Evidence-based medicine in clinical pharmacy practice

1. EVIDENCE-BASED MEDICINE
IN CLINICAL PHARMACY
PRACTICE
BY
PHARM. MOHAMMED USMAN NDABIDA
AMINU KANO TEACHING HOSPITAL. KANO STATE
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2. OUTLINE
 INTRODUCTION
 SOURCE OF KNOWLEDGE
 RESEARCH
 STRAFICATION OF EVIDENCE
 PICO PROCESS
 APPLY EBM TO CLINICAL
SETTING
 CLINICAL CONCERNS
 EVALUATION OF EVIDENCE
 BIAS
 DATABASES
 CASE STUDY
 BARRIES TO THE USE OF EBM.
 REFERENCES
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3. INTRODUCTION
 What is evidence-based medicine?
 The conscientious, explicit, and judicious use of current best evidence in making
decisions in the care of individuals.
( (Sackett, et al.1996)
 Why am I doing it this way? Is there evidence that guides me to better outcomes?
 Define as the use of current best evidencence research to make practice and policy
decisions.
 A shift away from making health care decisions on opinion, precedent and past
practice.
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4. Introduction cont..
 Shift t toward making more use of science and research to guide clinical
decision making
 Integrating individual clinical experience with the best available external
clinical evidence.
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5. DIFFERENCE BETWEEN EBM AND
TRADITIONAL WAY OF PRACTICE
The most important difference between
evidence-based medicine and traditional
medicine is not that EBM considers the
evidence while the latter does not. Both take
evidence into account; however, EBM
demands better evidence than has traditionally
been used.
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6. TASK OF EVIDENCE BASED CLINICIANS
EBM-oriented clinicians of tomorrow have three tasks:
To use evidence summaries in clinical practice
To help develop and update selected systematic reviews
or evidence-based guidelines in their area of expertise
 To enrol patients in studies of treatment, diagnosis and
prognosis on which medical practice is based.
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7. REQUIRED SKILL FOR EMB
 Ability to find
 Critically appraise
 Incorporate sound scientific
evidence into their own
practice
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8. Sources of knowledge.
 Reference to tradition. Accepting certain truths as given.
 Reference to authorities: placing trust in those who are authorized or experts on
issues.
 Trial and error: applying multiple attempts to find a solution by chance.
 Logical reasoning: Involving deductive reasoning is a systemic method of concluding
by using a series of three interrelated statements.
 Scientific Research or method: applying a logical sequential process to develop a
conclusion. This process Involves Identifying the problem, organizing a collection of
data analyzing the data and interpreting the findings.
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9. Research.
 Research is a systemic scientific process that generates new or
validates existing knowledge and includes.
 Research question
 A review of current literature
 A study designed to answer the questions
 An intervention with the result
 Analysis of the data
 Dissemination of the results.
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10. Stratification of Evidence
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11.  A technique used in evidence-based decision-making process of framing And
answering a clinical Questions.
 Pico is a mnemonic used to help remember the four important parts of a well
but clinical question.
PICO PROCESS
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12. PICO Cont…….
 P: patient problem or population
Patient or the problem to be addressed
 I: intervention.
The intervention of interest – treatment/tests
 C: comparison
control or comparison intervention treatment/placebo
 Outcome: outcome of interest
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13. APPLYING EBM TO CLINICAL SETTING
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14. Requestor demographics and background questions:
Who is requesting the information?
• Where is the inquirer located? Which phone number can he/she be
reached?
• When does the inquirer need the information?
• What information is requested?
• Why is the inquirer seeking the information?
• What background information is pertinent and available for the
information requested?
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16. Search strategy and evaluate: step-wise approach
to using drug information resources
• Tertiary literature (Textbooks, drug compendia or review article).
• Secondary literature- computerized data-
• Primary literature (suggested important journals in Internal Medicine
and Pharmacotherapy)
• Alternative resources
• Newsletters.
• Internet.
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17. Tertiary literature
Sources that condense information from primary and secondary literature
• Allowing a brief, introductory review of key principles or practices that
relate to a topic.
• Common examples include textbooks, dictionaries, encyclopedias, and
handbooks. Biomedical literature examples include clinical practice
guidelines and review articles. Online databases includes Lexicomp and
Micromedex
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18. Secondary literature
Resources provide indexing or abstracting sources that assist in
conveniently locating primary literature (e.g. clinical trials) and tertiary
literature.
Examples include the Cochrane Library, International Pharmaceutical
Abstracts (IPA) and indexing platforms such as PubMed and MEDLINE.
• These sources allow health care providers to search and identify
pertinent biomedical literature that can be applied to patient care.
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19. Primary literature
Any published paper that reports original research.
• Examples include firsthand clinical research results such as clinical trials,
case reports, cohort studies, meta‐analyses, survey research, etc.
• Clinical research provides the basis for making evidence based
decisions concerning patient care.
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21. Formulation and provision of response
verbally or in writing (1)
• Steps in presenting the information.
• Present the competing viewpoints or considerations.
• State the assessment of the literature or information reviewed and
claim the superior viewpoint.
• Succinctly refute the major strengths and present the weaknesses of the
inferior viewpoint.
• Defend the major weaknesses and promote the strengths of the superior
viewpoint.
• Reiterate the final assessment in support of the superior viewpoint.
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22. CLINICAL CONCERNS
Clinical Concern
 Therapy
 Diagnosis
 Etiology or harm
 Prognosis
 Prevention
 Clinical Examination
Study Design of choice
 Randomized control trial
(preferred):cohort, case-control..
 A prospective, blind comparison
 Randomized control trial cohort,
case-control
 Cohort, case-control, case series
 Randomized control trial; cohort
 Prospective, blind comparison to the
gold standard.
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23. EVALUATING THE EVIDENCE FOR
THERAPY/ APPRAISAL
VALIDITY
 Were patients randomized to treatments?
 Was there blinding? Patients, clinicians, study personnel?
 Were groups similar at the beginning of the trial?
 Was everyone who was initially enrolled accounted for at the end?
 Did groups receive equal treatment other than the comparisons?
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24. Evidence Evaluation cont…..
MAGNITUDE OF EFFECT
 What are overall results?
 Are results applicable to my patient or population?
 What was the size of the Treatment effect? - Relative Risk, Odds
Ratios, Numbers Needed to Treat
 Were all relevant outcomes addressed?
 Are benefits worth cost or potential harm?
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25. BIAS
 Publication bias - How similar are results from published versus
unpublished studies?
 Watch for:
• Incomplete or selective reporting of outcomes.
• Arbitrary limits such as language or choice of resources
 Truncation bias - study is published in a briefer form with fewer
details
 Time-lag bias - delayed publication of findings
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26. BIAS Cont……….
 Citation Bias - citation/non-citation of research findings.
 Selective outcome reporting bias - selective reporting of some outcomes but
not others.
 Location bias - journals with different ease of access/levels of indexing in
standard databases.
 Multiple (duplicate) publications.
 Database bias - some databases are more likely to index certain
languages/journals.
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27. TOOLS & DATABASES FOR EVIDENCE
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28. ROLE OF PHARMACIST IN EBM
 To Improve rational use of medications making sure that patients
receive the right medicine in the right dose for the right diagnosis at
the right time at the lowest possible cost suitable to their individual
requirements
 clinical pharmacist may be asked questions by physicians, nursing
personnel and patients regarding drug information . Hence, the
pharmacist must have a vast knowledge about various drugs, their
interactions and adverse effects, proper dosage and must have
good communication skil. It is advisable to have a proper awareness
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29. CASE STUDY
 A well-known type ll diabetic patient, Mr, KT.
Asked if the new anti-diabetic agent, SGL-T2
inhibitor, can reduce weight as he saw on the news
media.
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30. CASE STUDY Cont….
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31. CASE STUDY CONT….
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41. BARRIES TO EBM
 Lack of relevant evidences
 Lack of confidence in literature searching skills
 Publication bias
 Newness of the concept
 Lack of confidence in evaluating literature
 Cost of properly designed trials
 May not recognized individual factors such as value for life
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42. RECOMMEDATIONS
 Guidelines must be developed in every country for the
implementation of evidence-based practice (Regular training and
workshops on the advanced treatment practices, usage of latest
drug information databases help in improving the pharmacist
knowledge)
 A functional drugs information unit should be set up in all
Secondary, tertiary health institutions to promote therapeutic
research
 Drugs and therapeutic committee should be constituted in every
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44. REFERENCES
 www.futurelearn.com. (2021,06,15). Evidencebasedmedicineinclinicalpharmacy.
Retrieved from www.google.com
 Albrecht S. Evidence-based medicine in pharmacy practice. US Pharmacist.
2009;34:HS14-HS18
 Toklu HZ. Promoting evidence-based practise in pharmacies. Integr Pharm
Res Pract. 2015;4:127-131.
 Bryant PJ and Pace HA. The pharmacist guide to evidence-based medicine for
clinical decision making. American Society of Health-System Pharmacists,
Bethesda, Marylandd. 2009.
 Sackett DL, et al. Evidence based medicine: What it is and what it isn't. BMJ.
1996;312:71-72.
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