Defining the Evidence Based Practice Decision-Making Model

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Original Editor - Wanda van Niekerk

Top Contributors - Wanda van Niekerk, Jess Bell and Angeliki Chorti

Introduction

Evidence-based practice (EBP) was first introduced in the early 1990's as evidence-based medicine (EBM). This “new paradigm” initially involved the practice of clinical medicine with the aim to develop and advance a transparent and rational process for clinical decision-making that did not exclusively rely on intuition and single clinical expertise and can be taught, refined, and applied by all clinicians. Since then, various models and frameworks have been proposed in the healthcare setting that do not apply to the field of medicine only.

Satterfield et al. in 2009 further developed the evidence-based practice model and provided it with a transdisciplinary perspective by adding each discipline's efforts towards addressing deficiencies and making advances. The aim was to provide a common language across disciplines. This model had a new external frame that provided environmental and organisational context. The three inner pillars of the model involved the best available research evidence, client or population’s characteristics, state, needs, values and preferences and resources including practitioner’s expertise. At the centre of this evidence-based model was clinical decision-making, giving clinical expertise a key role in the EBP decision-making process.

EBP Steps

Step 1: Determining the patient’s needs to formulate a clinical question

Step 2: Locating the knowledge resources

Step 3: Appraising the quality of the knowledge resources

Step 4: Discussing the options with the patient

Step 5: Formulate the treatment plan

Step 6: Implementing the treatment plan

Step 7: Evaluate the effectiveness of the treatment plan and the evidence-based practice process

5 A’S of EBP

Evidence-based practice is a 5-step process that is commonly refered to as the five ‘A’s: Ask, Access, Appraise, Apply, Audit.

Terminology

Evidence-based treatment

Best practice –

Research-informed practice

Evidence-based practice applications

Levels of evidence questions

And link to page

Challenges of EBP

Lack of time to search for and apply the best available evidence – mostly due to heavy patient case loads Naghibi D, Mohammadzadeh S, Azami-Aghdash S. Barriers to evidence-based practice in health system: a systematic review. Evidence Based Care. 2021 Jul 1;11(2):74-82.

Not enough or not good enough research available on all conditions and scenarios Sadeghi‐Bazargani H, Tabrizi JS, Azami‐Aghdash S. Barriers to evidence‐based medicine: a systematic review. Journal of evaluation in clinical practice. 2014 Dec;20(6):793-802.

Finding the right resources between the masses is difficult H, Tabrizi JS, Azami‐Aghdash S. Barriers to evidence‐based medicine: a systematic review. Journal of evaluation in clinical practice. 2014 Dec;20(6):793-802.

Accessing the resources Ibikunle PO, Onwuakagba IU, Maduka EU, Okoye EC, Umunna JO. Perceived barriers to evidence‐based practice in stroke management among physiotherapists in a developing country. Journal of Evaluation in Clinical Practice. 2021 Apr;27(2):291-306.

Lack of administrative support Naghibi et al

Not skilled in critical appraisal Naghibi

Not enough role models who practice evidence-based practice regularly

Advantages

It offers the surest and most objective way to determine and maintain consistently

high quality and safety standards in medical practice.

It can help speed up the process of transferring clinical research findings into

practice.

It has the potential to reduce healthcare costs significantly.”

Reduce variability of care

Increases healthcare provider empowerment and role satisfaction

Meets expectations of an informed public 

Resources

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