Cooper Brian
Section of Old Age Psychiatry, Institute of Psychiatry, London SE5 8AF, UK.
Br J Psychiatry. 2003 Aug;183:105-13. doi: 10.1192/bjp.183.2.105.
Arguments for and against evidence-based psychiatry have mostly centred on its value for clinical practice and teaching. Now, however, use of the same paradigm in evaluating health care has generated new problems.
To outline the development of evidence-based health care; to summarise the main critiques of this approach; to review the evidence now being employed to evaluate mental health care; and to consider how the evidence base might be improved.
The following sources were monitored: publications on evidence-based psychiatry and health care since 1990; reports of randomised trials and meta-analytic reviews to the end of 2002; and official British publications on mental health policy.
Although evidence-based health care is now being promulgated as a rational basis for mental health planning in Britain, its contributions to service evaluation have been distinctly modest. Only 10% of clinical trials and meta-analyses have been focused on effectiveness of services, and many reviews proved inconclusive.
The current evidence-based approach is overly reliant on meta-analytic reviews, and is more applicable to specific treatments than to the care agencies that control their delivery. A much broader evidence base is called for, extending to studies in primary health care and the evaluation of preventive techniques.
支持和反对循证精神病学的争论大多集中在其对临床实践和教学的价值上。然而现在，在评估医疗保健时使用相同的范式产生了新的问题。
概述循证医疗保健的发展；总结对这种方法的主要批评；回顾目前用于评估精神卫生保健的证据；并考虑如何改进证据基础。
监测了以下来源：1990年以来关于循证精神病学和医疗保健的出版物；截至2002年底的随机试验报告和荟萃分析综述；以及英国关于精神卫生政策的官方出版物。
尽管循证医疗保健目前在英国被宣传为精神卫生规划的合理基础，但其对服务评估的贡献明显不大。只有10%的临床试验和荟萃分析关注服务的有效性，而且许多综述尚无定论。
当前的循证方法过度依赖荟萃分析综述，并且更适用于特定治疗而非控制治疗实施的护理机构。需要一个更广泛的证据基础，扩展到初级卫生保健研究和预防技术评估。
