Five Steps of Evidence-Based Health Care
Evidence-based health care is actually a five-step process, and each step takes time and energy. All five steps can take up to an hour or longer to complete, depending on the complexities and access to the original studies. The first step is defining the question that needs to be answered: this is often more difficult than first envisioned. Librarians often equate this step with the “reference interview” process that takes place each time a person asks for library assistance. The second step is collecting evidence to answer the question. This is the step where librarians can (and should) play a key role. This role can involve the provision of the evidence itself, or teaching clinicians and clinicians-in- Chapter 1 Introduction 3 training how to effectively and efficiently find evidence in the health care literature. The third and fourth steps are the ones that utilize basic knowledge and previous clinical experience. Third is the formal evaluation of the evidence gathered. This step is also called critical appraisal—the reading and analysis of the studies found, taking into account the patient, setting, situation, and problem as defined. Fourth is the integration of the evidence and patient factors to make and carry out the decision. The fifth step, one often omitted, is the evaluation of the whole process with a view to improving it the next time the EBHC cycle is followed.
Clinicians who use EBHC techniques do not use the five steps for every one of their health care encounters. Often the full five-step process is done once or twice a week on a specific question that the clinician feels needs consideration. An example of this would be a general internist who has noticed several new studies of drugs for congestive heart failure. At home one evening she mentally reviews the three patients she has seen that day, and is worried about one patient who does not seem to be responding to the usual drug regimen. She wonders if she should change or update her prescribing for Mr. Augustine for his congestive heart failure which is complicated by insulin-dependent diabetes mellitus. She determines the question she wishes to address, does a literature search, reads two articles, and decides that Mr. Augustine does not need to start amiodarone therapy. Because of this review of new drugs for congestive heart failure she has confirmed that how she cares for these patients is current and appropriate. As this pattern of several EBHC cycles per week is followed, most of the common situations a clinician encounters will be addressed and updated, if needed. Clinicians can never be completely current, especially when patients present with diseases or conditions that are uncommon in their practice. Evidence-based health care “allows” that clinicians cannot know or be current on everything, and provides mechanisms for helping them give the best care they can. In addition, good clinicians know their own abilities and when to treat or refer patients.5475
Content on this page was last changed on March 19, 2009.
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| 5475. | McKibbon, A. PDQ Evidence-Based Principles and Practice, 1999, BC Decker Inc., Hamilton, Ontario. |