The document discusses the application of evidence-based medicine (EBM) in patient care, emphasizing patient-centered approaches and high-quality evidence for clinical decisions. It outlines considerations for making treatment decisions, including assessing evidence, collaborating with patients, and staying updated with drug information and clinical guidelines. The importance of evaluating interventions that matter to patients and utilizing various methods for keeping informed is also highlighted.

1. Applying Drug Literature to Patient
Care

2. Evidenced Based Medicine (EBM)
• The best method of caring for patients
• Application is complicated by:
– Patient-specific factors
– Clinician-specific judgment and expertise
– Availability of evidence
– Assessment of evidence

3. Applying Evidence to Patient Care
• Two underlying principles:
1. Care is patient-centered
2. Decisions based on most applicable and highest
quality evidence
• Both principles must be weighed to make a patient
care decision

4. Patient-Centered Considerations
• Quality of life
– Cost
– Risk versus benefit
– Lifestyle changes
• Values and preferences
• Collaborating with the patient

5. Patient-Centered Considerations
• Adherence
• Health literacy
• Biological factors (e.g., race)

6. Considerations for Making a Treatment
Decision
• Gather applicable evidence
• Assess quality of evidence
• Share evidence with patient
• Collaborate with patient

7. Applying Clinical Trials to Patient Care

8. Applying Guidelines to Patient Care
• Ideally, the practice guideline should:
– Be objective and have a scope aligned with the
clinical scenario
– Review all issues relevant to the clinical scenario
– Comprehensively review all treatment options
– Systematically review the literature
– Clearly define the process for reviewing the
literature and making recommendations

9. Practice Guideline Considerations
• Not always up to date
– Determine when they were last updated
• Sometimes based on expert opinion
– Check level AND type of evidence on which
recommendations are based

10. Practice Guideline Considerations
• Based on value judgments
– Determine if based on perspective of patient,
society, guideline author
– Ideally consider patient perspective

11. Staying Up with Drug Information
1. Focus on your scope of practice
2. Identify a method that works best for your
preferred learning style
3. Incorporate a system into your usual routine

12. POEM
• Patient-oriented evidence that matters
• Evaluates the effect of an intervention (e.g., test, drug)
on an outcome that matters to patients
• Studies a “common” medical problem with a feasible
intervention in a given setting
• Supplies information with potential to induce a practice
change

13. Other Methods to Stay Up To Date
• Search online databases (e.g., pubmed.gov)
• Foraging tools
– Summaries of literature in a given field
• Journal clubs

14. Other Methods to Stay Up To Date
• Precepting
• Continuing education