for courses and seminars to inform clinicians on how to make use of medical literature in their day-to-day patient care. Some challenges to obtaining the current and best evidence inlcude the large amount of literature that is available that may vary in scientific quality, as well as finding the time to review this information. Another challenge is once clinicians are aware of evidence, it needs to be accepted, applicable, available, actioned on, agreed to, and adhered to.

Thirdly,  patient preference is an important part of EBP, especially with increasing expectations of healthcare. Patient preferences relates to what suits the patient best through assessing their needs, preferences, personal circumstances and should be consistent with their values.

References

Evidence-Based Medicine Working Group (1992) “Evidence-Based Medicine. A New Approach to Teaching the Practice of Medicine” JAMA, 268(17): 2420–2425.

Haynes RB, Sackett DL, Gray JM, Cook DJ & Guyatt GH (1996). “Transferring evidence from research into practice. 1. The role of clinical care research evidence in clinical decisions” ACP Journal Club, 125(3): A14-

Sackett DL, Rosenberg WM, Gray JM, Haynes RB & Richardson WS (1996). “Evidence based medicine: what it is and what it isn't. British Medical Journal, 312: 71-72.