Evidence based practice integrates the best available research evidence, clinical expertise, and patient values and preferences. It has roots in evidence based medicine and was developed to address issues with traditional clinical practice being based on small numbers of opinions and poorly organized medical literature. Evidence based practice benefits patients through improved treatment, benefits clinicians through high quality care, and benefits researchers through increased testing of new products. While it has advantages like improved patient outcomes, barriers to implementation include the large volume of evidence, dissemination challenges, and lack of time and incentives for clinicians to incorporate evidence into practice.

1. EVIDENCE BASED PRACTICE- I
PRESENTED BY : DR. VINI MEHTA
MDS II
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2. Contents
• Introduction
•History of Evidence Based Practice (EBP)
•What is Evidence
•Prior of EBP
• Shortcomings from earlier methods
•Need for EBP
• Three Domains of EBP
•Who benefits from EBP
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3. •Who benefits from EBP
•Types of EBP
•Advantages of EBP
•Disadvantages of EBP
•Barriers to EBP
•Conclusion
•References
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4. Introduction
•Evidence Based Practice is the integration of clinical expertise, patient values, and the best research
evidence into the decision making process for patient care.
• Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient
brings to the encounter his or her own personal preferences and unique concerns, expectations, and
values.
• The best research evidence is usually found in clinically relevant research that has been conducted using
sound methodology.
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5. History of Evidence Based Practice
•Evidence-Based Practice has its roots in Evidence Based Medicine (also referred to as Evidence –
Based Health Care).
•EBM was created in the 1980s and popularized in the early 1990s as a response to medical
textbooks being unable to keep up with rapid changes in medicine and being frequently based
on the interpretations of a small number of people in a respective field.
•At the same time, the medical literature in journals was being produced in record numbers, but
at the same time was poorly organized.
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6. What is Evidence ?
In the context of evidence based practice this is research published in professional and academic
journals and systematic reviews of research found in databases of evidence
‘ Knowledge derived from a variety of sources that has been found to be credible’
Types of Evidence
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Muir Gray, 1997

7. Other forms of Evidence
•Evidence based on experiences (professional or personal)
•Evidence gathered from patients/clients
•Evidence based theory that is not research based.
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8. Definition of Evidence based Practice
It is “the careful, explicit and judicious use of current best evidence in making decisions about
the care of individual patients.”
(Sackett 1996)
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9. Prior to EBP
1. Unsystematic clinical observation to establish and maintain knowledge about prognosis
and treatment efficacy
2. Understand patho-physiologic principles as sufficient guide for clinical practice
3. Traditional training and common sense as adequate to evaluate new therapies
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10. Shortcomings of Earlier Method
1. Lack of scientific background
2. Information obtained from others might vary from one person to another
3. At times it’s difficult to judge the treatment modalities received from others.
Health Professionals Relied on :
1. Own clinical experience
2. Knowledge of underlying biology
3. Text book
4. Experts opinion
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11. Need for EBP
•EBP provides guidelines that help clinician make intelligent decisions.
•Helps the clinician to evaluate the mass of data and choose in skilled manner, what to use and what to
discard.
•New evidence is constantly being generated which might significantly change the way we care for
patients, but most clinicians usually fail to get it.
•Our knowledge and clinical performance deteriorate with time, so we should update it timely.
EBP provides :
•High quality, clinically oriented and relevant research which provides better information for the clinician.
•It will yield improved treatment for the patient.
•Personal satisfaction that “my patients are being offered the best treatment”.
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12. Evidence Based Approach
The approach of EBP will emphasize:-
1. Precised definition of patient problems to facilitate efficient literature search.
2. Understanding rules of evidence to interpret literature regarding correct prognosis and therapeutic approach.
3. Extraction of the clinical message and application to the patient problem.
4. High quality, clinically oriented and relevant research which provides better information for the clinician.
5. Improved treatment for the patient.
6. Personal satisfaction that my patients are being offered the best treatment.
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13. Three Domains of EBP
EBP
Scientific
evidence
Clinical
experience
Patients’ values
and preferences
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14. Evidence Based Practice
Must know about EBP :
1.The explosion in the quantity of information makes it virtually impossible to keep up with the current reading
subscribing every journal and attempting to read every issue is not only impossible but also unfocused and
wasteful of time.
2.The increasing use of randomized controlled trial and more emphasis on research methodology has resulted
in much greater strength of evidence.
3.Introduction of systematic reviews and meta analysis of multiple properly designed studies has improved
our ability to draw conclusions.
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15. Who benefits from EBP ?
1. Patients
2. Dentists
3. Researcher
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16. Patients
•Saves time
•No need to approach other dentists when treatment plan is based on evidence based practice
•Harm to the patient is relatively low
•Patients needs and preferences are valued
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17. Dentists
•Personal satisfaction
•High quality of care will be rendered to patients.
•Greater confidence in treatment planning
•Wastage of resources is minimized.
•Good rapport will be developed between patients and dentists
•It also favors the dentists to take up new and better treatments in his practice
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18. Researchers
•They are being called upon to do the clinical testing necessary before new products are
introduced into the market.
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19. Types of EBP
1. Evidence based guidelines
2. Evidence based individual decision making
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20. Evidence based guidelines
• Evidence-based guidelines (EBG) is the practice of evidence-based medicine at the organizational or
institutional level.
• This includes the production of guidelines, policy, and regulations.
• This approach has also been called evidence based healthcare(EBHC)
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21. Evidence based individual decision making
Evidence-based individual decision (EBID) making is evidence-based
medicine as practiced by the individual health care provider .
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22. Advantages of EBP
• It improves the effective use of research evidence in clinical practice
• It uses the resources more effectively
• It relies on evidence rather than authority for clinical decision making
• It enables practitioner to monitor and develop clinical performance
•It will serve patients better because only tested procedures will be certified.
•It will increase the standing of the profession because it will ensure that proven treatments are offered.
• The goal of evidence-based dentistry is high-quality, clinically orientated, and relevant research, which
provides better information for the clinician and improved treatment for the patient.
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23. Advantages of EBP
•It will serve patients better because only tested procedures will be certified.
•It will increase the standing of the profession because it will ensure that proven treatments
are offered.
• The goal of evidence-based dentistry is high-quality, clinically orientated, and relevant
research, which provides better information for the clinician and improved treatment for the
patient.
Evidence-based practice in dentistry; New Zealand Dental Journal 98: 32-35; 2002
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24. Disadvantages of EBP
Making clinical decisions based on evidence does pose several problems like
1. Amount of evidence
2. Quality of evidence
3. Dissemination of evidence
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25. Amount of Evidence
Currently,
Two million biomedical articles are published annually in some 20,000 journals. There
are about 500 journals related to dentistry. Clearly not all of these articles are
relevant to all areas of dental practice, nor one can hope to read any more than a
small minority.
Hackshaw AK, Paul EA and Davenport ES: Evidence-based dentistry: an introduction: Community Dent Oral Epidemiol 2007; 35: 318–319
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26. Quality of evidence
•Most of the publications are not subjected to peer review.
•There is tendency for “publication bias”.
•This bias occurs when there is tendency both by researchers and by editors to publish positive
reviews
•Value the evidence with negative results and it is the duty of every researcher to publish the
trials with negative results
•This will minimize the publication bias in the literature
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27. Dissemination of evidence
•Unless good methods of dissemination are available, even where there is good evidence, it takes
many years for a particular treatment to become the norm.
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28. Key Points of EBP
•EBP is a structured approach for clinical decision making.
•It assists the practitioner in finding and applying the best evidence in clinical practice.
•EBP manages the information overload and uncertainty.
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29. Barriers to implement EBP
•Lack of interest
•Lack of involvement
•Lack of time
•Lack of remuneration
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30. Potential Barriers to Change Clinical
Practice
1. Knowledge and attitude of practitioner
• Information overload
• Clinical uncertainty
• Influence of opinion leaders
• Outdated knowledge
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31. 2. Patient factors
•Demands for care
•Perceptions and beliefs about appropriate care
3. Practice Environment
•Time constraints
•Poor practice organization
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32. 4. Educational environment
•Inadequate continuing education programs
•Inadequate preparation of dental faculty for teaching
5. Wider health system
•Inappropriate funding system
•Lack of financial support for innovation
•Failure to provide practitioners with access to appropriate information
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33. Conclusion
•Evidence based practice is the most effective approach for treating patients.
•Evidence-based approach improves patient care through decision making.
•Incorporates research evidence, along with clinical expertise and patient preferences.
•Research evidence should help guide, rather than dictate, clinical decisions.
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34. References
•Booth, A. & Brice, A. (2004). Evidence based practice for information professionals. Bodmin, Cornwall (UK):
Facet Publishing.
•Sackett, D.L., Strauss, S.E., Richardson, W.S., Rosenberg, W. and Haynes, R.B. (2000) Evidence Based Medicine:
How to Practice and Teach EBM, 2nd edn, Edinburgh, Churchill Livingstone.
•Donald, A. and Greenhalgh, T. (2000) A Hands-on Guide to Evidence Based Healthcare: Practice and
Implementation, Blackwell Science, Oxford
•Carnwell, R. (2001) ‘Essential differences between research and evidence-based practice’, Nurse Researcher,
Vol.8, No.2, pp.55-68
•Derek Richards, Jan Clarksom: Evidence-Based Dentistry: Managing Information for better Practice
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