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Applying an Evidence-Based Model: Benefits and Pitfalls

Introduction

Most health care policies and systems in use by different countries have evidence based approaches incorporated into the procedures. There is a general consensus that is growing about the role of particular health determinants such as healthcare. The last two decades have seen a tremendous amount of change and new innovations being developed as a result in advancements in the health science field. This has been made possible with the introduction of new technology and knowledge in the field. These advancements have been used to support medical and clinical practices that have led to health care decisions being now based on information gathered from research. This approach is referred to as evidence based health care/medicine or evidence based clinical practice.

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Philosophy of science deals with questions raised by scientists, researchers or medical practitioners that the science field only cannot answer. The history of philosophy of science goes back to the ancient Greeks with notable names such as Plato, Newton, Galileo, Euclid and Kepler contributing to this field of science. The main argument behind philosophy science is that all the sciences particularly medical and nursing sciences have a heavy reliance on the ability of the person to reason logically and from this reasoning come up with a valid argument that will support their decisions (Rosenberg 2005).

Models on Evidence Based health care

Dawes et al (2005) define evidence based health care as a practice that is aimed at providing the best available evidence that will be used to solve medical and clinical issues that are affecting patients or a particular population. Evidence based research has its origins from medical researchers based in Canada who wanted to ensure that the health care and medical field had its basis on research evidence. Evidence based healthcare is carried out in five stages which are translating uncertain medical decisions into answerable questions, the systematic retrieval of the best evidence available, the critical appraising of the evidence to ensure that it is relevant and valid, and the application of evidence results to the medical practice and the evaluation of the applied evidence. Pearson et al (2005) define evidence based research as the conscientious and explicit use of the best available evidence in decision making as pertains to matters related to the care of individual patients. Evidence based research on medical and clinical practices are also the techniques and methods of integrating a clinician’s medical expertise with the best available clinical evidence. Evidence based health care is mostly focused on evidence based decision making on the facts about a patient, or a selected population under study.

According to Gray (2001), decision making is important in the healthcare sector because of two reasons which are that an enormous number of decisions are made in the healthcare sector every year. For example in the UK, 40 to 50 million decisions are made per one million people by doctors, clinicians or medical practitioners. The second reason for focusing on decision making is that decisions have a direct impact on the costs of health care delivery. The 21st century will see health care decision makers being forced to adopt evidence based approaches when making decisions about patients and target populations. Every medical decision will have to be based on a systematic appraisal of the evidence that is available in the prevailing medical environment. This will involve finding the most suitable evidence and applying it, a situation that will create the need for gaining evidence management skills and creating an environment that will be conducive for evidence based approaches (Wan 2002).

Evidence based research on healthcare can be used in three ways which are to improve patient choices, improve on clinical practices and improve on health service management. Evidence based patient choice involves allowing patients to choose treatment options that will be most suitable for to deal with diseases. The patients make choices by basing decisions on the best available knowledge. Evidence based clinical practices are approaches that are used by clinicians to make decisions based on the best available evidence and after consulting the patient on the treatment options that are most preferable. Evidence based health management is used by managers who are in charge of providing health services and healthcare delivery to groups of patients or a particular population. The managers use evidence to make decisions on healthcare policies, health management and purchasing or commissioning of health services (Pearson et al 2007).

A model that has been used for evidence based healthcare is the JBI (Joanna Briggs Institute) model evidence based healthcare. This model conceptualizes the evidence based approaches that can be used by clinicians in their decision making activities. The model considers the best options according to available evidence in the contextual settings of the healthcare delivery, the client’s preference and the professional judgement of the clinician (Pearson et al 2005). The JBI model incorporates the four components of the evidence based healthcare process which are generation of healthcare evidence, analysis of the evidence, knowledge/evidence transfer and the use of the evidence in clinical matters. Evidence based healthcare is represented in a cyclical process that first derives questions and healthcare needs from people in the healthcare sector and then addresses these questions by generating evidence that will be used to meet medical needs and demands. The evidence should be feasible and meaningful to the specific population and context in which it is meant for. The evidence undergoes appraisal after which it is transferred to the health care professionals for use (Joanna Briggs Institute, 2010).

Epistemology and Ontology

In understanding how general knowledge is formulated epistemology and ontology are key concepts that are used for this process. Epistemology is the study and research of knowledge and how knowledge about certain aspects can be judged to be the ‘true’. Truth has always been an uncertain concept of philosophy which explains why the word true is in inverted commas in the definition of epistemology. The search to determine what truth is has accounted for a majority of new interpretations for new knowledge concepts. Discussions and arguments into new ideas have always been important to determine the validity of new knowledge and concepts (Taylor and Kermode 2006).

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Ontology is defined as the study of the concept of existence and the meaning of life. Various authors have given their own definitions on the meaning of life. One such author is Martin Heidegger who considered that ontology and epistemology were one and the same. The main argument was that in trying to understand the meaning of life and existence, the nature of knowledge had to be used to generate answers that would be used to gain the meaning existence. Ontology has some relevance in medical research more specifically in nursing. This is because nurses and medical health workers are meant to ask questions about existence and life in the course of carrying out health care services. Such questions are viewed to be important in forming the foundation of their professions. Examples of epistemological questions are what a person knows and how the information came about to be known, whether it is trustworthy information while ontological questions are when a person asks about the nature of existence (Taylor and Kermode 2006).

The use of evidence based models will ensure people in the health care sector are able to determine the kind of evidence and knowledge that will yield the greatest benefit to the population receiving the health services. The benefits of using evidence based models in healthcare can be looked at in terms of individual, clinical and patient benefits. The individual benefits are that it enables medical practitioners to continuously improve and increase knowledge on medical matters; it improves the clinician’s understanding on the available research methods, and it increases a manager’s confidence when faced with making decisions related to health care matters (Rosenberg and Donald 1995).

Benefits and Pitfalls of using Evidence Based Models in Healthcare

The benefit of evidence based healthcare research to clinical teams is that it provides the teams with a framework that will be used to solve problems. For patients the benefits will be that patients will be able to effectively use the medical knowledge available to make decisions about what treatment options are most suitable. The patients will also gain useful information about the rational behind the clinician’s decisions. Overall benefits of evidence based health care approaches are that these approaches integrate medical theories into practical applications, the approaches can be used by anyone in the medical field for career advancement, it has the potential to improve the uniformity of healthcare services through the use of common medical approaches and guidelines developed by medical practitioners, evidence based healthcare provides a structure to clinical teams that will ensure that the teams are effective and efficient as well as providing a framework that will be used by these teams in problem solving activities. Evidence based medicine helps clinicians and medical officers to make good use of the available limited resources in providing quality healthcare services (Rubin et al 2001).

The pitfalls of evidence based health care is that it takes a long time to learn the necessary approaches as well as apply them to health care systems. For example it might take a long time to come up with a suitable question, find the appropriate evidence for the question, conduct an appraisal on the evidence, and then apply the evidence to meet the needs raised by the question. Another pitfall is that establishing the necessary structures that will enhance evidence based medicine practices will cost a lot of money. It will be a costly venture especially if the health care provider has to purchase additional resources that will be used to practice the approaches (Strite and Stuart 2008)

For the inexperienced clinician or medical practitioner, evidence based healthcare will expose gaps in medical practises and healthcare systems which might complicate the delivery of healthcare services. Another pitfall is that some of the approaches lack coherency in the definition of the evidence which might lead to inconsistencies in the evidence based research (Selvaraj et al 2010). It is difficult for medical practitioners and clinicians to apply the evidence to individual patients only. The research can mostly be used for large groups of people or a particular population. Evidence based research is also seen to be a barrier to the practice of advanced medicine. It is seen to be an impediment to medical practitioners who wish to improve medical skills and knowledge in the medical field (Straus and McAlister 2000).

Conclusion

Despite its shortcomings, evidence based research is a very important concept to the medical industry. It continues to gain more interest because of the fact that it applies evidence and outcomes from medical research to the care of patients. The best doctors in the world are known to use both their clinical skills and medical research evidence when they are treating their patients. Clinicians and medical practitioners would not consider practicing medicine without a basic understanding of knowing what effect the drugs they prescribe to patients would have. Without the current clinical evidence from research, practicing medicine or treating people would be a difficult task especially if outdated treatment methods and medicine are still in use.

Evidence based research provides an important basis for finding out various aspects of medicine and their effects or impacts to the society. Evidence based medicine allows medical practitioners the opportunity to practice safe medical practices and also offer quality healthcare to their patients. The use of these approaches will also ensure that new and more effective treatment options are available to treat different types of diseases. The skills of doctors and other medical staff will be updated together with their knowledge on how to treat different kinds of illnesses.

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References

Dawes, M., Davies, P, Fray, A., Mant, J. Seers, K., Snowball, R. (2005) Changing policy and practice in evidence based practice: a primer for healthcare professionals.2nd Edition. Edinburgh, UK: Elsevier Churchill Livingstone.

Gray, J.A. (2001) Evidence based healthcare: how to make health policy and management decisions. Scotland: Harcourt Publishers Limited.

Joanna Briggs Institute (2010) Joanna Briggs Institute model of evidence based health care. Web.

Pearson, A., Field, J., and Jordan, Z. (2007) Evidence-based clinical practice in nursing and healthcare: assimilating research, experience and expertise. Oxford, UK: Blackwell Publishing Limited.

Pearson, A., Weichula, R., Court, A., and Lockwood, C. (2005) The JBI model of evidence based healthcare. International Journal of Evidence Based Healthcare, Vol. 3, No. 8, pp 207-215.

Rosenberg, A. (2005) Philosophy of Science: a contemporary introduction. 2nd Edition. New York: Rutledge.

Rosenberg, W. and Donald, A. (1995) Evidence based medicine: an approach to clinical problem-solving. Web.

Rubin, H.R., Pronovost, P., and Diette, G.B. (2001) The advantages and disadvantages of process-based measures of healthcare quality. International Journal for Quality in Health Care, Vol.13, No.6, pp 469-474.

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Selvaraj, S., Yeshwant, K, Elakiya, M., Prarthana, S.C., Balaji, D., Nagamani, P., and Surapaneni, K.M. (2010) Evidence based medicine: a new approach to teach medicine: a basic review for beginners. Biology and Medicine, Vol 2, No.1, pp 1-5.

Straus, S.E., and McAlister, F.A (2000) Evidence-based medicine: a commentary on common criticisms. Canadian Medical Association Journal, Vol.163, No. 7, pp 837-841.

Strite, S.A, and Stuart, M.E. (2008) Applying evidence-based pharmacotherapy to formulary decisions. Version: Pre-publication version.

Taylor, B. and Kermode, S. (2006) Research in nursing and healthcare: evidence for practice. Oxford, UK: Blackwell Publishing.

Wan, T.H. (2002) Evidence-based health care management: multivariate modeling approaches. Massachusetts: Kluwer Academic Publishers.

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