scholarly journals The medicine selection process in four large university hospitals in Brazil: Does the DTC have a role?

2015 ◽  
Vol 51 (1) ◽  
pp. 173-182
Author(s):  
Elisangela da Costa Lima-Dellamora ◽  
Rosangela Caetano ◽  
Claudia Garcia Serpa Osorio-de-Castro
Keyword(s):  
Decision Making ◽  
Selection Process ◽  
Two Dimensions ◽  
Qualitative Approach ◽  
Evidence Based ◽  
University Hospitals ◽  
Direct Observations ◽  
Drug And Therapeutics Committee ◽  
Based Medicine

Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC) is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country.

The debate over rational decision making in evidence-based medicine: Implications for evidence-informed policy

2019 ◽  
Author(s):  
Christopher R. Sheldrick ◽  
Justeen Hyde ◽  
Laurel K. Leslie ◽  
Thomas Mackie
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Research Evidence ◽  
Evidence Based ◽  
Rational Decision ◽  
Decision Sciences ◽  
Rational Decision Making ◽  
Based Medicine ◽  
Rational Decisions

Many of the resources developed to promote the use of evidence in policy aspire to an ideal of rational decision making, yet their basis in the decision sciences is often unclear. Tracing the historical development of evidence-informed policy to its roots in evidence-based medicine (EBM), we distinguish between two understandings of how research evidence may be applied. Advocates for EBM all seek to use research evidence to optimise clinical care. However, some proponents argue that ‘uptake' of research evidence should be direct and universal, for example through wide-scale implementation of ‘evidence-based practices'. In contrast, other conceptualisations of EBM are rooted in expected utility theory, which defines rational decisions as choices that are expected to result in the greatest benefit. Applying this theory to medical care, clinical decision-making models clearly demonstrate that rational decisions require not only a range of relevant evidence, but also expertise to inform judgments regarding the credibility of estimates and to assess fit-to-context, and stakeholder preferences and values to weigh trade-offs among competing outcomes. Using these models as exemplars, we argue that attempts to apply research evidence directly to practice or policy without consideration of expert judgement or preferences and values reflect fundamental misconceptions about the theory of rational decision making that can impede implementation. In turn, the decision sciences highlight the need to consider the role of expertise and judgment when interpreting research evidence, the role of preferences and values when applying it to specific decisions, and the practical limits imposed by the uncertainty inherent in each.<br /><br />key messages<br /><ol><li>Uncertainty is inherent to research evidence and to decision making.</li><br /><li>Rational decisions require judgment to interpret evidence and stakeholder values to apply evidence.</li><br /><li>Decisions can be sensitive to evidence, expertise, and/or preferences and values to varying degrees.</li><br /></ol>

scholarly journals "Doctor Knows Best"

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Dylan Mirek Popowicz
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Evidence Based ◽  
Patient Relationship ◽  
Medical Practitioners ◽  
Making Sense ◽  
Decision Making Processes ◽  
Based Medicine

We often consider medical practitioners to be epistemic authorities: “Doctor knows best,” as the saying goes. The place of expert judgment in evidence-based medicine hierarchies, and the crucial role of patient preferences and values in medical decision-making, however, pose problems for making sense of such authority. I argue that there is an account of such medical epistemic authority that does justice to the complexities of the doctor–patient relationship, while maintaining that medical practitioners hold an epistemically privileged position. Such a view can better inform medical practice by clearly illuminating the distinct roles of patients and doctors in decision-making processes.

scholarly journals Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisanne S. Welink ◽  
Kaatje Van Roy ◽  
Roger A. M. J. Damoiseaux ◽  
Hilde A. Suijker ◽  
Peter Pype ◽  
...  
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Stimulated Recall ◽  
Previous Discussion ◽  
Based Medicine ◽  
Stimulated Recall Interviews ◽  
Gp Training

Abstract Background Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient’s preferences and the general practitioner’s (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other’s consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other’s EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner’s consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner’s actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other’s considerations well with those who did not, we developed a model describing the aspects that influence the observer’s recognition of an actor’s EBM behaviour. Results Overall, there was moderate similarity between an actor’s EBM behaviour and the observer’s recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. Conclusions GP trainees and supervisors do not fully recognise EBM behaviour through observing each other’s consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

scholarly journals From evidence based medicine to mechanism based medicine. Reviewing the role of pharmacogenetics

2011 ◽  
Vol 33 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Bob Wilffert ◽  
◽  
Jesse Swen ◽  
Hans Mulder ◽  
Daan Touw ◽  
...  
Keyword(s):  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine

Evidence Based Medical Prevention: International Experience

2016 ◽  
pp. 34-37
Author(s):  
Olha Puzanovа
Keyword(s):  
Health Care ◽  
Preventive Medicine ◽  
Scientific Information ◽  
International Experience ◽  
Evidence Based ◽  
Task Forces ◽  
Cochrane Reviews ◽  
The Us ◽  
Based Medicine

The objective: was to study the international experience of evidence based preventive medicine development as well as to estimate its perspectives in Ukraine. Patients and methods. Main principles and methods of scientific knowledge and research have been used including universal ones, methods of systemic approach, quantitative and qualitative information analysis, classification and systematization of theoretical and empirical data, hystorical and logical methods, health statistics as well). In total 529 scientific information sources have been studied, particularly a number of evidence based medicine (EBM) computer databases, special task forces recommendations and Cochrane reviews on prevention, Register of medical and technological documents for health care standards in Ukraine et al. Results. The contribution of foreign scientific schools in the development of EBM has been determined, as well as the crucial role of scientific works carried out in the US and Great Britain in 1930–80s as to the development of evidence based preventive medicine. The international experience of the development and functioning of evidence based practice centers’ and special task forces on prevention has been summarized, as the experience of the development and implementation of recommendations on prevention in primary health care (PHC) in high income countries acceptable for Ukraine. The concept of evidence based prevention has been first proposed. It is revealed, that EBM implementation in Europe has been prioritized in both the field of infectious diseases prevention and PHC, while there are both the development of differentiated evidence based prevention and early evidence based diagnosis in PHC in the US. Conclusion. The results proved importance of taking into consideration of international experience while evidence based PHC is being developed as a priority in Ukraine.

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