Practical Evidence-Based Medicine

Evidence-based medicine, the practice of making decisions about individual patient care using the best current evidence, is important for improvement of medical care. However, successfully implementing evidence-based medicine is difficult and complicated; only 15% of medical interventions are supported by evidence-based medicine. The majority of physicians spend less than 2 hours per week reading about clinical care. In addition, industry-sponsored continuing medical education is increasingly prone to bias and has been shown to be ineffective in altering physician practices. Furthermore, despite the explosion of knowledge brought about by the information age, clinicians are forced to refer to journal articles, textbooks, or the Internet to obtain the information they need; physicians need distilled, timely, and concise information. In an ideal system, evidence-based medicine in real-time is part of a classic four-step feedback loop of continuous quality improvement. Clinical information is collected in step one, information is processed in step two, evidence-based libraries monitor clinical care for treatment recommendations in step three, and feedback is delivered to the clinician at the point of care in step four. This article describes the procedure for development of such a system. Psychopharmacology Bulletin. 2002;36(4):20-26