Evidence-Based Clinical Practice in Health Care

Evidence-based clinical practice is an approach to health care in which professionals use the best evidence possible—i.e., scientific data and other appropriate information—to make clinical decisions about patient care.1 Evidence-based practice (EBP) has been on the rise for over 20 years,2 and in health care in particular, it involves the combination of scientific evidence, clinical expertise and individual patient needs.1 EBP is particularly important because it allows health professionals to use data from systematic research in their everyday practices, thus giving individualized purpose to broad studies and keeping health care standard across clinicians.3

EBP not only applies to individual or group health care practices, but also to organizational and national guidelines on medical care. For one, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD in 2009, and then updated these guidelines in 2015 based on research in GERD epidemiology, pathophysiology and treatment during this period.4 These new data informed the society’s suggested practices, including those regarding treatment with proton pump inhibitors (PPIs). Later, in 2017, Farrell et al. used a systematic review of PPI trials and side effects to recommend reducing or stopping treatment with PPIs after a short period of time.5 Clearly, the case of gastroenterology’s fast-pace updates to standard practice guidelines demonstrates the influence that systematic evidence can have on individual patient care.

Meanwhile, evaluations of clinical practice quality—aside from simply suggestions or guidelines—are also influenced by scientific evidence. The Centers for Medicare & Medicaid Services (CMS) lists evidence-based care as one of its core competencies in its initiatives for quality health care.6 Thus, health professionals’ quality of patient care is assessed based on their individual patients’ outcomes as well as on their ability to integrate scientific evidence into their practices. Indeed, EBP and quality improvement efforts are often linked within health care;7 EBP is cited as a critical part of quality improvement8 and as a mechanism through which health professionals can improve quality of care.

Nonetheless, EBP has faced challenges throughout the years of its popularity. For example, Hisham et al.’s interviews of various primary care doctors revealed that—despite being aware of and having a positive attitude toward EBP—participants cited heavy workload and lack of training as barriers to implementing EBP in their own clinical practices.10 Additionally, some doctors were concerned that EBP compromised personalized patient care and did not consider an individual physician’s clinical experience. Meanwhile, De Smedt et al. found that while physicians, nurses and paramedics used forums such as the Internet and textbooks to gather evidence, they claimed that lack of time, the overwhelming mass of literature and difficulties integrating evidence into practice were the most common barriers to EBP.11 Overall, EBP is not universally acknowledged as a panacea, and its general acceptance may not necessarily lead to EBP-friendly workplaces.

In sum, EBP can serve as a method for systematic research to make its way into the everyday lives of patients and health care professionals. EBP helps medicine keep pace with clinical evidence and allows professional organizations to standardize practice.12 Future researchers must explore if EBP is feasible given health professionals’ heavy workloads, if it encourages personalized solutions for patients and, ultimately, if it can lead to improved quality of health care.

1.         McKibbon KA. Evidence-based practice. Bulletin of the Medical Library Association. 1998;86(3):396–401.

2.         Guyatt G, Cairns J, Churchill D, et al. Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA. 1992;268(17):2420–2425.

3.         Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ. 1996;312(7023):71–72.

4.         Iwakiri K, Kinoshita Y, Habu Y, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. Journal of Gastroenterology. 2016;51(8):751-767.

5.         Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline. 2017;63(5):354-364.

6.         Centers for Medicare & Medicaid Services. Quality Initiatives: General Information. April 2018;

7.         Banerjee A, Stanton E, Lemer C, Marshall M. What can quality improvement learn from evidence-based medicine? Journal of the Royal Society of Medicine. 2012;105(2):55–59.

8.         Solomons NM, Spross JA. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. Journal of nursing management. 2011;19(1):109–120.

9.         Grimshaw J, Eccles M, Thomas R, et al. Toward Evidence-Based Quality Improvement. Journal of General Internal Medicine. 2006;21(S2):S14–S20.

10.       Hisham R, Ng CJ, Liew SM, Hamzah N, Ho GJ. Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study. BMJ Open. 2016;6(3):e010565.

11.       De Smedt A, Buyl R, Nyssen M. Evidence-based practice in primary health care. Studies in Health Technology and Informatics. 2006;124:651–656.

12.       Masic I, Miokovic M, Muhamedagic B. Evidence based medicine – New approaches and challenges. Acta Informatica Medica: Journal of Academy of Medical Sciences of Bosnia and Herzegovina. 2008;16(4):219–225.