Friday, July 15, 2016

What is evidence based practice?

Evidence based medicine, evidence based practice, EVM, EBP
What is evidence based medicine and what does evidence based practice look like? Bosca is searching here for evidence of snacks.

What does evidence based medicine look like in practice? This was one of the questions explored by Dr Marnie Brennan, Deputy Director of the Centre for Evidence-based Veterinary Medicine (EVBM or EVM) and Assistant Professor in Epidemiology at Nottingham University, in Sydney this week.

Dr Brennan defines EVM as “the use of scientific (peer-reviewed) evidence, clinical expertise, owner and patient circumstances together”. Her analogy is that evidence is like a pair of glasses – if you put them on they may clarify things, but not always – so we sometimes need to put them on and take them off again.

We need to ask ourselves five questions:
  1. What is the question I am trying to answer? What do we not know?
  2. How do I find this evidence – where do I go? Databases? Journals?
  3. How do I work out if its any good? Can I trust this material enough to use it?
  4. Is it relevant to my practice? Relevant to this case?
  5. How did I do? What were the outcomes? Was this approach better or worse than the standard approach?

The big barriers to evidence-based practice (EBP) are time, a concern by some that it robs them of clinical autonomy (it doesn’t – we still need to exercise judgement), a concern that EVM yields a one-size-fits-all protocol (it can’t), bias in the types of evidence available (some research is more readily funded than other research) and concerns that evidence in veterinary medicine is generally non-existent or poor. But in the words of evidence-based veterinary dermatologist Hal Williams, “It’s better tolight a candle than curse the darkness.” (Actually those words are an old proverb but we like their application in veterinary dermatology, and to life in general).

So what does an EVP look like? This was the topic of much of our discussion, but our group agreed it would use
  • Some sort of clinical audit/benchmarking including analysis of case outcomes
  • Lots of continuing professional development
  • Case discussions
  • Journal clubs (effective journal clubs using structured worksheets)
  • Development of evidence-based guidelines/protocols
  • Review of same

Dr Brennan pointed out some great EVP resources available online, including Best Bets for Vets or this one on evidence based guidelines on cardiopulmonary resuscitation for vets which describes the process of developing these. 

Many veterinarians are using EVM without badging it as such, but it would be great to see these resources developed further and used widely, and more measurement of outcomes.

You can be part of the process by contributing to international research. Dr Brennan is working with postdoctoral researcher Dr Natalie Robinson to interview owners and veterinarians about booster vaccine consults. To participate, visit - and remember this is for vets or clients. It doesn't take long (maybe 1/3 of a cup of tea worth of time?).