From evidence to action

Despite the availability of vast quantities of evidence from basic biomedical and clinical studies, a gap often exists between the optimal practice suggested by the evidence and actual practice. For many clinical situations, however, evidence is unavailable, of poor quality or contradictory. Out of necessity, clinicians have become accustomed to relying on non-evidence-based tools to make decisions. Out of habit, they rely on these tools even when high-quality evidence becomes available. Growing out of an increasing awareness of this problem, the evidence-based medicine (EBM) movement sought to empower clinicians to find the evidence most relevant to a specific clinical question. Various organizations have used EBM techniques to develop systematic reviews and practice guidelines to aid physicians in making evidence-based decisions. A systematic review follows a process of asking a clinical question, finding the relevant evidence, critically appraising the evidence and formulating conclusions and recommendations. Results are mixed on whether educating physicians about evidence-based recommendations is sufficient to change physician behavior. Barriers to adopting evidence-based best practice remain, including physician skepticism, patient expectations, fear of legal action, and distorted reimbursement systems. Additionally, despite enormous research efforts there remains a lack of high-quality evidence to guide care for many clinical situations.