| Harnessing experience: exploring the gap between evidence-based medicine and clinical practice. | |
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MedLine Citation:
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PMID: 19018899 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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RATIONALE, AIMS AND OBJECTIVES: There is mounting evidence of a gap between Evidence-based Medicine (EBM) and physician clinical practice, in part because EBM is averaged global evidence gathered from exogenous populations which may not be relevant to local circumstances. Local endogenous evidence, collected in particular and 'real world' patient populations may be more relevant, convincing and timely for clinical practice. Evidence Farming (EF) is a concept to provide such local evidence through the systematic collection of clinical experience to guide more effective practice. METHODS: We report on the findings of a pilot study of 29 individual and three focus group (n = 10) interviews exploring physicians' evaluations how they use multiple sources of information in clinical decision making and their thoughts on EF. RESULTS: Physicians recognize a gap in translating EBM to practice. Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and EBM summarizing electronic clinical resources rather than refer directly to EBM literature. Confidence in making decisions based on clinical experience increases over time, yet few physicians reported having systems for tracking their clinical experience in designing treatment plans and patient outcomes. Most physicians saw EF as a promising way to track experience, thereby making scientific evidence more relevant to their own clinical practices. CONCLUSION: Clinical experience is relatively neglected by the EBM movement, but if that experience were systematically gathered through an approach such as EF, it would meet a need left unfulfilled by EBM. |
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Authors:
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M Cameron Hay; Thomas S Weisner; Saskia Subramanian; Naihua Duan; Edmund J Niedzinski; Richard L Kravitz |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of evaluation in clinical practice Volume: 14 ISSN: 1365-2753 ISO Abbreviation: J Eval Clin Pract Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-11-21 Completed Date: 2009-02-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9609066 Medline TA: J Eval Clin Pract Country: England |
Other Details:
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Languages: eng Pagination: 707-13 Citation Subset: IM |
Affiliation:
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Department of Anthropology, Miami University, Oxford, OH, USA. mchay@ucla.edu |
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| MeSH Terms | |
Descriptor/Qualifier:
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Attitude of Health Personnel* California Clinical Medicine / education, organization & administration* Data Collection Decision Making Decision Support Techniques Diffusion of Innovation* Evidence-Based Medicine / education, organization & administration* Focus Groups Health Knowledge, Attitudes, Practice Health Services Needs and Demand Humans Information Storage and Retrieval Outcome Assessment (Health Care) Patient Care Planning Physicians / psychology* Pilot Projects Practice Guidelines as Topic Questionnaires Randomized Controlled Trials as Topic |
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