Concepts
The concepts of Evidenced-Based Practice (EBP) combine multiple disciplines, include interventions that are evidence based, promotes improved patient care, and expands the knowledge base in the profession.
View articles on EBP concepts
- Haber, et al. Evidence-Based Clinical Practice: Concepts and Approaches. Am J Health Syst Pharm.2000; 57: 2235.
- M Etminan.. Evidence-based pharmacotherapy: review of basic concepts and applications in clinical practice. The Annals of Pharmacotherapy; 32 (11): 1193-1200.
- Jill S Burkiewicz. Evidence-Based Practice by Pharmacists: Utilization and Barriers. The Annals of Pharmacotherapy; 39(7):1214-1219.
- Mayer, Dan. Evidence-based medicine. Epilepsia 2006;47(1):3-5
- Hewlett-taylor J. Evidence-based practice. Nurs Stand. 2002 Dec 18-31;17(14-15):47-52.
Elements (PICO Model)
The elements of EBP follow the PICO Model and include an application which starts with identification of a patient (P); then an intervention in question is recognized (I); when alternative interventions (comparison) are found, the intervention in question and control are compared (C); and finally, for interventions that are identified, list desired outcomes such as (O) the length of hospital stay or decrease in cost or based on desired outcomes, you can then select or reject your intervention.
View articles on the elements of EBP
Principles
EBP combines clinical expertise and decision-making with thorough unbiased literature research and evaluation. Listed below are the three most common questions asked when conducting evidenced based research and evaluation. Click on a question below to read articles, tutorials and other information related to these basic principles.
How to ask a clinical question?
How to ask a clinical question?
- Will I find an answer to this question in medical literature?
- Can I simplify my question to perform a search based on a few keywords?
The following two tutorials will help you to learn how to ask an answerable question:
- Introduction to Evidence Based Medicine
- Center for Evidence-Based Medicine-Asking Focused Clinical Questions
More on How to ask a clinical question articles
How to perform an relevant and effective search?
Where to search for relevant evidence? How to perform an effective search?
The following is a list of practice resources used for evidence search.
- Journals
- Online databases
- Practice Guidelines
- Clinical trials
- Drug Information Resources
- Online journal clubs
- Other Online resources
- Books
Read more information on search strategies see the following articles
- Crumley E., et al. Which resources should be used to identify RCT/CCTs for systematic reviews: a systematic review. BMC Med Res Methodol. 2005;10:5:24.
- Avenell A., et al. Lessons for search strategies from a systematic review, in The Cochrane Library, of nutritional supplementation trials in patients after hip fracture. Am J Clin Nutr. 2001;73(3):505-10.
- Ebbert J., et al. Searching the medical literature using PubMed: a tutorial. Mayo Clin Proc. 2003;78(1):87-91.
- Doig G., et al. Efficient literature searching: a core skill for the practice of evidence-based medicine. Intensive Care Med. 2003;29(12):2119-27.
- Sood A., et al. Literature search using PubMed: an essential tool for practicing evidence- based medicine. J Assoc Physicians India. 2006;54:303-8.
- Demaershalk D. Literature-searching strategies to improve the application of evidence-based clinical practice principles to stroke care. Mayo Clin Proc. 2004;79(10):1321-9.
- Feldstein D. Clinician's guide to systematic reviews and meta-analyses. WMJ. 2005 ;104(3):25-9.
- Smith C., et al. Searching the medical literature. Clin Orthop Relat Res. 2004;(421):43-9.
- Grandage K., et al. When less is more: a practical approach to searching for evidence-based answers. J Med Libr Assoc. 2002 Jul;90(3):298-304.
- Melnyk B. Finding and appraising systematic reviews of clinical interventions: critical skills for evidence-based practice. Pediatr Nurs. 2003 Mar-Apr;29(2):147-9, 125.
- Chan K., et al. Systematic reviews for evidence-based management: how to find them and what to do with them. Am J Manag Care. 2004 Nov;10(11 Pt 1):806-12.
How to appraise gathered evidence?
How to appraise gathered evidence?
- Read gathered articles, editorials, and opinions
- Rate your evidence based on relevance, statistical and clinical importance, clinical application, bias, flaws and accuracy
- Select the most appropriate resources and formulate your own opinion based on available evidence
- Accept or reject interventions from your evidence
- To implement evidence check for availability of resources and form a multidisciplinary team to approve the intervention
More literature evaluation and application to clinical practice see the following articles:
- Ford, S. et al. Implementation of evidence based practice (EBP) using automated information technology for acute myocardial infarction in a community hospital. [Abstract of meeting presentation] Ashp Midyear Clinical Meeting. 39(DEC): p P317D. 2004.
- Shelby L. Corman, et al. Evaluation of conflicting literature and application to formulary decisions. Amer J of Health-System Pharmacy 2007; 64(2):182-185.
- Maureen O. Meace. Selecting and Appraising Studies for a Systematic Review. Annals of Int Med 1997;127(7):531-537.
- Mansfield, Lyndon . The reading, writing, and arithmeric of the medical literarute, part3: critical appraisal of primary research. Annals of Allergy, Asthma and Immunology. 2006; 96 (1):7-16.
- Motl SE, et al. Evaluating the accuracy of health news publications in a drug literature evaluation course. American Journal of Pharmaceutical Education 2006; 70(4):83.
- LA Sanchez. Applied pharmacoeconomics: evaluation and use of pharmacoeconomic data from the literature. Am. J. Health Syst. Pharm. 1999; 56: 1630 - 1638.
- Mateo M. Using evidence-based practice in providing care. Lippincotts Case Manag. 2001 Jan-Feb;6(1):19-23.
- Zaccai J. How to assess epidemiological studies. Postgrad Med J. 2004 Mar;80(941):140-7.
- DeMetz D. Statistical issues in interpreting clinical trials. J Intern Med. 2004 May;255(5):529-37
- Braitman L. Confidence intervals assess both clinical significance and statistical significance. Ann intern med 1191; 114:515-7.
- Levine M, Ensom M. Post-hoc power analysis: An idea whose time has passed? Pharmacotherapy 2001;21(4);405-9.
- Bland J, Altman D. Survival probabilities ( the Kaplan-Meier method). BMJ 1998;317:1572
- Lachin J. Statistical considerations in the intent-to-treat principle. Control Clin Trials. 2000 ;21(3):167-89.
- Wiffen P., Moore R. Demonstrating effectiveness - the concept of numbers-needed-to-treat. J Clin Pharm Thera 1996;21:23-7.
How to effectively communicate your response to patient care teams?
After you found your evidence and selected desired intervention, it is essential to be able to communicate your results to members of patient care team. Multidisciplinary care approach has shown to be superior for disease management and patient outcomes. Effective communication between healthcare professionals is important to patients’ wellbeing. The SBAR (Situation-Background-Assessment-Recommendation) provides a useful platform upon which professional communication can be build. SBAR is used widely in U.S. hospitals by nurses; however it can be adapted in different practice settings by all practitioners. The Institute for healthcare Improvement developed a useful tool that teaches effective SBAR approach.
For more information see the following articles:
- Till L., et al. Assessment of clinical pharmacist management of lipid-lowering therapy in a primary care setting. J Manag Care Pharm. 2003 May-Jun;9(3):269-73.
- Skledar, SJ. Culley, CM. Collaboratively designed practice guidelines promote appropriate use of intravenous proton pump inhibitors. Hospital Pharmacy 2005; 40(6): 497-504.
- Duggan, C. Multi-professional collaboration: Examples and experiences. Pharmacy Education 2004;4(2):111-113.
- Pierce CH. Practical aspects of presenting information to practicing physicians. J. Clin. Pharmacol.1981; 21; 262.
- Dayton E. Communication failure: basic components, contributing factors, and the call for structure. Jt Comm J Qual Patient Saf. 2007 Jan;33(1):34-47.
- Master O., et al. Multidisciplinary group behavioral and pharmacologic intervention for cardiac risk reduction in diabetes: a pilot study. Diabetes Educ. 2007 Jan-Feb;33(1):118-27. http://tde.sagepub.com/cgi/content/abstract/33/1/118
- Borenstein J., et al. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy. 2003 Feb;23(2):209-16.
- Haig K., et al. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf. 2006 Mar;32(3):167-75.