Evidence‐based Practice in General Practice and Primary Care

Lipman, Toby

doi:10.1002/9780470699003.ch3

Cited by 23 publications

(3 citation statements)

References 32 publications

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“…Many of these critics are aiming at the wrong target. EBM is not claimed to be a replacement for traditional medical practice, but is merely an additional set of skills, processes and attitudes which can enhance the ability to choose appropriate courses of action (Lipman 2000a). These are essentially the right and obligation to challenge established practice; the careful defining through logical questioning of the issues at stake for an individual, and their consequences; the application of epidemiological principles to the management of individual patients; and the use of critical appraisal to assess the validity of research evidence ( Sackett et al .…”

Section: The Abuse Of Ebmmentioning

confidence: 99%

The doctor, his patient, and the computerized evidence‐based guideline

Lipman¹

2004

Evaluation Clinical Practice

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This paper explores some of the issues raised by the finding in a randomized controlled trial (RCT) that general practitioners (GPs) taking part failed to use a computerized evidence-based guideline, nor did it have any impact on patient outcomes. GPs are expected to 'make an initial decision on every problem [patients] may present' and to address psychological and social problems in addition to biomedical ones. The computerized guideline imposed an external, largely biomedical, agenda that superseded the patient's. This disrupted the normal pattern of GP consultations and it was therefore ignored. Guidelines for any particular disease are effective if backed up by a detailed programme of education and audit. However, the large number of different conditions seen in general practice means that it is impractical to have such programmes for more than a small fraction of the clinical workload. The reductionist assumptions underlying the construction of evidence-based guidelines from systematic reviews lead to inflexible recommendations on the management of disease. Anthropologists and sociologists make an important distinction between scientifically defined diseases and the culturally constructed experience of illness. Because GPs deal with patients suffering illness that may or may not result from disease, disease-centred guidelines often conflict with their needs and wishes. The development of evidence-based medicine (EBM) was intended as a tool to help doctors make sense of evidence in the context of individual patients' problems. Few GPs are skilled in it, and it has been appropriated by powerful expert groups such as guidelines developers and the pharmaceutical industry. It is suggested that more understanding of EBM by GPs leads to better informed decision making by them and their patients.

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Section: The Abuse Of Ebmmentioning

confidence: 99%

The doctor, his patient, and the computerized evidence‐based guideline

Lipman¹

2004

Evaluation Clinical Practice

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“…), applying the evidence to clinical problems and finally evaluating the effects of the interventions (1). EBP usually begins with an acknowledgement of uncertainty in which the evidenced-based practitioner strives to identify gaps in knowledge (2). In contrast, evidenced-based nursing (EBN) implies using the best available evidence from research, along with patient preferences and clinical experience when making nursing decisions (3).…”

Section: Evidence-based Practicementioning

confidence: 99%

“…Strong evidence from at least one systematic review of multiple welldesigned randomised controlled trials[2] Strong evidence from at least one properly designed randomised controlled trial of appropriate size[3] Evidence from well-designed trials without randomisation, single group pre-post, cohort, time series or matched case-control studies[4] Evidence from well-designed non-experimental studies from more than one centre or research group. [5] Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committee.…”

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Evidenced Based Nephrology Care

Sedgewick

2003

EDTNA-ERCA Journal

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This paper highlights the importance of evidenced-based practice (EBP) and its implications to patient and health professionals working within nephrology. The need to ensure that practice is based upon best evidence should be a concern for all health care professionals. Confusion sometimes surrounds the concept of EBP and the potential impact this may have upon patient outcomes. It is the intention of this paper to firstly demystify the process of EBP highlighting the important factors to be considered in moving towards EBP in nephrology care. Secondly, the paper draws upon a number of well-conducted research studies, which have important implications for nephrology care. These selected examples of best evidence will highlight further where ongoing work could be focused. Whilst there is much published within current literature concerning research within nephrology it is essential that practitioners are encouraged to develop the skills to critically search literature, appraise and evaluate its usefulness in developing appropriate and meaningful evidence to enhance practice and patient care.

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Studying and Changing Healthcare Professionals Behaviour

Walker¹

2004

Health Psychology in Practice

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Evidence‐based Practice in General Practice and Primary Care

Cited by 23 publications

References 32 publications

The doctor, his patient, and the computerized evidence‐based guideline

The doctor, his patient, and the computerized evidence‐based guideline

Evidenced Based Nephrology Care

Studying and Changing Healthcare Professionals Behaviour

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