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Highlights of the Basic Components of Evidence-Based Practice

      Abstract

      This editorial provides a brief review of the basic components of evidence-based practice.
      Evidence-based practice (EBP) offers a rational model for practitioners that allows them to provide the best possible care for their patients. However, for a few, there is a misunderstanding about EBP. Some people may think that EBP represents an “evidence-only” approach. Some may think that if multiple randomized controlled trials do not exist, then one cannot practice EBP. Others may misuse the term to mean “evidence only” such as to debate a point or to deny payment for healthcare services. The misuse of the term creates even more frustration and confusion for patients and for those practicing in the field, causing some practitioners to shy away from providing healthcare in an evidence-based way. It is possible that some of the confusion stems from being unaware of the full definition of this model. Upon review of the basic components of EBP, most healthcare providers find that the principles on which it is founded are simple, practical, and appeal to common sense.
      The concept of EBP was initially described in 1991.
      • Dickersin K
      • Straus SE
      • Bero LA
      Evidence based medicine: increasing, not dictating, choice.
      • Sackett DL
      • Straus S
      • Richardson S
      • Rosenberg W
      • Haynes RB
      Evidence-based medicine: how to practice and teach EBM.
      Since that time, many have expanded on this concept and various health professions have embraced this model as a means to improve patient care.
      • Sackett DL
      • Rosenberg WM
      • Gray JA
      • Haynes RB
      • Richardson WS
      Evidence based medicine: what it is and what it isn't.
      • Guyatt G
      • Cook D
      • Haynes B
      Evidence based medicine has come a long way.
      • Reilly BM
      The essence of EBM.
      • Bolton JE
      The evidence in evidence-based practice: what counts and what doesn't count?.
      • Nicholson LJ
      • Warde CM
      • Boker JR
      Faculty training in evidence-based medicine: improving evidence acquisition and critical appraisal.
      • Jenicek M
      Evidence-based medicine: fifteen years later. Golem the good, the bad, and the ugly in need of a review?.
      One may define EBP as “… the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”
      • Sackett DL
      • Rosenberg WM
      • Gray JA
      • Haynes RB
      • Richardson WS
      Evidence based medicine: what it is and what it isn't.
      It is important to note that there are 3 fundamental components of the EBP model.
      • Sackett DL
      • Straus S
      • Richardson S
      • Rosenberg W
      • Haynes RB
      Evidence-based medicine: how to practice and teach EBM.
      Although each component is valuable on its own, it is not until all 3 are combined together that we truly have EBP. To shine some light on the matter, Figure 1 demonstrates the 3 components and their combination to make the EBP model.
      Figure thumbnail gr1
      Fig 1Shining a light on each of the 3 components of EBP: EBP occurs when all 3 areas of best evidence, patient values, and clinical experience combine together with the aim of providing best possible patient care.
      • Sackett DL
      • Straus S
      • Richardson S
      • Rosenberg W
      • Haynes RB
      Evidence-based medicine: how to practice and teach EBM.
      (Modified from Sackett et al
      • Sackett DL
      • Straus S
      • Richardson S
      • Rosenberg W
      • Haynes RB
      Evidence-based medicine: how to practice and teach EBM.
      .)
      Evidence-based practice makes sense because it helps to deliver the most appropriate care to the patient. This care is based upon the most up-to-date and appropriate scientific clinical evidence, the doctor's knowledge and clinical experience, and the values of the patient. Evidence-based practice requires that the doctor takes an active role in healthcare decisions and delivery. This means that EBP is a good fit for practitioners who are critical thinkers and have the best interest of the patient in mind. However, it is not a good match for those who wish to practice cook-book healthcare or have a primary financial focus (eg, the practice focuses on increasing revenues through practice management strategies) instead of a focus on what is in the best interest of the patient.
      Whether one is a doctor of chiropractic, medical doctor, doctor of osteopathy, physical therapist, nurse, or other practitioner, healthcare providers fundamentally want to do what is best for their patients. The fundamentals of EBP provide a sound foundation to provide best possible patient care.

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        Evidence-based medicine: how to practice and teach EBM.
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