S4) Evidence-based Practice

Question 1

What is the argument for evidence-based healthcare?

Answer 1

Health service delivery should be based on best available evidence which emerges from findings of rigorously conducted research

Question 2

Which two factors should the evidence for healthcare consist of?

Answer 2

• Effectiveness (of drugs, practices, interventions)

- Cost-effectiveness (in a system with finite resources where should money be spent to gain the maximum utility?)

Question 3

Identify 4 factors which influence healthcare practices

Answer 3

• Professional opinion
• Clinical fashion
• Historical practice and precedent
• Organisational and social culture

Question 4

What is evidence based practice?

Answer 4

Evidence-based practice involves the integration of individual clinical expertise with the best available external clinical evidence from systematic research

Question 5

Systematic reviews and meta-analyses have become very important in informing evidence base.

Why are they needed?

Answer 5

• Traditional literature reviews may be biased and subjective
• Quality of studies reviewed variable and sometimes poor
• Help address clinical uncertainty
• Highlight gaps in research/poor quality research

Question 6

Provide 4 reasons as to why systematic reviews are useful to clinicians

Answer 6

• Offer quality control and increased certainty
• Offer authoritative, generalisable and up-to-date conclusions
• Reduce delay between research discoveries and implementation

- Help to prevent biased decisions being made

Question 7

What are the 3 practical criticisms of the evidence-based practice movement?

Answer 7

• An impossible task to create and maintain systematic reviews across all specialities

- Challenging and expensive to disseminate and implement findings

​- Requires ‘good faith’ on the part of pharmaceutical companies

Question 8

What are the 3 philosophical criticisms of evidence-based practice?

Answer 8

• ‘Does not align with most doctors’ modes of reasoning
• Aggregate, population-level outcomes don’t mean that an intervention will work for an individual
• Professional responsibility/autonomy