Balancing health care evidence and art to meet clinical needs: policymakers' perspectives.
Balancing health care evidence and art to meet clinical needs: policymakers' perspectives.
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平衡医疗保健证据和艺术以满足临床需求：决策者的观点。
DOI：
10.1111/j.1365-2753.2009.01209.x
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发表时间：
2009-12
影响因子：
2.4
通讯作者：
Owen RR
中科院分区：
文献类型：
--
作者：
Parker LE;Ritchie MJ;Kirchner JE;Owen RR
尽管许多人认为循证实践（EBP）具有巨大潜力，但批评者也指出了其局限性，包括关注随机临床试验（RCT）证据而排除其他证据类型以及忽视医学艺术。然而，其他人则认为，正确应用 EBP 需要对各种信息进行合理考虑；因此，医学与艺术之间的二分法可能是错误的。我们探讨了退伍军人健康管理局（EBP 运动的领导者）的执行层政策制定者关于证据的构成以及在确定临床政策时证据与实际需求的相对重要性的观点。我们进行了 26 次半结构化定性访谈并进行了内容分析。尽管知情者普遍相信 EBP 的价值以及随机对照试验在其中的作用，但他们也重视其他类型的证据。此外，他们的担忧有时与严格遵守基于证据的方法是相反的。这些包括实际问题，符合组织价值观以及当地情况、资源、政治压力和患者需求。他们特别关心如何解决影响许多没有循证治疗的个人或高危人群的医疗状况。如果可能，医疗保健实践应以证据为基础。如果这是不可能的，医疗保健提供者必须通过使用基于共识的最佳实践来求助于医学艺术。此外，政策制定者和研究人员必须共同努力开发实用且满足需求的 EBP。
Although many believe that evidence-based practice (EBP) has great potential, critics have identified limitations including a focus on randomized clinical trial (RCT) evidence to the exclusion of other evidence types and a disregard for the art of medicine. Others have argued, however, that proper application of EBP involves reasoned consideration of a wide variety of information; thus, the dichotomy between medical science and art may be false. We explore the views of executive-level policymakers from the Veterans Health Administration, a leader in the EBP movement, regarding what constitutes evidence and the relative importance of evidence versus practical needs when determining clinical policy. We conducted 26 semi-structured qualitative interviews and performed a content analysis. Although informants generally believed in the value of EBP and the role of RCTs within it, they also valued other types of evidence. Further, they had concerns that were sometimes antithetical with strict adherence to an evidence-based approach. These included practical concerns, fit with organizational values and with local circumstances, resources, political pressures and patient needs. They were especially concerned about how to address medical conditions that affect many individuals or high-risk populations that have no evidence-based treatment. When possible, health care practice should be evidence-based. When this is not possible, health care providers must turn to the art of medicine by using consensus-based best practices. Further, it is important for policymakers and researchers to work in concert to develop EBPs that are practical and meet needs.
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影响因子：
3.2
作者：
Parker, Louise E.;de Pillis, Emmeline;Meredith, Lisa S.
通讯作者：
Meredith, Lisa S.
影响因子：
4.1
作者：
Ashcroft, RE
通讯作者：
Ashcroft, RE
影响因子：
2.4
作者：
Lewis, Steven
通讯作者：
Lewis, Steven
影响因子：
4.1
作者：
Danzer, G;Rose, M;Klapp, BF
通讯作者：
Klapp, BF
影响因子：
6.7
作者：
Sinclair, S
通讯作者：
Sinclair, S