15211 - Beyond evidence based practice Richard Smith...

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Beyond evidence based practice Richard Smith Editor, BMJ
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What I want to talk about Reflections on whether evidence based practice is radical Thoughts on what next from a few players From information to change Combining EBP and improvement Improving dissemination The thing Conclusions
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Is evidence based practice a radical change? Combines with other drivers of change “Consumerism”; the resourceful patient The arrival of the internet The desire of owners to manage more the clinical process Growing gap between what could be done and what can be afforded
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Has EBP changed the world? Source of knowledge is expert opinion Clinical skills are seen as semimystical Research is marginal to practice Source of knowledge is systematic review of evidence Clinical skills can be audited and managed Research and evidence go together
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Has EBP changed the world? Analysis of research is haphazard Not important to gather new evidence from patients routinely Analysis of research is systematic Patients should be included in trials wherever possible
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Has EBP changed the world? Main information sources are experts, selected journals, and books Most of what doctors need to know is in their heads Essential to have immediate (electronic) access to systematically collected evidence Doctors must use information tools constantly
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Has EBP changed the world? Only lip service is paid to keeping up to date and learning new skills Most medical care is assumed to be beneficial Essential to keep learning new skills Widespread recognition that the balance between doing good and harm is fine
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Has EBP changed the world? Clinical performance is not systematically audited Managers have little involvement in clinical proceses Clinical performance is regularly reviewed and managed Managers are involved in clinical processes
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Has EBP changed the world? Organisational model is hierarchical Doctor patient relationship is essentially master/pupil Organisational model is much more democratic, based on ability to use evidence Patient partnership is the norm
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Has EBP changed the world? Patients do not have easy access to the knowledge base of doctors The doctor is smartest Patients have as much access to the evidence base of medicine as doctors Often the patient is smarter
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Predictions of what comes next
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Alex Jadad (the crown prince), director McMaster evidence based practice centre Shift from evidence based medicine to evidence guided or evidence informed decisions Development of user friendly ways to present information to users Implications of the internet and other informatics developments on EBM Misuse of evidence (i.e., by funders, media, industry, etc.)
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Alex Jadad Better integration of evidence and anecdotal information More respect for anecdotal information Strategies to help consumers understand evidence Strategies to help decision makers accept and feel more comfortable with uncertainty
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This note was uploaded on 02/23/2012 for the course PHARM 290 taught by Professor Staff during the Fall '10 term at Rutgers.

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15211 - Beyond evidence based practice Richard Smith...

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