Evidence-based medicine (EBM) uses scientific, well-researched facts in the application
of medicine. EBM is used these days versus traditional medicine in that EBM has an
emphasis on using actual proof or evidence that specific treatments work. The research
studies used are qualitative, clinical trials, observational or case studies, reviews, metaanalyses, and expert opinions. The assigned reading for EBM in this unit is geared
toward primary care physicians (PCP) and how to systematically integrate EBM into
their practice, how to be critical of studies, and doing this quickly since there is not a lot
of time for busy practitioners to read the vast number of studies they need for general
practice (Masic, n.d.).
Comparative effectiveness research (CER) is looking at studies critically and
extrapolating the information from this process and then use in practice. Doctors can
evaluate which treatments work best by using different studies for the same illness. For
example, CER can look at two other drugs that treat the same disease. By looking at
the studies, one can see the benefits and risks of both clinical outcomes. Therefore,
CER is a process that moves medicine along by comparing and contrasting clinical
studies and research on new drugs, innovations in surgery, and technology with new
medical supplies and devices. The U.S. government invested $1.1 Billion in these
studies (Sox, MD & ACP Journal, 2010).
Clinical practice guidelines are taking the information from EBM and CER and making
those into policies and procedures for practitioners and healthcare facilities. These
policies and procedures have been vetted and thoroughly examined to provide the
newest and best research into practice. Clinical practice guidelines take the whole of
EBM from meta-analysis to expert opinions and put them neatly into highly organized
playbook institutions use to deliver healthcare. The guidelines are written statements for
institutions to follow but are not set in stone. As every patient is different, different
treatment methods are needed for each case. The clinical practice guidelines are
routinely updated as new information is available. The guidelines in the hospital setting
are usually called policies and procedures and should be readily available to all staff at
any time to review. Many years ago, the policies and procedures were typed and
placed into a large binder and located in each department, usually at the front
desk. These days with fully computerized charting, the guidelines are now available
online at almost any computer in the facility, making access very quick and easy.
The Center for American Progress, a political, nonpartisan organization trying to
improve the lives of Americans by thinking progressively and less conservatively, has
stated,
“It’s estimated that one-third of procedures and treatments administered in the
United States have no proven benefit and account for up to $700 billion
annually in current spending. Moreover, some of these treatments can have
harmful side effects, produce worse health outcomes, and then, as a result, add
to the soaring costs of medical care.” (Whelan et al., 2009)
Statements such as this, if indeed true, are shocking when revealed, and the exact
reason the American Recovery and Reinvestment Act of 2009 (ARRA) and the Patient
Protection and Affordable Care Act of 2010 (ACA) were put into place over a decade
ago. Both acts, signed into effect by President Barack Obama, were part of the
significant economic stimulus package needed after the economic recession of
2008. These two acts injected billions of dollars into healthcare in many different
aspects to try and improve healthcare for all Americans. The ACA, also nicknamed
Obamacare, tends to have a negative connotation in that it’s mostly remembered as the
act that changed health insurance, making premiums rise for most middle-class families
while allowing those with pre-existing conditions the chance to have health insurance
and not be denied. But more to the point, the ARRA and ACA helped further healthcare
by ensuring electronic medical records (EMR) were a fundamental part of all facilities.
And also, towards funding many different government health organizations with grants
for research into new medicines, devices, treatments, and surgeries through organizing
committees and new governmental departments whose main job is to gather the data
and information needed to provide for better healthcare and lower or keep the costs
from increasing (Clinical Practice Guidelines | NCCIH, n.d.).
It has been over a decade since the Acts were put into place. The Act’s main intentions
were to provide healthcare access to more Americans through lower premiums and
allow those with pre-existing conditions not to be denied. The ACA also provided a
significant investment into the state’s Medicaid programs and funded research into
better health practices to reduce healthcare costs. It is a slow process, but
improvements have been made.
References
Clinical Practice Guidelines | NCCIH. (n.d.). National Center for Complementary and
Integrative Health. Retrieved July 23, 2022, from
https://www.nccih.nih.gov/health/providers/clinicalpractice
Masic, I. (n.d.). Evidence Based Medicine – New Approaches and Challenges. NCBI.
Retrieved July 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/
Sox, MD, H. C., & ACP Journal. (2010, October 5). Comparative Effectiveness Research: A
Progress Report. Comparative Effectiveness Research: A Progress Report. Retrieved
July 23, 2022, from https://www.acpjournals.org/doi/10.7326/0003-4819-153-7201010050-00269
Whelan, E. M., Sekhar, S., & The Center for American Progess. (2009, September 9). Better
Health Through Better Information. Retrieved July 23, 2022, from
https://americanprogress.org/article/better-health-through-better-information/