Evidence-Based Health Care
The practice of Evidence-Based Health Care is to base your clinical decisions on the best available scientific evidence, together with clinical expertice and your patients preferences.
Evidence-Based Health Care involves four steps:
- Ask Answerable Questions
- Search for Evidence
- Appraise the Evidence
- Apply the Evidence
1. Ask Answerable Questions
Start with asking of well-built clinical question. This usually contains four elements (PICO):
How would I describe my patient? Age, male/female, condition…
Which main intervention am I considering? Test, drug, treatment…
What is the main alternative to compare with the intervention? Standard care, placebo…
In what aspect will this effect my patient? Quality of life, mortality, comorbidities…
2. Search for Evidence
- Initiate the search by looking for a systematic review that has collected and analyzed the existing research on the topic:
Cochrane Systematic Reviews is a good place to start.
SBU makes systematic reviews in Swedish.
- Can’t find any reviews? Try to search different sources for evidence at the same time:
Search DynaMed to get evidence-based recommendations about treatment, diagnosis and prevention.
Search Clinical Key to find published clinical studies, medical ebooks, pictures and First Consult treatment guides.
I TRIP to find systematic reviews, clinical guidelines, websites, pictures and published clinical studies.
Nationellt kliniskt kunskapsstöd is the regions’ joint knowledge support for everyone who works in health care in Sweden. The content is written and quality assured by experienced healthcare personnel around the country and includes care programs and guidelines.
- VISS contains processing programs and care programs for caregivers in the Stockholm Region.
- Vårdhandboken offers clinical guidelines, methods and tools for how care can best be carried out, based on science and proven experience.
- Still no answer to your question? Search for clinical studies:
PubMed let you filter your search to a specific category (therapy, diagnosis, prognosis…) This is also a place to find systematic reviews.
3. Appraise the Evidence
It is important to assess the quality of the studies you have found. Use CASP critical appraisal tools when you assess Randomied Controlled Trials, Systematic Reviews, Qualitative Research, Economic Evaluations etc.
4. Apply the Evidence
- Are the evidence generalisable to my patient / my question?
- Are the benefits of this intervention larger than the possible side effects?
- Can we afford the intervention?
- How strong is the evidence?
- GRADE is an international grading system, often used to assess if the body of evidence found is strong or limited.