Evidence based health care – What is it? And what is it not?
The May 2012 issue of The Australian Chiropractor magazine by the Chiropractors Association of Australia contained an article by the association president on the use of the modern catch cry of Evidence Based Practice (EVP).
This subject often comes up during discussion with health professionals and there is often contention between clinical practice and academic attitude. I feel that the recent article covered the subject well.
Modern expectations are that all health professionals are asked to practice in a manner that is consistent with the principle of ‘Evidence Based Practice’ (EBP) and this includes chiropractors.
It is unfortunate that many proponents of EBP use the term with inadequate understanding of clinical practice and the appropriate use of EBP in that setting.
Many times those that propose the EBP are actually referring to the use of current research evidence, without recognition that evidence based practice is much more than research evidence alone.
A quote from David Sackett in his 1996 article in the British Medical Journal (BMJ):
“Evidence based practice requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patient’s choice. It cannot result in a slavish, cookbook approach to patient care. External clinical expertise can inform, but can never replace, individual clinical expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into the individual decision. Similarly, any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient’s clinical state, predicament, and preferences, and thus whether it should be applied.”
Evidence based practice has three integrated components:
- research findings
- clinical expertise and experience
- patient values and expectations
When considering whether we practice EBP we need to consider all three components.
For further information and references: