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Pharmacy: Evidence Based Practice

What is Evidence Based Practice?

A nice, clear definition of the term "evidence based practice" based on Dr. David Sackett's pioneering work in the field.

Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That is, it integrates the best external evidence with individual clinical expertise and patients' choice.

Evidence-based practice involves 5 steps:

    1. Ask a focused question to satisfy the health needs of a specific patient 

    • What is your clinical question? - use the P.I.C.O. model below.
    • What type of clinical question is this?  Therapy?  Diagnosis?  Use the table below.
    • What is the best study design to answer this type of clinical question? Use the table below.

    2. Find the best evidence by searching the literature 

    • What is the highest level of literature to support the question?  See the pyramid below.
    • Where should you look for this material?  See the table below.

    3.  Critically appraise the literature: testing for validity, clinical relevance, and applicability

    •   What are the results of the study?

    4. Apply the results in clinical practice

    5. Evaluate the outcomes in your patient

    Adapted from: the Centre for Evidence-Based Medicine and Sackett DL, Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.

    Point of Care Tools

    Systematic Reviews

    Clinical Guidelines

    PICO Model

    Breaking up your question into these 4 elements (which you can easily remember with the mnmeonic device PICO) will make your literature search process easier:

    Patient, population, &/or problem
    • Description of the patient, population and/or the target disorder of interest
    • What are the most important characteristics of the patient?
    • How would you describe a group of patients similar to yours?
    • What is the disorder and condition of interest?
    Intervention
    • Which intervention, prognostic factor, diagnostic tool, or exposure are you considering?

    Comparison intervention

    • What alternative do you want to compare with the intervention?
    • Examples: standard of care, reference standard, Placebo

    Outcome

    • What outcome you hope to accomplish or measure?

    Evidence of Reviews Pyramid

     

    Sources of research may be either pre-appraised (summaries), primary literature or more anecdotal.

    Systematic Reviews or Meta-analysis
    MEDLINE, Cochrane Library
    Critically-Appraised Topics DynaMed
    Critically-Appraised Articles ACP Journal Club
    Randomized Controlled Trials Original articles (search MEDLINE)
    Cohort Studies Original articles (search MEDLINE)
    Case-Controlled Studies etc. Original articles (search MEDLINE)
    Background Info/Expert Opinion Books, editorials
        

      Books in the Library