EbM von unten: Sind Fragen nach Evidenz zu klinischen Alltagsproblemen beantwortbar?

Abstract

Many physicians agree on the advantages of using Evidence-based Medicine (EbM) in daily practice, but they do not make use of this method very often. One reason for this lack of EbM implementation is that it is difficult to access clinically relevant and appropriate information in daily practice. The division "Principles and Practices of EbM" in the German Network for Evidence-based Medicine (DNEbM) initiated a pilot project to improve their information management. During two weeks in February 2007 physicians in a local setting in the southeast part of Germany were offered an EbM expert service. They were asked to formulate open-ended questions arising from daily practice. Seventeen experts answered these questions within a three day period. In addition, all participants regularly received an edited version of these topics, and finally a questionnaire was sent out to evaluate physician satisfaction. Five family doctors and two hospital departments formulated 28 questions in two weeks. There was a wide range of answers, from evidence summaries (including full texts of the trials or relevant guidelines) up to expert opinion together with a discussion of different action strategies in the case of uncertain evidence. The participating physicians' satisfaction with this offer of low-barrier access to the best available evidence and the answers provided by the experts was high. Apart from the suggested solutions to the respective problems the project initiated a critical self-analysis of their individual clinical practice among the participating physicians. All of them saw the need for continuing this project. Further investigations are needed in order to optimise both the process of EbM implementation on a long-term basis and the health care quality by providing EbM expert services.