A critical analysis of evidence-based practice - moving towards a more patient-oriented EBP model

Introduction: Reservations are emerging as to the suitability of a strict, highly researched evidence base for clinical health care. While such an evidence base is considered essential, there is growing support for a more patient centred system. Background: Questions surrounding the previously accepted gold standard are outlined together with suggestions that the roles of empirical and anecdotal evidence as well as patient input may need to carry greater weight in EBP. Review: Some grounds for even considering change is presented, these include the confusing plethora of hierarchical evidential models, the individual consideration of each patient, as well as limitations in the currently adopted system. Not only are there different models of evidential levels, but also these levels change from time to time over the decades. Patient Satisfaction: Personalised patient feedback is suggested as critical. It is generally the patient that initiates a visit to a health practitioner. So, if it is important to listen to a patient at that initial consultation, surely it is just as important to listen to them during, and particularly at the end of it. Summary: Patient involvement in more personalised feedback data could essentially lead to a challenge to the theories of current evidential hierarchical levels. Calls have also been recognised for a greater emphasis to be placed on anecdotal and empirical evidence in such models. Conclusion: This presentation has sought to review, and construct a case for modifying and merging the current, generally accepted standards in EBP with a broader patient-involved base. Recommendations: A model incorporating a Visual Analogue Scale of patient self-assessment (30%) and practitioner assessment (30%) is offered, together with a weighted evidence formula (anecdotal and empirical 20% and formal evidence 20%) as well as an adopted assessment format. While the offered transcript is intended to open discussion on the topic, at this early stage additional research is also recommended regarding the form that any modifications may take.