Evidence-based medicine in clinical pharmacy

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 1

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 2

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. 3

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. 4

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. 5

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. 6

7. REQUIRED SKILL FOR EMB Ability to find Critically appraise Incorporate sound scientific evidence into their own practice 7

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. 8

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. 9

10. Stratification of Evidence 10

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 11

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 12

13. APPLYING EBM TO CLINICAL SETTING 13

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? 14

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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. 16

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 17

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. 18

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. 19

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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. 21

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. 22

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? 23

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? 24

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 25

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. 26

27. TOOLS & DATABASES FOR EVIDENCE 27

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 of newer medical conditions, their diagnosis, prognosis and prevention, etc.  28

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. 29

30. CASE STUDY Cont …. 30

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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 41

42. RECOMMEDATIONS Gu idelines 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 heath institutions for advisory purpose. 42

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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. 44