Gronseth Gary S
Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
NeuroRx. 2004 Jul;1(3):331-40. doi: 10.1602/neurorx.1.3.331.
Despite the availability of vast quantities of evidence from basic biomedical and clinical studies, a gap often exists between the optimal practice suggested by the evidence and actual practice. For many clinical situations, however, evidence is unavailable, of poor quality or contradictory. Out of necessity, clinicians have become accustomed to relying on non-evidence-based tools to make decisions. Out of habit, they rely on these tools even when high-quality evidence becomes available. Growing out of an increasing awareness of this problem, the evidence-based medicine (EBM) movement sought to empower clinicians to find the evidence most relevant to a specific clinical question. Various organizations have used EBM techniques to develop systematic reviews and practice guidelines to aid physicians in making evidence-based decisions. A systematic review follows a process of asking a clinical question, finding the relevant evidence, critically appraising the evidence and formulating conclusions and recommendations. Results are mixed on whether educating physicians about evidence-based recommendations is sufficient to change physician behavior. Barriers to adopting evidence-based best practice remain, including physician skepticism, patient expectations, fear of legal action, and distorted reimbursement systems. Additionally, despite enormous research efforts there remains a lack of high-quality evidence to guide care for many clinical situations.
尽管基础生物医学和临床研究提供了大量证据，但证据所建议的最佳实践与实际实践之间往往存在差距。然而，在许多临床情况下，证据并不存在、质量不佳或相互矛盾。出于必要，临床医生已习惯于依靠非循证工具来做决策。出于习惯，即使有高质量的证据可用，他们仍依赖这些工具。基于对这一问题的日益认识，循证医学（EBM）运动旨在使临床医生有能力找到与特定临床问题最相关的证据。各种组织已使用循证医学技术来开展系统评价和制定实践指南，以帮助医生做出循证决策。系统评价遵循提出临床问题、寻找相关证据、严格评估证据以及形成结论和建议的过程。关于向医生传授循证建议是否足以改变医生行为，结果不一。采用循证最佳实践仍存在障碍，包括医生的怀疑态度、患者期望、对法律诉讼的担忧以及扭曲的报销制度。此外，尽管进行了大量研究工作，但对于许多临床情况，仍缺乏高质量的证据来指导治疗。
