Chynthia Pradiftha Sari

Introduction
In the information age, we are presented with
a daunting number of diseases and possible
treatments to consider as they care for
patients each day
Knowledge increases and the technology for
accessing information becomes widely
available
Health care professionals are expected to
stay current in expertise and to remain
competent throughout the careers.
 Introduction
How does the health care professional nd
valid information from such a cacophony?

Increasingly, clinicians and pharmacists are

turning to the principles of evidence-based
medicine (EBM) to identify the best course
of action for patient therapy.
 What is EBM???
Integration of best research evidence with
clinical expertise and patient values
(Sackett, et al 2001)
 What is EBM..??
EBM is an approach to medical practice
that uses the results of patient care
research and other available objective
evidence as a component of clinical
decision making.
 Summary
EBM (Evidence Based Medicine):
proses sistematis dalam mencari, memilih, dan memakai bukti
penelitian terkini sebagai dasar untuk membuat suatu keputusan
medis
penggunaan bukti terbaik untuk membuat keputusan mengenai
perawatan dari pasien. (Kathmandu University Medical Journal, 2006,
vol.4, no.3, issue 15, 383-389)
EBM merupakan integrasi dari 3 unsur, yaitu bukti klinis (best
research evidence), keterampilan klinis (clinical expertise), serta
Patient Values.
Bukti klinis (best research evidence) adalah bukti yang
berdasarkan hasil riset klinis yang berorientasi kepada pasien.
Keterampilan klinis (clinical expertise) adalah kemampuan
dokter/apoteker untuk mengaplikasikan kemampuan klinis dan
pengalaman klinis/empirisnya
Patients values adalah pilihan, kepedulian, dan harapan dari
setiap pasien. (Sackett, et al, 2001
 What is EBM???
Menggunakan segala pertimbangan bukti
ilmiah (evidences) yang sahih dan up to
date untuk menentukan tindakan
pengobatan pada pasien yang sedang
kita hadapi.

Bukti ilmiah yang dimaksud adalah bukti

ilmiah lebih lanjut setelah obat
dipasarkan.
 Why Practice EBM
Implementing EBM in a practice provides
a framework and the skills to strengthen
confidence in pharmacotherapeutic
decisions
Results in better communication with
colleagues involved in the decision-making
process
Using EBM principles enables practicing
health care professionals to update their
knowledge continuously
 Evidence Based Medicine
Darimana kita mendapatkan bukti ilmiah
terkait pengobatan??
Dari hasil-hasil penelitian yang dipublikasikan di
berbagai literatur
 Evidence Based Medicine
Kategori literatur
Primer
Sekunder
Tersier
Contoh ???
Penggunaan???
 What is the level (L)
of evidence ?
L1a. Randomized controlled trial (best evidence)
L1b. Meta-analysis (pros and cons)
L2. Retrospective analysis (case-control studies)
L2. Prospective follow-up (cohort studies)
Cross-sectional population (prevalence studies)
Previous reviews (position statements)
Clinical interventions (non-randomized)
 National Health Service
( level of evidence [LOE])

Pembagaian berdasarkan pendekatan prevention,

diagnosis, prognosis dan therapy.
Level A:
Consistent Randomised Controlled Clinical Trial,
Level B:
Consistent Retrospective Cohort, Ecological Study,
Case-control Study, atau extrapolasi dari studi level A.
Level C:
Case-series Study atau extrapolasi dari studi level B
Level D:
Opini tanpa critical appraisal atau berdasarkan
patophysiologi.
How is LoE implemented in
Recommendation Guidelines? (1)
Levels of Evidence for Heart Failure:

A. Data derived from multiple RCTs.

B. Data derived from a single randomized trial or
non-randomized studies.
C. Consensus opinion of experts was the primary
source of recommendation.

www.guidelines.gov/
 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/
 Incorporating EBM into Drug
Information Service (DIS)
The practice of EBM is to:
a. recognize an information need while caring for a
patient
b. identify the best existing evidence to help resolve
the problem
c. consider the evidence in light of the actual
circumstances
d. integrate the evidence into a medical plan
 Incorporating EBM into DIS
Four steps involved in applying the EBM
process to DIS are:
Recognize information needs and convert them
into answerable questions

Conduct an efcient searches for the best

evidence with which to answer these questions

Critically appraise the evidence for its validity and

usefulness

Apply the results to answer the question(s)

 Conducting an efficient Search
Four options to identify the best evidence:
Ask a colleague for his or her expert opinion

Review practice guidelines (evidence-based or

expert-opinionbased) or a textbook for
appropriate disease management

Consult electronic databases of systematic

reviews and/or meta-analyses

Conduct a literature search using an electronic

database such as MEDLINE
Formulasi Pertanyaan Ilmiah
Patient/Problems
Terkait pasien, problems yg dihadapi bisa
berupa etiologi, diagnosis, terapi, prognosis
Intervention/Indicator
Terkait tes diagnostik, terapi, paparan, dll
Comparison
Terapi standart, gold standart, placebo
Outcome
Perbaikan klinis, mortalitas, morbiditas, QOL
Seorang dokter menyarankan Tn A seorang
pasien IMA untuk menggunakan
simvastatin untuk menurunkan angka
mortalitas akibat kardiovaskuler

Seorang dokter ingin melihat tingkat

akurasi penegakan diagnosis CAD
dengan EKG dan Echo pada
pasien wanita dgn resiko PJK

Penggunaan terapi sulih hormon (HRT)

pada pasien post-menopause dapat
meningkatkan resiko kanker payudara (Ca
mammae)
Sistem
Sinopsis
Search Engine
Sintesis
Study
 IMPORTANT TO
REMEMBER

EBM selalu applicable?