Patient Care Model
One of the most common definitions of EBM is taken from Dr. David Sackett. Evidence-based medicine is
"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means blending individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett D, 1996)
EBM is the integration of these three components into the decision making process for patient care:
- Clinical expertise - refers to the clinician's cumulated experience, education and clinical skills;
- Patient values - bringing to the encounter his or her own personal and unique concerns, expectations, and values;
- Best available evidence - usually found in clinically relevant research that has been conducted using sound methodology.
(Sackett D, 2002)
Evidence, by itself, does not make a decision for you, but it can help support the patient care process. Full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life.
The practice of EBM is usually triggered by patient encounters which generate questions about the:
- Effects of therapy
- Utility of diagnostic tests
- Prognosis of diseases
- Etiology of disorders
Evidence-based medicine requires new skills of the clinician, including efficiently finding evidence-based answers to specific clinical questions in point-of-care databases and the application of formal rules of evidence in evaluating the clinical literature. An additional skill is searching the voluminous primary literature index databases such as MEDLINE and PubMed when evidence cannot be found in highly approachable point-of-care databases such as DynaMed and UpToDate. Teaching this additional skill is beyond the scope of this tutorial.
In the patient care model the EBM process can be visualized in the following steps: