Evidence-based medicine

Evidence-based medicine has emerged as a new paradigm for the practice and teaching of clinical medicine. This new paradigm places greater emphasis on procurement and interpretation of clinical research in order to choose the most efficacious diagnostic procedures and therapies. This will enable optometrists to apply state-of-the-art clinical practices and keep pace with the ever-changing health care environment.

The process of evidence-based medicine involves five steps: (1) convert the problem to a clinical question; (2) find the evidence; (3) evaluate the evidence; (4) apply the evidence; and (5) evaluate the process. The educational prescription is presented as a tool to teach and practice evidence-based medicine in various clinical settings that is based on this 5-step process.

The definition of the clinical question includes three key concepts: the characteristics of the patient, the intervention being considered, and the desired outcome. Finding the evidence requires knowledge of the hierarchy of information products, which includes Medline, secondary journals, electronic collections of systematic reviews, and clinical practice guidelines. After accessing of the appropriate information, the clinician must still interpret the evidence and apply it to a specific patient care encounter. When performed appropriately, the process has the potential to enhance patient care quality and healthcare outcomes.

Information technology has become the cornerstone of evidence-based practice. As bandwidth is enhanced and the electronic medical record is more widely adapted, evidenced-based medicine will become more integrated into clinical practice. Significant resources will be required to develop educational programs and research into the impact of evidence-based medicine on healthcare outcomes.