From the Guidelines
The concept of Evidence-Based Medicine (EBM) has its origins dating back to the mid-nineteenth century. The age of EBM is approximately 170-180 years old, with its roots in the systematic application of the scientific method into healthcare practice 1. While the formal term and structured approach to EBM may have emerged later, the underlying principles of using current best evidence to guide clinical decision making have been evolving over time.
Key Points
- EBM is a constantly evolving process, with old tests and treatments being replaced by more accurate, powerful, effective, and safer ones 1.
- Clinical practice guidelines (CPGs) have become the primary mode of communicating current best practices across a range of clinical disorders 1.
- The ultimate goal of practice guidelines is to facilitate the translation of the most recent evidence into practice to improve patient care and outcomes 1.
- Despite the benefits of EBM, there is a long history of poor uptake of CPGs by providers, with many studies reporting rates of nonadherence at or exceeding 50% 1.
Evolution of EBM
The concept of EBM has been influenced by various factors, including the work of earlier medical empiricists and the development of clinical trials. However, the modern form of EBM, with its emphasis on systematic reviews, meta-analyses, and hierarchies of evidence quality, is a relatively recent development in medicine's long history 1.
Importance of EBM
The systematic application of scientific evidence to medical practice has revolutionized medical decision making, shifting from tradition and authority-based decision making to a more structured evaluation of research evidence combined with clinical expertise and patient values 1. This approach has fundamentally changed how clinicians approach medical decisions and treatment protocols, with the ultimate goal of providing optimal clinical care to patients 1.
From the Research
History of Evidence-Based Medicine
The concept of Evidence-Based Medicine (EBM) has a long and evolving history.
- The term "evidence-based medicine" is relatively new, with its formal origin dating back to the mid-nineteenth century 2.
- However, the history of EBM goes back for centuries, with ancient era EBM consisting of ancient historical or anecdotal accounts of what may be loosely termed EBM 3.
- The modern concept of EBM has been rapidly and constantly developing over the past two decades, with its roots dating back more than 150 years 4.
Development of EBM
- The development of EBM can be divided into several eras, including the ancient era, renaissance era, transitional era, and modern era 3.
- The renaissance era of EBM began roughly during the seventeenth century, with the development of personal journals and textbooks 3.
- The transitional era of EBM (1900-1970s) saw the sharing of knowledge through textbooks and peer-reviewed journals, while the modern era of EBM has been shaped by technology, including computers, database software, and the Internet 3.
Evolution of EBM
- EBM has continued to evolve over time, with the incorporation of clinical expertise and patient values and preferences into the concept 5.
- The future of EBM is likely to involve the widespread utilization of clinical decision support systems and evidence-based summaries 5.
- Despite its evolution, EBM has faced criticism and challenges, including the changing paradigm of healthcare, cost-effectiveness, and changing evidence 2.