Evidensbaserad vård - vad är det och vad är det inte?

Abstract

Evidensbaserad vård är att på ett medvetet sätt använda bästa sammantagna vetenskapliga bevis – evidens – i kliniska beslut. Men evidensbaserad vård innebär inte att man mekaniskt kan följa en "kokbok". I stället måste man samtidigt ta hänsyn till varje patients unika förutsättningar och sin kliniska erfarenhet. Det kan vara svårt att vid sidan av patientarbetet hålla sig à jour med den ständigt växande vetenskapliga litteraturen, följa nya rön och värdera resultatens tillförlitlighet och tillämpbarhet. Tandläkarna måste hitta sätt att hantera den växande kunskapsmassan, sätt att sovra och sammanställa informationen så att den blir kliniskt användbar. Evidensbaserad vård innebär en sådan strävan efter vård på säkrare vetenskaplig grund och är en logisk följd av vårdens ledstjärnor – vetenskap och beprövad erfarenhet.Evidence is the collection of results that have been systematically collected and scrutinized to fulfil well-established criteria on validity. Evidence-based health care is often defined as the careful, precise and systematic implementation of evidence in clinical decision-making. However, evidence alone is never enough. A more appropriate description of evidence-based health care includes a combination of the implementation of the best available clinical evidence, the consideration of the patient’s circumstances, values and preferences and the clinician's experience. The goal of evidence-based health care is to improve people’s health through the explicit use of scientific findings, which is in contrast to the concept that relies on intuition and the use of unsystematic clinical experience, as well as authoritative statements by experts. During decision-making, the clinician must combine evidence together with different preferences, such as weighing what our patients and society will gain or lose. This includes the question “Should health care resources be reserved primarily for procedures that are proven to be effective?” Evidence-based health care tries to address this question by analysing the efficacy and cost-effectiveness of heath services. A number of myths are applied to evidence based health care. Firstly discarding evidence that has not been scientifically assessed, although lack of evidence does not mean lack of effect, the benefits may not yet have been assessed. Analysis of the scientific literature always reveals clinical issues that require further research. Second, is that randomised trials always generate the best evidence, this is incorrect. The research question determines which type of study design will yield the most valid answer. Third, evidence-based health care is said to be incompatible with trusting patient-clinician relationships, again false. If clinicians ignore information, patients can be misinformed and will have difficulty in actively participating in decisions that affect their health. A continuing challenge to evidence-based health care and education is the integration of new clinical research with the time-honoured craft of caring for patients and their health