Using Evidence at the Point of Care

Physicians have many sources of clinical information, from throwaway or non-peer-reviewed journals to evidence-based, searchable databases. Each of these has advantages, disadvantages, and different methods of access (Table 8-4).

Table 8-3 Distinguishing Characteristics of Evidence-Based Medicine

Characteristic

Description

Explicit methods

Databases are searched and search strategies described.

Focus on patient-oriented outcomes

Concentrates on clinical research that reports patient-oriented outcomes.

Systematic searches

The searches are systematic and thorough so that important evidence is not missed.

Standardized critical appraisal

Important sources of potential systematic and random error are assessed in each study.

Hierarchy of study design

More weight is given to stronger study designs.

Designation of levels of evidence

Each study is designated with respect to the strength of the study design and its quality of evidence.

Grading of accumulated recommendations

Each recommendation is graded according to the strength of the evidence from research studies that support the recommendation.

Verifiable findings

The explicitness of the methods of searching and critical appraisal allows others to verify or refute findings and recommendations.

One model to help busy physicians stay clinically current, called information mastery, has been advocated by Slawson and Shaughnessy (1999), Ebell and colleagues (1999), and Geyman (1999). In this model, physicians seek the answer to clinical questions through secondary sources of information that have been created by experts through a review of the medical literature. Secondary sources include the following (Table 8-5):

• Evidence-based summaries, such as Cochrane Collaboration reviews, Patient-Oriented Evidence that Matters (POEMs), Clinical Inquiries, and Priority Updates from the Research Literature (PURLs), as published in the Journal of Family Practice.

• Systematic reviews, including PubMed and Clinical Inquiries.

• Guidelines, written by professional societies and accessed through sites such as the National Guideline Clearinghouse (www.ngc.gov).

• Evidence-based databases, such as Essential Evidence Plus, DynaMed, and PEPID PCP.

The following example describes the type of relevant information that a busy clinician can access using two of these EBM resources.

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