In a recent BMJ article on evidence-based medicine, the authors warn that an over-dependence on clinical evidence could inappropriately drive clinical decisions according to a rule rather than encouraging providers to respond to the needs of the patient. "Inflexible rules and technology driven prompts may produce care that is management driven rather than patient centered," the authors comment. "Evidence based guidelines often map poorly to complex multimorbidity." Responding to the article, PIPC Chairman Tony Coelho agrees that "a return to 'real' evidence-based medicine means bringing the patient back to the center."
Chairman Coelho notes that evidence-based medicine should inform individual patients and their providers about the range of treatment options, while ensuring that care is patient- and not management-driven:
"If a campaign for a return to 'real' evidence-based medicine means bringing the patient back to the center, then count us in. The Partnership to Improve Patient Care has been to devoted to advancing patient-centeredness in EBM and comparative effectiveness research since our founding.
"We agree that, particularly as health care continues to move to models in which providers are at risk for hitting financial targets and relies on evidence-based protocols and pathways to meet those targets, keeping EBM centered on patient needs and values is more challenging than ever. In this environment, the patient voice is going to be more important than ever. We recognize and seek to champion the importance of the patient voice, not only in research but in clinical practice. Evidence-based medicine should inform individual patients and their providers about the range of treatment options and their impact on people with similar characteristics and preferences. Access to those treatment options that are best suited for the individual patient must be built into any payment or delivery system that calls itself patient-centered. More data is one part of the solution to achieve patient-centeredness. Engaging and empowering patients in the process is a core component to ensure that a) data is capturing patient needs, outcomes and preferences b) that research findings are being implemented through shared decision-making tools that are similarly patient-centered, and c) care is patient-driven and not “management driven.” We hope others who share these principles will join us in supporting real, patient-focused EBM."
