Evidence-Based Practice Medicine is a collaboration between you and your patient to create the best course of treatment. It means taking a holistic approach to your practice by integrating clinical expertise while considering the needs and background of your patient. There are four components and five steps to an evidence-based approach medicine.
The Five Step Process is also known as PICO(T)!
The Four Components |
The Five Step Process |
|
Opinion: Clinical Expertise |
Ask a Question: What is the concern |
| Evidence: External and Internal |
Find Best Evidence: Look at articles |
| Perspectives: Patient-Caregiver-Provider |
Evaluate Evidence: Critique evidence |
| The Process: Making Clinical Decisions |
Apply Information: Discuss with patient and try treatment |
|
Evaluate Outcomes: Learn & Improve |
Image from Cochrane Essentials Training Module 1: Basics of EBM
When taking an evidence based approach to your practice, you're taking a holistic approach. It requires looking at opinions, evidence, perspectives, and process.
Opinion is the knowledge and critical reasoning that you already know. Evidence is the internal and external research available to gather information to inform your decision.
The external is scientific literature; reading an article on an unfamiliar case. The internal evidence is what your patient is displaying. Perspectives are preconceived notions; the cultural & personal background and expectations set by the patent and/or their caregiver.
The process of Evidenced Based Practice Dentistry consists of the following steps
This process is also known as the 6 A's: Assess, Ask, Acquire, Appraise, Apply
Integration of best evidence with clinical & patient preferences, informs but never replaces clinical judgement. It's important to recognize the patient environment but also to track down best available evidence. Making a clinical decision is the final step. In this you apply your research to your patient and evaluate treatment to see if it is useful going further.
This pyramid represents the hierarchy of research. It is a visual representation of the strengths of different research study designs. It can be helpful to think about evidence as a pyramid because as we know, not all research is created equal.
Part of the evidence based approach is to also look at potential barriers to treatment and care. There are three major barriers to consider
Clinicial questions can be divided into a variety of types. The four main types are diagnosis, therapy, prognosis, and harm/etiology.
When you are appraising as yourself- does this study focus on my question, are these valid methods to address the issue, are they applicable to my patient.
When looking at applying to your patient ask- are the characteristics of the study participants similar to my patients, what are the alternatives, what are the benefits, is this an appropriate outcome for my patient.
