Brackenridge Pharmacy Library: Evidence-Based Practice

Evidence based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000)

The three components (the "triad approach to EBP) are

1. The best external evidence (systematic reviews, randomized controlled trials, best practice guidelines, clinical practice guidelines) that support a change in clinical practice.
2. Individual practitioner's clinical expertise.
3. Patient's preference.

The "PICO" question helps to define a specific clinical or health-related question to be answered.

• P: Patient or Problem
• I: Intervention
• C: Comparison or control
• O: Outcome(s)

Two helpful tutorials from Yale University:

Framing Evidence with PICO

Finding Evidence in PubMed

Want to know more about EBP in Pharmacy?

Databases index EBP as a Document Type, Publication Type, or an Article Type.

UIW Databases

Additional Resources

Literature Review:

• Introduces context and current thinking, often without a specific question, is general and covers several aspects of a topic.
• Finds papers through a fairly random process, usually searching only a few databases. Use of grey literature common, but not usually systematic.
• Papers are read, ‘take home’ messages used in the review.
• May include 150 papers or more, depending on the topic.
• Writer interprets the meaning of the results.
• Prose paper, occasionally supported with diagrams.
• Actions/directions informed by evidence of various kinds drawn from included papers.

Systematic Review:

• Uses a precise question to produce evidence to underpin a piece of research. A stand‐alone piece of research, it should be conducted prior to undertaking further research, particularly in higher degree theses.
• Searches of several specified databases using precise search terms; a similar systematic search of grey literature sometimes included, depending on the question.
• Data extraction tool used to identify precise pieces of information; two or more researchers undertake data extraction.
• Usually less than 50 papers; often fewer than 10.
• Recognised, referenced, methods for data analysis; includes analysis of methods, rigour of conduct of research, strength of evidence, and so on.
• PRISMA/CONSORT or similar chart/table of included papers.
• Actions/directions are based on evidence from reviewed papers.

Information from Wiley Online Library

Meta-Analysis:

Once data of primary interest have been exhaustively collected, it is time to run a meta-analysis. A meta-analysis provides a powerful tool of combined analysis for all extracted data and gives weighted values for each study's effect sizes. A meta-analysis also provides whether a publication bias is present or not in assessing positive and negative studies e.g. using L'Abbé plot or inverted funnel-plots or even forest plots. Sometimes, a systematic review may be followed by simple pooled analysis when data are not sufficient.