Introduction
Evidence Based Health Care Definition
Evidence-based health care is a process of health care decision-making and related behavior. Several definitions have been developed to describe it. Definition one1 states that clinicians who practice EBHC build on their clinical experience and formal education (knowledge of pathophysiology and mechanisms of action) using current evidence from the published literature. Experience and basic knowledge are necessary, but not sufficient, for the practice of EBHC. Clinicians need to ground their practice in fundamental principles and then base their decisions and actions on appropriate evidence from health care research, taking into account the unique needs of the patient. This evidence can be from either original studies or trials or evidence-based secondary sources, such as systematic review articles and meta-analyses, decision analysis tools, clinical practice guidelines, and economic analyses. Definition one also emphasizes that knowing how to use the literature is imperative for ensuring that clinicians are providing optimal care.
According to definition two, EBHC2 “is the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions.” The key idea here is use of research findings that are currently the best available. Evidence-based health care means a strong commitment to keeping up-to-date with changing and improving health care innovations that are reported in the literature.
What is lacking, or at least not explicit in these first two definitions, is that the patient involved in the decision must be recognized as having his or her own needs, expectations, culture, spiritual beliefs, and preferences, and should take part in the decision- making process. The clinical setting, resources, practical implications, and cost constraints must also be considered on a case-by-case basis.
Definition three is the one most often used in describing EBHC3. It reads: “... the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” The definition implies conscious choice on the part of the clinician and patient, explicit and exact decisions being made and carried out, and always wisdom, experience, and judgment used to evaluate and apply this evidence. An individual patient with a specific need or problem is almost always involved. This definition reinforces and recognizes that EBHC is really the way many feel that our best clinicians have always practiced.5475
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| 5475. | McKibbon, A. PDQ Evidence-Based Principles and Practice, 1999, BC Decker Inc., Hamilton, Ontario. |
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