EVIDENCE BASED PRACTICE

Evidence Based Practice

Evidence Based Practice

Introduction

Since the earliest documentation of continuing medical education (CME) in 1947 by the American Academy of General Practice (now the American Academy of Family Physicians [AAFP]), the goal of continuing education (CE) has been to ensure that clinicians keep up with changes in clinical evidence and improve patient care.1 Through the years, continuing education has moved farther and farther away from the point of care. The commercialization of CE has moved it out of the clinical setting and into the hotel ballroom, or in worse cases, onto ski slopes and cruise boats. With the introduction of evidence-based practice, Internet-based learning, clinical decision support, and health care quality improvement, staying abreast of new clinical information is moving back into practice.

The term evidence-based treatment (EBT) or empirically-supported treatment (EST) refers to preferential use of mental and behavioral health interventions for which systematic empirical research has provided evidence of statistically significant effectiveness as treatments for specific problems. In recent years, EBP has been stressed by professional organizations such as the American Psychological Association and the American Occupational Therapy Association, which have also strongly encouraged their members to carry out investigations to provide evidence supporting or rejecting the use of specific interventions. Pressure toward EBT has also come from public and private health insurance providers, which have sometimes refused coverage of practices lacking in systematic evidence of usefulness.

Many areas of professional practice, such as medicine, psychology, psychiatry and so forth, have had periods in their pasts where practice was based on loose bodies of knowledge. Some of the knowledge was simply lore that drew upon the experiences of generations of practitioners, and much of it had no truly scientific evidence on which to justify various practices.

In the past this has often left the door open to quackery perpetrated by individuals who had no training at all in the domain, but who wished to convey the impression that they did for profit or other motives. As the scientific method became increasingly recognized as the means to provide sound validation for such methods, it became clear that there needed to be a way of excluding quack practitioners not only as a way of preserving the integrity of the field (particularly medicine), but also of protecting the public from the dangers of their "cures." Furthermore, even where overt quackery was not present, it was recognized that there was a value in identifying what actually does work so it could be improved and promoted.

Evidence-Based Practice

Evidence-based practice (EBP) in dentistry is modeled after evidence-based medicine (EBM) first described by David Sackett and his peers at McMaster University in the early 1990s. While controversial when it was first introduced in medicine, there has been acceptance in recent years and Sackett et al's2 2000 modified definition is now core in medical education: evidence-based medicine is the integration of best research evidence with clinical expertise and patient values. It is important to acknowledge each of the 3 components of the definition as equally important for quality clinical ...