Chapter 21: Applying Drug Literature to Patient Care

CHAPTER OBJECTIVES

• Understand the general principles of applying evidence to patient care

• Discuss application of randomized trial results to patient care

• Discuss application of practice guidelines to patient care

• Determine appropriateness of applying evidence to patient care

• Develop a system to keep up-to-date with drug information

KEY TERMINOLOGY

• Clinical practice guidelines

• Foraging tool

• Patient-centered care

• Patient-Oriented Evidence that Matters (POEM)

INTRODUCTION

Evidence-based medicine (EBM) is considered the best method of caring for patients.¹ Although this concept appears relatively straightforward—that is, employing the best available evidence to guide clinical decisions for patients—the actual practice of EBM is complicated by a variety of factors. Included in these factors are patient-specific values and circumstances, clinician-specific judgment and expertise, and the availability and appropriate assessment of evidence on which a decision can be based. For a clinician, incorporating these factors into healthcare decisions for a given patient is integral to ensuring optimal treatment outcomes. For example, many Jehovah’s Witnesses believe it is a gross sin to receive blood products. In situations where patients are volume depleted due to significant blood loss, the best option based on the evidence is to give them blood products, but for many Jehovah’s Witnesses, this is unacceptable and they refuse blood products based on their beliefs. As per EBM, the next best treatment plan is implemented, giving them nonblood fluid products.

Developing a systematic approach to EBM can promote efficiency and ensure that all relevant aspects of healthcare decisions are being considered. However, no two patients, clinicians, or situations are the same; thus, clinicians must remember that EBM is a process by which various intervention options can be assessed and, ultimately, individualized decisions can be made. This chapter will review the general principles of applying evidence to patient care. Specifically, it will focus on the incorporation of evidence from clinical trials and recommendations from clinical practice guidelines using examples. In addition, this chapter will discuss methods of staying up-to-date with the rapidly expanding body of drug information using the framework of Patient-Oriented Evidence that Matters (POEM) and foraging tools.

GENERAL PRINCIPLES OF APPLYING EVIDENCE TO PATIENT CARE

The practice of EBM is guided by two underlying principles: 1) care should be patient-centered and 2) decisions should be based on the most applicable and highest-quality evidence available.¹ The first principle, patient-centered care, includes understanding the impact of the problem and various interventions on the patient’s quality of life, recognizing and incorporating the patient’s values and preferences, and collaborating with the patient on managing the problem.² While patient values and preferences are often synonymous, values may be more reflective of a person’s belief system, whereas preferences may be more reflective of a person’s wants or desires. The second principle requires the clinician to obtain relevant evidence that is applicable to the clinical ...