Making Evidence Based Practice an Easier Practice

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The medical field is a wonderful balance of art and science. More and more, we, as practitioners, have access to the science and research at our fingertips. At the same time, our patients have more access to medical knowledge; it’s as easy as one or two clicks. This can be sometimes empowering for patients but potentially dangerous or frustrating for them too. It’s crucial for us to be ahead of the curve on the evidence and tell our patients to use caution with the headlines or websites that are unreliable.

Through evidence, we can improve our ability to provide the highest quality of care and prove to all invested that our services and treatments are justified and appropriate. Evidence Based Practice allows us to use methods that have shown to be effective and incorporate them into our daily practice. It’s a trendy phrase in healthcare, and for good reason.

It is equally important to know where and how to get it, and how to know its value. We are not all researchers or interested in research, but regardless, it is worth taking advantage of those who are doing the research in order to best help our patients and further our own knowledge.

Where do I look for research?

• If you want to find your own articles:
  • Pub Med Central: https://www.ncbi.nlm.nih.gov/pubmed/
  • Cochrane Library: http://www.cochranelibrary.com
  • EBSCOhost, including CINAHL for Nursing and Allied Health Professions: https://www.ebscohost.com
  • Ovid: http://www.ovid.com/site/index.jsp

• If you want a summary of the evidence:
  • Clinical Evidence: http://clinicalevidence.bmj.com/x/index.html
  • UpToDate: http://www.uptodate.com/home
  • Essential Evidence Plus: http://www.essentialevidenceplus.com

• Use your professional memberships to help guide you within your specialty. If you are a member, you often have access to clinical guidelines, full-text articles, and even online resources for learning more about Evidence Based Practice itself. Here are some quick links to a few:
  • Speech Language Pathologists: http://www.asha.org/Research/EBP/
  • Physical Therapists: http://www.apta.org/EvidenceResearch/
  • Occupational Therapists: http://www.aota.org/practice/researchers/ebp-resources.aspx
  • Nurses: http://www.nursingworld.org/EspeciallyForYou/Nurse-Researchers
  • Physician Assistants: https://www.aapa.org/practice-resources/clinical-practice-tools/
  • Nutritionists & Dieticians: https://www.andeal.org
  • Physicians: https://www.ama-assn.org/search?search=clinical+guidelines

How do I know if it is ‘good’ research?

• A general rule is to first look for well-known medical institutions and well-respected, peer-reviewed journals.
• Once you have found the research article, it is important to consider the level of evidence it provides. Was it a well-designed study with controls and a large sample? Or was it someone saying his or her expert opinion? Let’s have a quick review of levels of evidence by the Oxford Centre for Evidence-based Medicine.
  • 1a: Systematic Review of Randomized Controlled Trials
  • 1b: Randomized Control Trial
  • 2a: Systematic Review of cohort studies
  • 2b: Individual cohort study
  • 3a: Systematic Review of case-control studies
  • 3b: Individual case-control study
  • 4: Case-series
  • 5: Expert opinion
• Your best bet is a systematic review, which reviews other articles about a topic, or a randomized control trial, which is the best comparison between two treatments or treatment and no treatment.
• Unfortunately, there are many areas in medicine that lack adequate research. Case studies can be helpful, but make sure to closely read these for any flaws, or to see if it really would apply to your patient or population. If you can’t find something, start your own study!

It’s hard to fit in time to look for evidence; is there an easier way?

• See if your facility has access to a medical librarian who can do a comprehensive literature review or a quick article find for you. Be specific about what you are looking for, though!
• Support a culture of learning in your facility so it is a shared effort. Consider beginning or attending a journal club or sending out a monthly article review on a hot topic.
• Use students or interns to help you research various topics and have them present what they find to your staff.
• It may not always be easy, but do try to avoid taking short cuts and using websites that may not give you (or your patients) the full story.

Using the evidence you find, combined with your clinical reasoning, your experience, and your patient’s needs, you will become a better clinician.  Stay ahead of the curve with evidence based practice!

Reference:

OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence". Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653