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Implementation of Evidence-Based Medicine In Primary Care Settings

A practitioner including evidence-based medicine practice perspectives (EBM) engages in the conscientious and measured application of recent applicable research for the delivery of individualized patient care. Also known as evidence-based practice (EBP), EBM is enabled by a research and technological regime that emphasizes the use of relevant data from multiple sources, including the informed opinions of clinicians on healthcare’s frontlines. EBM takes into account individual patient characteristics, values and goals, in addition to what can be learned from the medical literature. EBM can be more complimentary than conventional medicine, incorporating holistic and integrative clinical perspectives to treat the whole patient, not just their acute complaints.

An evidence-based medicine practice is not currently a formal credential or designation. It is up to practitioners–including primary care providers–to stay current on the latest modes of EBM care.

What is Evidence-Based Medicine?

Evidence-based medicine is gaining popularity among practitioners who actively and judiciously apply current, best-available medical research in their everyday practice. It is an interdisciplinary, multi-faceted perspective that incorporates clinical experience with the specifics of a medical case. EBM is a response to previous styles of care that encouraged practitioners to generalize recently published findings that were often unproven in clinical settings.

EBM-based care occurs at the intersection of the latest medical evidence, an individual clinician’s experience and how a patient’s values and goals affect their clinical presentation and subsequent treatment. Administrative policy can be written at the practice level to take into account the needs of a medical population and simplify clinical decision-making for practitioners.

In sum, this mode of care may be best understood as delivering “the right care at the right time,” taking into account a patient’s background, personality and values. A patient may be from a vulnerable population, have traits that contraindicate a particular approach or have experienced negative outcomes from previous care. These can all impact the clinical decision-making process.

How is Evidence-Based Medicine Different?

Researchers and specialists studying evidence-based medicine approaches incorporate risk-benefit analysis, decision analysis and meta-analysis recommending medical guidelines or standards of care. The data generated from EBM research supports flexibility in its application while delivering actionable “bottom-line” guidance to practitioners. EBM encourages practitioners to use their best clinical judgment when deciding whether the medical literature applies to a case.

EBM research aims to improve on the, at times, marginal benefits of classic research that can over-emphasize the importance of incremental medical progress. Dubious data are presented as a major leap forward medically and valuable to nearly all patients by authors who feel immense pressure to publish. With an over-reliance on elite medical consensus, data that demonstrates internal validity may fail practitioners unable to generalize it to real-world cases.

Evidence-based medicine goes beyond the conventional research and application model to include perspectives from the social sciences, epidemiology and population health. This approach aims to develop targeted and data-supported clinical applications that are both more clinically sound and pragmatic for practitioners.

Evidence-based data and subsequent implementation can also include anecdotal evidence from other practitioners sharing anonymous case data. Digital applications are emerging to facilitate this type of real-time point of care information-sharing among practitioners.

Implementing an Evidence-Based Practice Model

Implementing the EBM or EBP model does not require an immediate overhaul of practice but rather a careful implementation over time. Medical facilities implementing evidence-based care can write a policy that supports the application of EBM by simplifying care with guidelines at the administrative level. In primary care practices, practitioners may write or influence policy by providing administrators with practical, real-world feedback. EMB can systematize the clinical decision-making process to help facilitate care that’s more cost-effective and scientifically sound.

For primary care practitioners, the evidence-based practice model centers on patient interaction and patient histories. Asking the right questions, accruing the right information and developing open patient relationships are key.

1. Ask questions in an EBP format.

PIOCT is a commonly accepted method for asking questions. This method probes patients for vital information in a way that’s clinically oriented and useful. P: Takes into account the patient population, I: intervention or area of interest,
C: comparison group intervention or group, O: outcome, T: and time.

2. Find the evidence to support an intervention.

Primary practitioners can use a variety of sources such as meta-analyses to help determine the most relevant and valuable research findings. Clinicians can then combine research with the opinions of experts, existing healthcare facility guidance and their own best judgment to choose an intervention that fits a patient’s needs.

3. Clinically assess the evidence.

Apply clinical judgment to the best available evidence and its relevance to a specific case. Search web-based, point of care databases to find relevant clinical information in real-time.

4. Integrate evidence with the patient’s personal and medical characteristics.

Determine how an intervention relates to the patient’s unique biology, values, and medical and personal goals for treatment. This can involve judgments as to how likely patients are going to be treatment compliant.

5. Evaluate intervention success.

Rigorously evaluate the success of treatment and be willing to change course based on observation and patient feedback. Communicate with patients that treatment evaluation is an ongoing measure. Enter case data into point of care platforms to share with other clinicians searching databases using case characteristics and keywords. Some of these systems are also a great way to earn CME credits while connecting with clinicians and sharing medical information.