Evidence Based Medicine Indah P. Kiay Demak Medical Education Unit Faculty of Medicine & Public Health Tadulako University

Pendahuluan Dalam pekerjaan sehari hari, dokter dihadapkan pada kebutuhan informasi tentang masalah medis yg relevan (evidence-based) sementara arus informasi berubah dengan cepat.

Tujuan Mencari bukti yang relevan dan bermanfaat untuk meningkatkan kualitas perawatan pasien

Apa itu EBM ? Adalah integrasi bukti penelitian terbaru (the best research evidence), keterampilan klinik dan masalah yang ada pada pasien. Research evidence ---- > clinically relevan research. Clinical expertise ---- > ability to use our clinical skills and past experience to rapidly identify. Patients values ----- > preference, concerns and expectations each patients bring to serve the patients.

Definisi Proses penelitian dan penggunaan informasi yg disajikan dalam literatur untuk memperbaiki perawatan pasien. Prosesnya: Mengubah “kekurangan pengetahuan” (knowledge deficit) menjadi pertanyaan klinik yg spesifik, Dgn cara meng-evaluasi bahan kepustakaan yg berhubungan dengan pertanyaan klinis, untuk memperbaiki perawatan pasien

LEVEL OF EVIDENCE Category I: Evidence from at least one properly randomized controlled trial. Category II-1: Evidence from well-designed controlled trials without randomization. Category II-2: Evidence from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. Category II-3: Evidence from multiple times series with or without intervention or dramatic results in uncontrolled experiments such as the results of the introduction of penicillin treatment in the 1940s. Category III: Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees. [Source: Harris, R.P. et al. (2001). Current methods of the U.S. Preventive Services Task Force: a review of the process. American Journal of Preventive Medicine. April 20 (3 Supplement): 21-35.]

The Knowledge Filter Correction of errors Primary literature How much is incorrect? Correction of errors Much of it is correct The Knowledge Filter (H.H. Bauer, 1995) (adapted)

http://www.rmh.mh.org.au/levels-of-evidence/w1/i1017827/

How is LoE implemented in Recommendation Guidelines? (2) Strength of Recommendation: Class I: Conditions for which there is evidence/general agreement that a given procedure/therapy is useful and effective. Class II: Condition for which there is conflicting evidence or divergence of opinion about the usefulness /efficacy of performing the procedure /therapy. Class IIa: in favor of usefulness Class IIb: usefulness is less well established Class III:Condition for which there is evidence/general agreement that a procedure/therapy is not useful/effective and may be harmful. www.guidelines.gov/

Aspek –aspek pembelajaran EBM : Mengidentifikasi kekurangan pengetahuan. Menentukan pertanyaan klinik yg spesifik. Menemukan artikel yg relevan dalam literatur medis.

Langkah-langkah melakukan EBM Merumuskan masalah (membuat pertanyaan klinik) Mencari informasi yang diperlukan Melakukan critical appraisal terhadap informasi yang didapat Menerapkan informasi yang didapat ke pasien Mengevaluasi keefektifitasannya

Langkah 1 Mempertanyakan pro dan kontra Terapi Pemeriksaan diagnostik Prognosis dan risiko Cost effectiveness

Langkah 2 Mencari melalui internet, jurnal, textbook

Langkah 3 Melakukan initial appraisal: pengarang, tahun terbit, edisi atau revisi, penerbit, judul jurnal Melakukan content analysis: intended audience, rasional, cakupan, cara penulisan, review Jika berasal dari website dianalisis: accuracy, authority, currency, objectivity, coverage

Langkah 4 Bagaimana menerapkan ke pasien Apakah ada hal-hal yang harus disesuaikan

Langkah 5 Evaluasi efek yang terjadi pada pasien tertentu Menerapkan lanjutan atau diganti yang lain

Elemen dalam penerapan P= patient I = intervention C = comparison O = outcome