Almost 20 years ago , Dave Sackett explained that evidence based medicine is the integration of individual clinical expertise with the best available research evidence. The scientific principles of epidemiology used to study the patterns, causes and effects of disease were coupled with the art of clinical practice to emphasise that clinical decisions should include consideration of research evidence. Later, it was recognised that these principles could also be used by nurses and allied health professionals – therefore the term evidence-based practice became commonly utilised.
Earlier this year, Carl Heneghan argued that evidence-based health care is an ideal where the delivery of healthcare is based on research evidence. He argued that while we can synthesise the research evidence to answer questions about treatment, diagnosis and prognosis of many common clinical conditions, we have yet to resolve the problems of bias and affordability.
So what are the core components and constraints of what we affectionately call EBHC ? At its core it is about health care professionals using the best quality research evidence to make clinical decisions respecting their own experience and patients’ needs, values and expectations. Then we would expect that as individuals work together in healthcare organisations, they would ensure clinical pathways and work practices are based on high quality research evidence. At the highest level, we hope that health policy supports good practice that is based on research evidence.
Yet we know what most health care professionals do not have the time or skills to repetitively look up and critically appraise the research literature. So, many organisations have developed and adopted clinical guidelines as a way of summarising the best evidence for use in their local context. However, we know that many of these guidelines do not distinguish in their recommendations between those made on high quality research evidence and expert advice, and often clear descriptions of context are missing. Many are not kept up to date. Therefore, the use of research evidence at organisational levels is often distorted. Further, when guidelines are used as the basis for minimum standards in determining health policy, it becomes even more difficult to distil the contribution of high quality research evidence. Finally, we know that practice is heavily influenced by the power of politics and the scarcity of resources in healthcare organisations – these factors also distort the research evidence…
Therefore, I think the biggest challenge for using evidence at all levels of healthcare; individual, organisational and policy; is to develop systematic ways to access and summarise the research evidence and to be transparent about how this is being used together with other forms of knowledge.