Evidence Based Practice

Research - Best Practice - Clincial Judgement - Patient Preference
What Is Evidence-Based Practice?

 

The most commonly used definition of Evidence-Based Practice (EBP) is from Professor David Sackett OC FRCS, a founder of the University of Oxford Centre for Evidenced Based Medicine and inductee to the Canadian Medical Hall of Fame.

 

“EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." [1] [2]

On its web site, Duke University goes on to say, “EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s accumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)

The evidence, by itself, does not make the decision, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, and/or the aetiology of disorders.”

Behavioural Optometrists practice evidence-based care
The Evidence -Based Process

Assess the Patient

Start with the patient -- a clinical problem or question arises from the care of the patient

Ask the Question

Construct a well built clinical question derived from the case 

Acquire The Evidence

Select the appropriate resource(s) and conduct a search

Appraise The Evidence

Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)

Apply: Talk With the Patient

Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice

Self-Evaluation

Evaluate your performance with this patient

Informed Consent

Occasionally health professionals will use treatments that are evolving with regard to evidence. This is particularly so if the treatment looks very helpful and has low risk for the patient.

You have a right to be given understandable and clear information about your choices so you can make the right decisions about your health and healthcare. If you have questions don't be afraid to ask your optometrist.

1. Sackett DL, Rosenberg WM, Muir Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't BMJ 1996;312:71