By Swedish law, health service staff must work in accordance with scientific knowledge and accepted standards of practice. Research results and comprehensive clinical experience should guide the delivery of health care. But how should this be done?
Each year, millions of scientific articles are published in biomedical journals worldwide. It is extremely difficult for the individual caregiver to monitor the extensive and ever increasing flow of new research findings, even within a specialized field. Furthermore, research results are not always clear, consistent, and reliable. There is a need to review all of this knowledge systematically and critically – scientific assessment is needed.
Assessing an intervention involves evaluating benefits and harm. Relevant information about the intervention is systematically collected, and the intervention is compared with other interventions or with the absence of any intervention. When weighing different options, decisions on the best alternative can be informed by solid evidence. Thus, assessment results form a base for decision making.
SBU's assessments review the benefits, risks, and costs of methods used in healthcare delivery. For example, the reports may show which methods are most appropriate for treating asthma, preventing blood clots, dealing with obesity, managing wounds, or alleviating chronic pain.
However, the assessments do not point out the effective methods only. It is equally important to identify methods that are ineffective, or not cost effective, so they can be avoided. Such information is equally important in the delivery of appropriate medical and nursing care and assures that healthcare resources yield the greatest possible benefit.
It is also essential to identify important knowledge gaps – areas where people simply do not know which methods offer the greatest benefit and where further research is urgently needed.
Simply stated, evidence based health care refers to a conscious and systematic effort to design health services in accordance with the best possible scientific evidence – a concept that has been supported by Swedish legislation for many years. Many who work in the healthcare sector consider this approach to be essential.
So why do we need a special concept to denote something so self-evident? One reason is that the scientific basis for health services is not always as strong as it should be. New approaches may be needed to keep abreast of advancements in research and to assure that practice always keeps pace with the evidence.
Moreover, available research findings are not always acted upon. For example, new methods may find their way into clinical practice without having been scientifically assessed. Other methods, which have been shown to be obsolete but have become routine, continue to be used. Hence, we need an ongoing process of evaluation – do the interventions we offer actually provide the benefits that we believe in and hope for?
Implementing evidence based health care means that decisions are supported by the best available scientific evidence from rigorous trials – as a complement to other knowledge and to input from patients and caregivers.
Important healthcare decisions that concern a patient's health should always proceed from the best available scientific evidence.
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