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PHCY 504 - Primary and Secondary Literature Tutorial: EBP, PICO & Clinical Questions

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Evidence Based Practice

Now that we have explored a number of database, let's take a look at how you would use them in the context of evidence-based pharmacy.

The practice of evidence-based medicine involves “integrating individual clinical experience with the best available external clinical evidence from systematic research.” (Sackett D, 1996)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)

What this means, essentially, is that evidence-based practice is formed by a practice triangle.

It is where your experience as a clinician meets the evidence gathered by researchers in the literature, and is applied to the specific environment of a particular patient’s circumstances.

There are two purposes or types of EBP: institutional and individual. Institutions like a hospital or pharmacy will use EBP to inform decisions for things like practice guidelines or formulary development, while individual clinicians can use EBP to inform decisions for a specific patient.

An example of an institutional EBP question might be: do critical care patients who are able to receive visitors at any time of day have significantly shorter hospital stays, compared with patients in areas with restricted visiting hours?

Here, a hospital may search for and compare different studies that look at visiting hours in critical care units to see if the affect length of stay outcomes, and then use those studies to help formulate their own visiting hour policy.

An example of an individual EBP question might be: for your patient, a 70 year-old in congestive heart failure, which type of therapy (or if there is a specific therapy) that improves survival, and does its effectiveness vary according to how old your patient is or their gender?

Here, a clinician may search for an individual study or systematic review that looks at drug therapy for patients in congestive heart failure, preferably a study or review with subgroup analyses broken down by patients' age and gender.

This brings us to the five steps to EBP:

Step 1: Articulate a well-built clinical question

Step 2: Locate the best relevant research information to answer the clinical question

Step 3: Critically appraise the identified information for validity, impact and usefulness in clinical practice

Step 4: Integrate the best evidence with clinical expertise and the unique needs and values of the patient 

Step 5: Evaluate effectiveness of clinical decisions made based on integrating evidence based information

In the upcoming module, we'll be covering steps 1 and 2: articulating a well-built clinical question and locating the best relevant research information to answer that question.