Evidence-Based

Medicine
AMIRAH MUHAMMAD ABDULLAH
201710401011057
EBM adalah…

Pengintegrasian antara bukti ilmiah berupa hasil

penelitan yang terbaik dengan kemampuan klinis
dokter serta preferensi pasien dalam proses
pengambilan keputusan pelayanan kedokteran, sedang
Geddes (2000) menyatakan bahwa EBM adalah strategi
yang dibuat berdasarkan pengembangan teknologi
informasi dan epidemiologi klinik dan ditujukan untuk
dapat menjaga dan mempertahankan keterampilan
pelayanan medik dokter dengan basis bukti medis yang
terbaik.
Komponen EBM

 Bukti ilmiah terbaik mungkin berasal dari ilmu kedokteran dasar, namun lebih sering muncul dari
penelitian klinis berpusat pada pasien.

 Dokter mungkin sering mencari bukti untuk kemanjuran dan keamanan regimen terapeutik,
rehabilitatif dan preventif, namun juga bukti yang terkait dengan akurasi dan presisi tes diagnostik
atau kekuatan marker prognostik.

 Keahlian klinis adalah kemampuan untuk menggunakan keterampilan klinis dan pengalaman klinis
untuk mengidentifikasi keadaan kesehatan pasien dengan cepat, risiko individu dan manfaat
potensial dari intervensi, dan nilai dan harapan pribadi mereka.

 Preferensi pasien adalah preferensi individu, kekhawatiran dan harapan yang dibawa pasien ke
proses pembuatan keputusan klinis. Mengintegrasikan ketiga elemen ini memungkinkan klinisi dan
pasien membentuk aliansi diagnostik dan terapeutik yang mengoptimalkan hasil klinis dan kualitas
hidup (Smith et al, 2006).
 Type of study Definition
Evaluating results of condition or treatment in a defined
population
Observational
Retrospective: analyzing past events
Prospective: collecting data contemporaneously

Series of patients with a particular disease or condition

Case-control
contrasted with matched control patients

Measurements mode on a single occasion, not looking at

Cross-sectional whole population but selecting small similar group &
expanding results

Measurements are taken over a period of time, not looking at

Longitudinal whole population but selecting small similar group &
expanding results

Two or more treatments are compared. Allocation to treatment

Experimental
groups is under the control of the researcher

Randomized Two randomly allocated treatments

Randomized
Includes control group with no treatment
controlled
EBM and Disease Management: The
Tipping Point Questions

 Diagnostics and enrollment…

 Are predictive models based on appropriate application of the
evidence?
 Do predictive models account for co-morbidities?
 Are enrollee values incorporated with treatment directives?
 How is clinician adherence evaluated?
EBM and Disease Management: The
Tipping Point Questions

 Care Management processes

 How is co-morbidity managed?
 How are guidelines from societies
adapted/modified based on evidence?
 How is the clinician engaged as coach?
 Are enrollee values incorporated with treatment
directives/coaching methods?
EBM and Disease Management: The
Tipping Point Questions

 Results management…
 What measures are important for monitoring adherence?
Outcomes?
 How is appropriate variation measured/accomodated?
Moving toward Evidence-based Care
Management

 Need to invest in clinical tools, processes for

integration of evidence and outcome measurement
 Need to adapt coaching models to include clinicians
as well as consumers
 Need to evaluate models in context of payment
systems for providers and consumers
 Need to be transparent
 Evidence Based Medicine

Pros, Cons, and

Limitation
PROS
• Clinicians update knowledge base routinely
• Improved understanding of research methods
• Physician becomes more critical in use of data
• Increased confidence in management decisions
• Increased computer literacy, data search technology
• Better reading habits
• Provides framework for group problem solving, team
generated practice
• Transforms weakness or paucity of knowledge into positive
change (uncertain, skeptical, flexible)
• Integrates medical education, research and clinical
expertise
• Can be learned by non-clinicians – other HCWs, patient
groups, purchasers, etc.
• Allows us to keep up with our better-educated patients
 Evidence Based Medicine

PROS
• Increased contribution of junior MDs
• Increased patient benefit
• Better communication with patients re: rationale
of management decisions
• Promotes better and more appropriate use of
limited resources
• May reduce costs or medical care or practice by
eliminating outdated or unnecessary factors
• Can be learned at any stage of physician’s career
 Evidence Based Medicine

CONS
• Time consuming
• Information overload
• Time to learn and practice
• Time may be needed for team conferencing,
planning and review
• Takes money to establish resource infrastructure
– library, office, etc.
• computers, peripherals
• Internet costs
• Programs, software information, CD-ROMS
• Subscription costs – online and paper resources
 Evidence Based Medicine

CONS
• May increase cost of care (but hopefully offset by
elimination of unnecessary medical interventions,
tests, journals, etc. – plus save time in getting
proper intervention)
• Online references made to unavailable journals or
references
• Exposes gaps in the evidence (but provides ideas
for researchers)
• Requires computer skills (but can be done with
minimal computer literacy and skill)
• May expose your current practice as obsolete or
dangerous (loss of authority and respect)
 Evidence Based Medicine

LIMITATIONS
• Lack of evidence (shortage of studies)
• Difficulty applying evidence to care of a particular patient
• Barriers to the practice of high quality medicine
• Lack of skills (search, appraise, etc.) (foster
development of new skills)
• Lack of time to learn and practice EBM (promotes lifelong
learning thru better focus)
• Lack of physician resources for instant access to evidence
(EBM has worldwide applicability)
• RESTRICTED AVAILABILITY OF LAB TESTS
• NON-TEXTBOOK CASE
• co morbidity, additional risk factors
• AFFORDABILITY (MD & PT)“I can’t afford to practice EBM.”
• Language barriers – available evidence may be
unreadable, should be included
Sumber

 Kementrian Kesehatan RI, 2011. Modul Penggunaan Obat Rasional. Kemenkes RI.
Jakarta.
 Smith FG, Tong JL, Smith JE. 2006. Evidence Baced Medicine. The Board of
Management and Trustees of the British Journal of Anaesthesia. Vol 6 No. 4.
 Surabaya Neurotrauma Institute, 2014. Pedoman Tatalaksana Cedera Otak.
Fakultas Kedokteran. Universitas Airlangga.
 Tumbelaka A., 2016. Evidenced-Based Medicine. DOI: 10.14238/sp3.4.2002.247-8.
 Viebahn-Hansler R., et al., 2016. Ozone in Medicine: Clinical Evaluation and
Evidence Classification of the Systemic Ozone Applications, Major
Autohemotherapy and Rectal Insufflation, According to the Requirements for
Evidence-Based Medicine. The Journal of the International Ozone Association.Vol:
38(5). Pp. 322-345
TERIMA KASIH