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A decision-making process to establish a clinical treatment plan according to medical evidence that is compatible with national health policy and patient factors. Abbreviation: eBM, evidence-based medicine.
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Abstract: Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a compl...
Context in source publication
Context 1
... the critical question should be asked "Is that applicable to this patient?" EBM ( Figure 2) is a final decision-making process for implementing the best treatment plan for the patient accord- ing to the external medical evidence that is compatible with national health policy and patient factors. [3][4][5][6] Evidence-based pharmacy Traditional pharmacy practice usually focuses on the order (prescription/over the counter), which is fulfilled on demand, and the pharmacist gives a drug-oriented service. ...
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Introduction
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Citations
... To perform this duty properly, pharmacists must use and be familiar with EBM (1,(15)(16)(17). The World Health Organization (WHO), the American Association of Colleges of Pharmacy (AACP), and the International Pharmaceutical Federation (FIP) have all stressed the signi cance of utilizing evidence-based medicine (EBM) to effectively implement good pharmacy practice (GPP) (18)(19)(20). EBM implementation in pharmacy practice improved the quality of life and reduced health-related costs (12,21). ...
Background: Evidence-based medicine (EBM) involves the conscious and careful utilization of the most reliable evidence available when making decisions regarding patient care. EBM can improve treatment plan success, patient compliance, rational use of medications, and healthcare costs.
Objectives: This study evaluated the knowledge, attitude, and practice of pharmacists regarding EBM utilization in community pharmacies.
Methods: A short questionnaire designed and validated to assess the knowledge and attitudes of community pharmacists. A simulated-patient method (SPM) was used to evaluate the practice one week after completing the questionnaire.
Results and Discussion: Within 284 pharmacy visits, the results of 200 pharmacists were collected entirely. The average knowledge score was 37.91 ± 15.4 out of 100. The pharmacists aged 24-29 demonstrated higher knowledge levels than older pharmacists (P=0.042). Furthermore, those who consult more than 30 prescriptions daily showcased a higher knowledge level (P=0.024). Additionally, it was found that pharmacists who utilized the UpToDate® clinical resource exhibited greater knowledge and practice in comparison to others (P<0.001). Most pharmacists had a positive attitude towards EBM and its implementation in the pharmacy (99.5%). The mean score of practice was 50.34 ± 21.35. A direct association was detected between knowledge and practice (r=0.73, P=0.023). There was no association between pharmacists' attitudes and their practice scores.
Conclusion: Most pharmacists agreed about the crucial need to incorporate EBM into pharmacy practices. Pharmacists with advanced knowledge of EBM and using UpToDate® showed better knowledge and practice.
Registration code: https://ethics.research.ac.ir/EthicsProposalView.php?id=152834
... Though carried out, more work is needed in accomplishing IOMR 5-6: Promote the consistency and equity of care through the use of evidence-based guidelines. The employment of evidence-based strategies has long been essential in the provision of pharmaceutical care [50][51][52]. Studies have found that pharmacists face barriers as a result of limited access to resources related to evidence based medicine and patient overload [52,53]. ...
... The employment of evidence-based strategies has long been essential in the provision of pharmaceutical care [50][51][52]. Studies have found that pharmacists face barriers as a result of limited access to resources related to evidence based medicine and patient overload [52,53]. Furthermore, gaps in care for other vulnerable populations have been identified using national consensus guidelines [54]. ...
As pharmacy practice shifts its focus toward population health care needs that serve public health, there is a need to understand community-based pharmacies’ contributions to the reduction in health disparities. A scoping review was conducted to identify what community-based pharmacies in the United States are doing to target racial and ethnic disparities in community-based pharmacies. Forty-two articles revealed that community-based pharmacy services addressed racial and ethnic inequities in a variety of ways, including the types of interventions employed, as well as the ethnicities and conditions of the sample populations. Future work should focus on ensuring interventions are carried out throughout pharmacy practice and accessible to all racial and ethnic minoritized populations.
... Además, incluye 4 tópicos que pueden realizar los FC y que han demostrado generar un impacto clínico y económico. Estos son: administración de fármacos, monitorización de toxicidades y RAM, información al equipo clínico y TS [19][20][21][22][23][24] . ...
Objectives:
The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU).
Methods:
A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1,781 patients was evaluated before and 2,129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5,209 and 2,246. In the after-SPEP period were 6,105 and 2,641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8,072 in the study period.
Conclusions:
This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.
... [12] research yielded similar findings that nurses' lack of knowledge and skill in using evidence (such as research findings), poor time management, a lack of motivation, inadequate resources, and inadequate training were the most common reasons given for not adopting the evidence-based practice. The same barriers were found with other professions like physiotherapy, pharmacist, and dieticians [99,100,101]. ...
The study aimed to determine clinical nurses' beliefs, knowledge, organizational readiness, and evidence-based practice implementation levels and identify the perceived factors affecting evidence-based practice implementation. A descriptive-correlational in quantitative approach with triangulation was used. Data were gathered through the administration of adapted survey questionnaires along with structured interviews and personal observation to supplement the data. Forty-two voluntarily participated and completed the survey. Frequency, percent, mean, and standard deviation were used to analyze and interpret the participants' demographic profile and evidence- based practice-related variables. Regression analysis was used to identify the predictors from the list of variables. For facilitating and hindering factors in the evidence-based practice implementation of clinical nurses, an open- ended question was asked to triangulate the quantitative data. Most of the nurses are female in their middle adulthood, have completed a bachelor’s degree in nursing, and have worked in the hospital as a senior staff nurse for considerable time. The result shows that nurses somewhat truly believe in evidence-based practice, have acceptable evidence-based practice knowledge, probably consider the culture and organizational readiness, and are interested in implementing specific evidence-based practice tasks. Also, it was found that only knowledge of evidence-based practice is a highly significant predictor of evidence-based practice implementation. Perceived facilitating factors include supportive policies, training opportunities, management, and peer support. At the same time, lack of knowledge and insufficient time were recorded as barriers to implementing evidence-based practice. The salient findings were used in crafting the policy brief.
... According to the estimates obtained in a related study, at least 11% of patients receive care that is inconsistent with the latest scientific evidence and may potentially be harmful to them (6). One of the challenges posed to medical specialists is to keep up with the latest developments and advances in various branches of this field (9). Pharmacy is one of the most dynamic fields of medical sciences. ...
... The EBM is considered essential in pharmacy for the provision of pharmaceutical care. The main goal pursued by EBM is that all decisions are based on the texts selected according to the standards of quantitative, qualitative, and theoretical studies (9). The EBM is key to achieving effective pharmaceutical care services (10). ...
Background & Objective: Evidence-based medicine (EBM) integrates the best available evidence from
authentic studies with clinical expertise and patients' values, helping pharmacists to have access to the best
available evidence to respond to clinical questions. The present study aimed to assess the level of awareness
and attitude of pharmacists as the initial step to improve these practices.
Materials & Methods: The instrument used in this cross-sectional study was a questionnaire of awareness
and attitudes towards EBM and its related terms (Abofarha et al., 2014). After localization, the questionnaire
was provided to the pharmacists working in the pharmacies of Zanjan province and pharmacy students in the
last two years of university, and the results were assessed.
Results: The participation rate was 75%, and 66.8% of subjects were familiar with the concept of EBM.
The participants who did not have sufficient knowledge had higher mean age scores in comparison with
those who did not (P=0.001). Moreover, 74.1% of students and 60% of graduates in this study showed
sufficient knowledge and the difference between the two groups was significant (P= 0.023). In addition,
84.1% of the participants had a positive attitude towards EBM. Students and graduates did not significantly
differ in terms of attitude.
Conclusion: As evidenced by the results of this study, pharmacists and pharmacy students in Zanjan
province had a good knowledge of EBM terms. Moreover, it was found that participants with more work
experience were less knowledgeable in this regard. The majority of them had positive attitudes towards
EBM, and it is suggested to include EBM in the pharmacy curriculum to increase students' knowledge in
this regard.
... 38,39 Lack of time, lack of understanding, lack of training, and resource constraints were also indented as main barriers at the pharmacist level. 39,40 Whereas time constraints, excessive bureaucratic and administrative workload, workforce shortage, lack of support from employers and other colleagues were identified as structural barriers. 40 Finally, poor communication with other pharmacists and healthcare professionals, and lack of support from professional associations were identified as the two major environmental barriers. ...
... 39,40 Whereas time constraints, excessive bureaucratic and administrative workload, workforce shortage, lack of support from employers and other colleagues were identified as structural barriers. 40 Finally, poor communication with other pharmacists and healthcare professionals, and lack of support from professional associations were identified as the two major environmental barriers. 38,40 ...
Background
The practice of pharmacy continues to evolve. Comprehensive research to monitor and assess the development of the practice is needed. Good Pharmacy Practices (GPP) have been adopted by many countries to enhance the quality of services. Little information is available concerning how pharmacy practices are being implemented in developing countries. Lebanon being a developing country is a good example where community pharmacy practice doesn't follow clear guidelines and no evidence of good clinical practice.
Objectives
This study aims to highlight GPP implementation, to identify obstacles impeding implementation, and to suggest how its application could be facilitated in Lebanon.
Methods
The review included studies published in English during the last five years covering aspects of pharmacy practice in relation to GPP standards. The search excluded research related to hospital pharmacy practice and primary health care centers since they have their own quality standards.
Results
The research identified 20 recent studies that covered aspects of community pharmacy practice in Lebanon in relation to GPP standards. Eight of the studies related to research and professional development,5 related to the provision of medicines,4 related to interaction and communication,1 related to trainees,1 related to pharmacotherapy monitoring, and 1 related to documentation systems. An additional 6 studies provided insight into factors that affect the pharmacy practice in general. It is apparent that the pharmacy practice would benefit if pharmacists were better supported with financial incentives and a readjustment of their working conditions as this would have a positive impact on their productivity, job satisfaction, and overall well-being. The review indicated that the standard of research and professional development was the most studied topic and it was recommended that pharmacists develop their research capabilities. It was observed that there is a tendency towards implementing Continuous Education for pharmacists and obstacles primarily included work and family commitments, lack of interest, lack of time, difficulties in commuting, and lack of competence in the use of technology. This standard is aligned with the FIP's developmental goal of continuing professional development strategies. The search also identified only one pilot study to assess GGP compliance among community pharmacies in Lebanon. This pilot study was limited and showed low adherence of community pharmacies in Lebanon to GPP standards.Barriers to implementation are lack of enforcing laws,inadequate dissemination of the standards among the community pharmacists, poor public perception, and the financial and soscioeconomically crisis facing Lebanon.
Conclusion
Collaborated efforts are needed to implement GPP standards in Lebanon.It is recommended to undergo training and awareness sessions to community pharmacists thus enhancing their commitment and motivation. It is also recommended to establish key performance indicators to monitor the implementation. İndicators should include structure indicators for regulating the storage of medications, process indicators for regulating the dispensing, and outcome indicators for reporting patient safety incidents, measuring public satisfaction and the provision and use of medicines.These recommendations can be used by Health authorities and Pharmacy educational institutions in Lebanon and in all similar low-income countries.
... Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients. 48 EBP is an essential approach to promote the rational use of medications, making sure that patients receive the right medicine in the right dose for the right diagnosis at the right time at the lowest possible cost suitable to their requirements. 48 Finally. the composite reliability was not performed in this research. ...
... 48 EBP is an essential approach to promote the rational use of medications, making sure that patients receive the right medicine in the right dose for the right diagnosis at the right time at the lowest possible cost suitable to their requirements. 48 Finally. the composite reliability was not performed in this research. It is suggested that it be verified using future studies to assess reliability with greater robustness, as well as confirmatory factor analysis, which makes it necessary to compose a larger sample of health professionals to administer the instrument. ...
Objectives To develop and validate an instrument to
measure Brazilian healthcare professionals’ perceptions,
behaviour, self-efficacy and attitudes towards evidencebased health practice.
Design Validation of an instrument using the Delphi
method to ensure content validity and data from a crosssectional survey to evaluate psychometric characteristics
(psychometric sensitivity, factorial validity and reliability).
Setting National Register of Health Establishments
database.
Participants We included clinical health professionals
who were working in the Brazilian public health system.
Results The Instrument to assess Evidence-Based Health
(I-SABE) was constructed with five domains: self-efficacy;
behaviour; attitude; results/benefits and knowledge/
skills. Content validity was done by 10–12 experts (three
rounds). We applied I-SABE to 217 health professionals.
Bartlett’s sphericity test and the Kaiser-Meyer-Olkin
(KMO) index were adequate (χ2
=1455.810, p<0.001;
KMO=0.847). Considering the factorial loads of the items
and the convergence between the Scree Plot and the
Kaiser criterion the four domains tested in this analysis,
explaining 59.2% of the total variance. The internal
consistency varied between the domains: self-efficacy
(α=0.76), behaviour (α=0.30), attitudes (α=0.644),
results/benefits to the patient (α=0.835).
Conclusions The results of the psychometric analysis of
the I-SABE confirm the good quality of this tool. The I-SABE
can be used both in educational activities as well as an
assessment tool among healthcare professionals in the
Brazilian public health settings
... One of the pillars of evidence-based health is to guide professional behavior through clinical guidelines drafted with a careful analysis of the available evidence, seeking to recommend health interventions with a better balance of risks, benefits, and costs [8][9][10] . ...
... Drug information provision to healthcare professionals, patients, and the general public is one of the leading pharmacists' roles. For effective pharmaceutical service, pharmacists must be able to locate the most updated and reliable drug information using appropriate resources (World Health Organization, 1994;Nathan, 2013;Ghaibi et al., 2015;Toklu, 2015). Thus, pharmacy students should have a good knowledge of the different categories of drug information resources and develop drug information skills to become competent in this aspect. ...
Objective: To identify drug information (DI) resources commonly used by pharmacy students of King Faisal University, Saudi Arabia, and to assess their ability to determine the appropriate ones for different clinical situations.
Methods: A cross-sectional study was conducted in April 2014 (n=92). A paper-based questionnaire was developed, validated, and administered to fifth-year Pharm.D. students and advanced pharmacy practice experience (APPE) interns. It investigated the students’ DI sources preferences. Besides, it evaluated their competency in classifying DI resources and identifying the best resource to answer case-based multiple-choice questions. Moreover, the study aimed at assessing the impact of providing a case-based combined module of evidence-based practice (EBP) and DI for fifth-year students (new study plan) compared to delivering separate EBP and DI modules through theoretical lectures (old study plan–APPE interns).
Results: The preferred resources to the students were online recourses (85.86%), soft copy books (26.08%), and mobile applications (25%). For the DI mobile applications, Medscape was the most common (63.4%), followed by Micromedex (53.5%), Lexicomp (42.3%), and Dynamed (16.9%). Fifth-year students’ scores were significantly higher than APPE interns for the case-based questions. Students’ GPAs were moderately correlated with their total scores.
Conclusion: Study participants preferred using electronic DI resources to printed ones. The combined EBP-DI course could be a better option as it links the DI knowledge to clinical situations.
... After systematic analysis and comprehensive evaluation, clinical pharmacists provide objective and reasonable suggestions to patients, using appropriate language, according to the relevant evidence (Table 1 and Figure 1). 1,19 The control group received care based on the general or traditional pharmaceutical care model, as follows. Patients are monitored according to the clinical experience of pharmacists, medication instructions, and individual case reports. ...
... Not all data have the same value in terms of evidence. 19 Obtained data require extensive scientific evaluation and interpretation, and different sources of evidence provide different levels of evidence in decision making. 25,26 In this study, we innovatively applied EBP care among patients using the principle of PICO-S (Participants' research object, Intervention, Comparison, Outcome, Study design). ...
Purpose:
We aimed to determine the effects of using evidence-based pharmacy care on satisfaction and cognition among patients with non-valvular atrial fibrillation (NVAF) and taking rivaroxaban.
Patients and methods:
Between July 2018 and June 2019, 200 consecutive hospitalized patients taking oral rivaroxaban, who were diagnosed with NVAF and registered in the hospital information management system, were randomly assigned to a control group (n=100) and a study group (n=100) in a single-blind manner. The control group received pharmaceutical care based on the general pharmaceutical care model whereas the study group received care based on an evidence-based pharmaceutical care model. Patients' satisfaction and cognition were evaluated regularly using questionnaires. The follow-up time was 1 year. We compared differences in satisfaction and cognition between the two groups after pharmaceutical-related care administered by clinical pharmacists.
Results:
The study group had higher satisfaction scores than the control group after the EBP intervention (14.58±0.88 vs.13.81±1.01, p<0.01); cognition scores were also higher in the study group (22.58±2.19 vs 20.80±3.02, p<0.01) after the intervention. In the study group, satisfaction was increased from a score of 10.15±1.33 before the EBP intervention. Cognition also increased after the intervention in the study group, from a score of 9.88±4.09 pre-intervention. In the control group, satisfaction was 10.04±1.29 before the traditional pharmaceutical care intervention, smaller than the 13.81±1.01 after the intervention (p<0.01). Cognition in the control group was 9.83±3.51 before traditional pharmaceutical care, smaller than the 20.80±3.02 after the intervention (p<0.01).
Conclusion:
The care model based on evidence-based pharmacy care can improve patient satisfaction and cognition, providing more comprehensive safety and efficacy of subsequent medication.
