آیا تصمیم ‌سازی بالینی ما مبتنی بر بهترین شواهد علمی است؟

چنگیز, طاهره; کبیری, پیام; مظفرپور, ‌سارا; خلیقی نژاد, نیما; طاهری, هاجر; صادقی‌زاده, عاطفه; عطایی کچویی, منیژه; امین پور, فرزانه

آیا تصمیم ‌سازی بالینی ما مبتنی بر بهترین شواهد علمی است؟

نوع مقاله : مقاله های پژوهشی

نویسندگان

¹ فارماکولوژیست، مرکز تحقیقات آموزش پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان،‌ ایران.

² اپیدمیولوژیست، گروه اپیدمیولوژی و آمار زیستی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی تهران، تهران و مرکز تحقیقات آموزش پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان،‌ ایران.

³ دانشجوی پزشکی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان،‌ ایران.

⁴ پزشک عمومی، اصفهان،‌ ایران.

⁵ دستیار کودکان،‌ دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان،‌ ایران.

⁶ دانشجوی دکترای تخصصی مدیریت اطلاعات سلامت، دانشگاه علوم پزشکی تهران، تهران و عضو مرکز تحقیقات آموزش پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

چکیده

مقـدمـه: پزشکی مبتنی برشواهد فرآیند دریافت، نقد و به‌ کارگیری نتایج تحقیقات بر بالین بیماران می‌باشد. با وجود انتشار مقالات متعدد پیرامون میزان تطابق عملکرد پزشکان با شواهد علمی در سایر کشورها، هنوز مطالعه‌ای در ایران صورت نگرفته است. هدف این مطالعه، تعیین این مطلب بود که چند درصد از خدمات بالینی ارایه شده در بخش‌های داخلی یک بیمارستان آموزشی منتخب، منطبق با شواهد معتبر علمی است.روش‌ها: پرونده‌ی 103 بیمار که در مدت یک ماه در هفت بخش داخلی بیمارستان آموزشی الزهرا (س) دانشگاه علوم پزشکی اصفهان بستری شده بودند، وارد مطالعه گردید. برای هر بیمار دو شاخص تشخیص و درمان اولیه مشخص شد. سپس منابع علمی پزشکی مبتنی بر شواهد جهت یافتن کارآزمایی‌های بالینی، مقالات مروری و راه‌کارهای طبابت بالینی جستجو شد و میزان تطابق درمان ارایه شده به بیمار با درمان منتخب بر مبنای بهترین یافته‌های پژوهشی مبتنی بر شواهد محاسبه و استخراج شد. یافته‌ها: بر اساس جستجوی انجام شده 71 مورد (9/68 درصد) از بیماران، مداخلات اولیه‌ی منطبق با سطح یک شواهد علمی و 32 مورد (1/31 درصد) منطبق با شواهد سطح دو علمی را دریافت کرده بودند. هیچ بیماری مداخله‌ی منطبق با شواهد سطح سه دریافت نکرده بود.نتیجه گیری: بیش از نیمی از مداخلات انجام شده در بخش‌های داخلی بیماستان آموزشی منتخب، منطبق بر شواهد معتبر علمی بوده است. تکرار این مطالعه برای سایر رشته‌ها و پزشکان غیر هیأت علمی ضروری است.

کلیدواژه‌ها

عنوان مقاله [English]

Is Our Clinical Decision Making Based on the Best Research Evidence?

نویسندگان [English]

Tahereh Changiz ¹
Payam Kabiri ²
Sara Mozafarpour ³
Nima Khalighinejad ³
Hajar Taheri ⁴
Atefeh Sadeghizadeh ⁵
Manizheh Kachuie ³
Farzaneh Aminpour ⁶

¹ Pharmacologist, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

² Epidemiologist, Department of Epidemiology & Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran and Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

³ Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

⁴ General Practitioner, Isfahan, Iran.

⁵ Resident of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

⁶ PhD Student, School of Management and Medical Information Science, Tehran University of Medical Sciences, Tehran and Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

چکیده [English]

Introduction: Evidence based practice is an approach to clinical practice which emphasizes the use of best clinical researches as a component of clinical decision making. The aim of this study was to determine the percentage of current clinical decision making and disease management which is based and supported by high-level evidence in an educational hospital located in Isfahan, Iran.Methods: A cross-sectional study was carried on 103 patients who were admitted during one month to seven Internal medicine wards in Alzahra hospital. For each patient, the primary diagnosis and primary treatment were recorded. Evidence based resources were then searched for randomized controlled trials (RCT’s), systematic reviews and clinical practice guidelines to find the best research evidence that the treatments were effective. The main outcome measure was the level of evidence which supports the primary intervention for the primary diagnosis of each patient.Finding: Level I evidence (at least one randomized trial) supported the primary intervention used in 68.9% of internal admissions and level II evidence (convincing non-experimental evidence) supported the primary intervention in 31.1% of admissions. None of patients received intervention with level III supporting evidence.Conclusion: Most patients had received high level supported interventions. It seems that we should repeat this study in other wards. Also it may be recommended to design some educational evidence based practice for non academic physicians.

کلیدواژه‌ها [English]

Evidence based practice
Evidence based clinical performance
Clinical practice guidelines

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