EBP is the result of the evolution of knowledge in the health sciences, but, more than that, it reflects the evolution of our society – in the way it embraces our society’s values, the trust it gives to its caregivers and how it listens to its patients.
Through the adoption of an EBP approach, each patient can benefit from the best care, practitioners can improve their skills, and society as a whole can ensure the sustainability and equity of its health care system.
Clinical Expertise
Patient Values and Preferences
Evidence
Context
EBP
- Clinical expertise is the set of skills and knowledge that a practitioner has developed in their professional life.
It is essential to refine this expertise through lifelong learning – for example in order to avoid cognitive biases. - EBP places the patient at the centre. Using the available evidence, the practitioner and the patient agree together on the different possible treatment options.
- Practicing EBP on a daily basis involves cultivating an open mind to new data from scientific research and taking a systematic approach to delving into the most relevant information with a critical eye.
Recommendations from guidelines as well as other verified information are made available to time-poor practitioners, to help them make informed choices about the treatments they may offer. - The EBP approach is part of a given context to which patient care is adapted, and which may include available infrastructure, health care policies, funding, or other elements.
In Summary
This fine balance is now taught to all future health professionals.
The EBP Approach in Practice
Lumbago – an example
A patient with a prescription of exercises to treat idiopathic lower back pain consults a physiotherapist.
The patient has assumed he was only going to receive massages and passive mobilisation, but the physiotherapist – based on recommendations to make exercise a priority – offers a programme of active, progressive exercises designed to alleviate the patient’s lower back pain.
As the patient is reluctant to move, the physiotherapist explains the impact that an overly sedentary lifestyle could have on his pain.
The physiotherapist understands that the patient needs up-to-date information on the management of lower back pain to motivate him to adhere to the treatment. He refers him to reliable sources of information for patients so that he can read up on this, and offers to see him again to talk it over.
At the second appointment, the patient, who has taken the time to educate himself, feels more motivated to move actively.
Going forward, they agree together on a programme combining active exercises to do at the physiotherapist’s practice and at home, as well as some appropriate adjuvant massages and mobilisations.
A 5-Step Process
EPB is not limited to an examination of the evidence: it is an approach that provides healthcare professionals with a useful framework for deciding on the most appropriate action for a given patient based on current best practices.
This approach involves several stages: asking a question, accessing evidence, assessing it, applying it by adapting it according to the expertise, the patient’s values and the context, and verifying the results.
In concrete terms, applying the EBP approach means a practitioner will follow a five-step method:
A- ASK: formulate the problem into a clinical question
A- ACQUIRE: effectively search for the best evidence that can usefully answer this question
A- APPRAISE: assess the methodological quality and applicability of the evidence found in its own real-life situation
A- APPLY: make a decision based on the available evidence, the patient’s preferences, wishes and expectations, as well as the practitioner’s own knowledge, experience and context.
A – ASSESS: assess the results following the adoption of this EBP approach
