Teaching evidence-based medicine skills can change practice in a community hospital

被引:74
作者
Straus, SE
Ball, C
Balcombe, N
Sheldon, J
McAlister, FA
机构
[1] Univ Toronto, Dept Med, Univ Hlth Network, Toronto, ON, Canada
[2] Univ Penn, Wharton Sch Business, Philadelphia, PA 19104 USA
[3] Burton Hosp NHS Trust, Queens Hosp, Burton Upon Trent, Staffs, England
[4] Univ Alberta, Div Gen Internal Med, Edmonton, AB, Canada
基金
加拿大健康研究院;
关键词
evidence-based medicine; medical education; practice of medicine;
D O I
10.1111/j.1525-1497.2005.04045.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
OBJECTIVES: Several studies have evaluated whether evidence-based medicine (EBM) training courses can improve skills such as literature searching and critical appraisal but to date, few data exist on whether teaching EBM skills and providing evidence-based resources result in change in behavior or clinical outcomes. This study was conducted to evaluate whether a multifaceted EBM intervention consisting of teaching EBM skills and provision of electronic evidence resources changed clinical practice. DESIGN. Before/after study. SETTING: The medical inpatient units at a district general hospital. PARTICIPANTS: Thirty-five attending physicians and 12 medicine residents. INTERVENTION: A multicomponent EBM intervention was provided including an EBM training course of seven 1-hour sessions, an EBM syllabus and textbook, and provision of evidence-based resources on the hospital network. MEASUREMENTS AND MAIN RESULTS: The primary outcome of the study was the quality of evidence in support of therapies initiated for the primary diagnoses in 483 consecutive patients admitted during the month before and the month after the intervention. Patients admitted after implementation of the EBM intervention were significantly more likely to receive therapies proven to be beneficial in randomized controlled trials (62% vs 49W P =.016). Of these trial-proven therapies, those offered after the EBM intervention were significantly more likely to be based on high-quality randomized controlled trials (95% vs 87%: P =.023). CONCLUSIONS: A multifaceted intervention designed to teach and support EBM significantly improved evidence-based practice patterns in a district general hospital.
引用
收藏
页码:340 / 343
页数:4
相关论文
共 20 条
[1]   INPATIENT GENERAL MEDICINE IS EVIDENCE BASED [J].
ELLIS, J ;
MULLIGAN, I ;
ROWE, J ;
SACKETT, DL .
LANCET, 1995, 346 (8972) :407-410
[2]  
FISHER BW, 2002, ANN R COLL PHYS SURG, V35, P467
[3]   Randomised controlled trial of a theoretically grounded tailored intervention to diffuse evidence-based public health practice [ISRCTN23257060] [J].
Louise Forsetlund ;
Peter Bradley ;
Lisa Forsen ;
Lena Nordheim ;
Gro Jamtvedt ;
Arild Bjørndal .
BMC Medical Education, 3 (1)
[4]  
GHALI WA, 1998, ANN ROY COLL PHYSIC, V31, P177
[5]   From best evidence to best practice: effective implementation of change in patients' care [J].
Grol, R ;
Grimshaw, J .
LANCET, 2003, 362 (9391) :1225-1230
[6]   All members of primary care team are aware of importance of evidence based medicine [J].
Hagdrup, N ;
Falshaw, M ;
Gray, RW ;
Carter, Y .
BRITISH MEDICAL JOURNAL, 1998, 317 (7153) :282-282
[7]  
Langham J, 2002, BRIT J GEN PRACT, V52, P818
[8]   From knowledge to practice in chronic cardiovascular disease: A long and winding road [J].
Majumdar, SR ;
McAlister, FA ;
Furberg, CD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (10) :1738-1742
[9]   DETECTING DIFFERENCES IN QUALITY OF CARE - THE SENSITIVITY OF MEASURES OF PROCESS AND OUTCOME IN TREATING ACUTE MYOCARDIAL-INFARCTION [J].
MANT, J ;
HICKS, N .
BMJ-BRITISH MEDICAL JOURNAL, 1995, 311 (7008) :793-796
[10]   Evidence-based medicine and the practicing clinician [J].
McAlister, FA ;
Graham, I ;
Karr, GW ;
Laupacis, A .
JOURNAL OF GENERAL INTERNAL MEDICINE, 1999, 14 (04) :236-242