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Balancing health care evidence and art to meet clinical needs: policymakers' perspectives

RATIONALE, AIMS AND OBJECTIVES: Although many believe that evidence-based practice (EBP) has great potential, critics have identified limitations including a focus on randomized clinical trial (RCT) evidence to the exclusion of other evidence types and a disregard for the art of medicine. Others hav...

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Autores principales: Parker, Louise E, Ritchie, Mona J, Kirchner, JoAnn E, Owen, Richard R
Formato: Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810443/
https://www.ncbi.nlm.nih.gov/pubmed/20367694
http://dx.doi.org/10.1111/j.1365-2753.2009.01209.x
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author Parker, Louise E
Ritchie, Mona J
Kirchner, JoAnn E
Owen, Richard R
author_facet Parker, Louise E
Ritchie, Mona J
Kirchner, JoAnn E
Owen, Richard R
author_sort Parker, Louise E
collection PubMed
description RATIONALE, AIMS AND OBJECTIVES: Although many believe that evidence-based practice (EBP) has great potential, critics have identified limitations including a focus on randomized clinical trial (RCT) evidence to the exclusion of other evidence types and a disregard for the art of medicine. Others have argued, however, that proper application of EBP involves reasoned consideration of a wide variety of information; thus, the dichotomy between medical science and art may be false. We explore the views of executive-level policymakers from the Veterans Health Administration, a leader in the EBP movement, regarding what constitutes evidence and the relative importance of evidence versus practical needs when determining clinical policy. METHOD: We conducted 26 semi-structured qualitative interviews and performed a content analysis. RESULTS: Although informants generally believed in the value of EBP and the role of RCTs within it, they also valued other types of evidence. Further, they had concerns that were sometimes antithetical with strict adherence to an evidence-based approach. These included practical concerns, fit with organizational values and with local circumstances, resources, political pressures and patient needs. They were especially concerned about how to address medical conditions that affect many individuals or high-risk populations that have no evidence-based treatment. CONCLUSION: When possible, health care practice should be evidence-based. When this is not possible, health care providers must turn to the art of medicine by using consensus-based best practices. Further, it is important for policymakers and researchers to work in concert to develop EBPs that are practical and meet needs.
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spelling pubmed-28104432010-01-26 Balancing health care evidence and art to meet clinical needs: policymakers' perspectives Parker, Louise E Ritchie, Mona J Kirchner, JoAnn E Owen, Richard R J Eval Clin Pract Original Articles RATIONALE, AIMS AND OBJECTIVES: Although many believe that evidence-based practice (EBP) has great potential, critics have identified limitations including a focus on randomized clinical trial (RCT) evidence to the exclusion of other evidence types and a disregard for the art of medicine. Others have argued, however, that proper application of EBP involves reasoned consideration of a wide variety of information; thus, the dichotomy between medical science and art may be false. We explore the views of executive-level policymakers from the Veterans Health Administration, a leader in the EBP movement, regarding what constitutes evidence and the relative importance of evidence versus practical needs when determining clinical policy. METHOD: We conducted 26 semi-structured qualitative interviews and performed a content analysis. RESULTS: Although informants generally believed in the value of EBP and the role of RCTs within it, they also valued other types of evidence. Further, they had concerns that were sometimes antithetical with strict adherence to an evidence-based approach. These included practical concerns, fit with organizational values and with local circumstances, resources, political pressures and patient needs. They were especially concerned about how to address medical conditions that affect many individuals or high-risk populations that have no evidence-based treatment. CONCLUSION: When possible, health care practice should be evidence-based. When this is not possible, health care providers must turn to the art of medicine by using consensus-based best practices. Further, it is important for policymakers and researchers to work in concert to develop EBPs that are practical and meet needs. Blackwell Publishing Ltd 2009-12 /pmc/articles/PMC2810443/ /pubmed/20367694 http://dx.doi.org/10.1111/j.1365-2753.2009.01209.x Text en Journal compilation © 2009 Blackwell Publishing Ltd http://creativecommons.org/licenses/by/2.5/ Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.
spellingShingle Original Articles
Parker, Louise E
Ritchie, Mona J
Kirchner, JoAnn E
Owen, Richard R
Balancing health care evidence and art to meet clinical needs: policymakers' perspectives
title Balancing health care evidence and art to meet clinical needs: policymakers' perspectives
title_full Balancing health care evidence and art to meet clinical needs: policymakers' perspectives
title_fullStr Balancing health care evidence and art to meet clinical needs: policymakers' perspectives
title_full_unstemmed Balancing health care evidence and art to meet clinical needs: policymakers' perspectives
title_short Balancing health care evidence and art to meet clinical needs: policymakers' perspectives
title_sort balancing health care evidence and art to meet clinical needs: policymakers' perspectives
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810443/
https://www.ncbi.nlm.nih.gov/pubmed/20367694
http://dx.doi.org/10.1111/j.1365-2753.2009.01209.x
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