Evidence-based medicine: Too much evidence?

Transcription

1 DISCLAIMER: The content of this presentation may not accurately reflect current legal or regulatory requirements, industry standards, or professional best practices. ISMPP is providing access to this presentation as a member service only, and does not recommend or condone the use of this presentation in whole or in part to support legal or professional decisions or practices. Evidence-based medicine: Too much evidence? Susan Ryan Keith Evans Tim Mills Chris Carswell

2 Why is evidence-based medicine (EBM) important? In % of US physicians believed that the current volume of scientific information was unmanageable 1 This volume of information has increased by 50% 2 A doctor would need to read 17 articles a day to keep up to date with their own area of medicine 3 Practising better medicine requires keeping up to date with new developments and integrating them into clinical practise To realize the full potential of EBM we need systems that deliver high-quality evidence at the point of clinical decision making 4 Our role as methodologists is to ensure the synthesis and assimilation of information in EBM 1 Williamson JW, et al. Health science information management and continuing education of physicians. A survey of US primary care practitioners and their opinion leaders. Ann Intern Med 1989;110: Craig JC, et al. Evidence-based medicine: useful tools for decision making. Med J Aust 2001;174: Davidoff F, et al. Evidence based medicine. BMJ 1995;310: Scott I, et al. The use of evidence based medicine in the practice of consultant physicians. Results of a questionnaire survey. Aust N Z J Med 2000;30:319 26

3 Introduction What is EBM?

4 The best definition? The conscious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practise of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Sackett DL, et al. Evidence-based medicine, what it is and what it isn't. BMJ 1996;312(703):71 2

5 EBM in MEDLINE The MeSH term for EBM is: The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Evidence-based medicine asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practise. Evidence-based medicine follows four steps: formulate a clear clinical question from a patient's problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice. The term "evidence based medicine" (no hyphen) was coined at McMaster Medical School in Canada in the 1980s to label this clinical learning strategy, which people at the school had been developing for over a decade. (From BMJ 1995;310:1122)

6 Results Too much evidence?

7 Methodology Search of MEDLINE using the Ovid platform The MeSH term used was evidence-based medicine Limited to publications since 1997 (when the MeSH term was introduced) A total of 26,738 publications were identified Publications from 2007 were excluded

8 Number of publications EBM publications MEDLINE Year

9 Discussion and Conclusions

10 Discussion The number of papers published has risen from 650 a year in 1997 to 3999 a year by 2006 The figures have risen every year since 1997, with an average increase of 23% (range 3 62%) There is an average number of 77 papers every single week on EBM This would appear to also be information overload It would appear that we (the methodologists) are failing to synthesize information

11 Conclusions Use of the EBM review filter to identify what is considered to be the best evidence means we have 388 papers left in total This is equivalent to 1.5% of all papers using the MeSH term evidence-based medicine We are producing too much low-grade evidence and are abusing the term We need to commit to producing good quality publications or we are in danger of seeing EBM perceived as another marketing exercise by the pharmaceutical industry If we do not address this issue, physicians will no longer turn to EBM publications for their information

12 The future True EBM requires that we use higher quality research in clinical practise Finding the evidence is still a major barrier to the practise of EBM If we persist in producing an ever increasing flood of EBM articles we will continue to fail to promote EBM practise Should we more rigorously define EBM articles to encourage purer EBM? Do we abandon EBM as a concept and shift to something new like science-based medicine?