by Sudesh Samuel

Created on: January 10, 2009

Evidence-based medicine (EBM) is the practice of integrating clinical experience and patient values with the best available research information to optimize patient outcomes.

A healthcare provider concluding on a clinical decision through EBM can be akin to a financial analyst concluding on a business model. A balance sheet of benefits and harms is drawn up based on a combination of research findings and the patient's unique circumstances and the clinician then makes an informed decision in the best interest of the patient's outcome.

Incorporating the best available research information is key to EBM decision-making and involves four essential steps:

1. Asking answerable questions

2. Accessing the best information

3. Appraising the information obtained for validity and relevance

4. Applying the information to specific patient care

In asking answerable questions, it is paramount to frame the clinical question appropriately. Information needs analysis has revealed an average of 1-2 questions arise for each outpatient consultation while the figure can go up to 5 for each inpatient consultation. About a third of questions will relate to treatment of a specific condition while a quarter will relate to diagnosis. Background questions that address basic physiological processes are best left to textbooks to answer while foreground questions that relate to clinical decision-making are best facilitated by EBM. Framing a good question to be answered is accomplished by defining a population with a clinical problem, the intervention or exposure to the population, a suitable comparator for the intervention, and the outcome variables to be assessed. An example of a patient's clinical question that relates to EBM may be rephrased as "In asymptomatic adult women at average risk of breast cancer (population), does screening at a cancer clinic (intervention) reduce the likelihood of breast cancer fatality (outcome) compared with routine self-examination (comparator)?"

In accessing the best available information, summarized primary (new studies and findings) research sources like evidence-based guidelines and systematic reviews are of the highest value. The ideal information source should have high quality data, be clinically applicable, be comprehensive and be user-friendly. Should the important summarized information be unavailable, the next best option is to access the primary research itself. The most common filter of primary research called MEDLINE, PubMed is available online.

EBM

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