Abstract
Evidence-based medicine (EBM) has been defined as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” EBM requires the ability to apply a knowledge of medical informatics (e.g., efficiently searching the medical literature) and clinical epidemiology (e.g., being able to critically appraise the literature) to the treatment of individual patients. This article provides an introduction to the history, philosophy, and methods of EBM as applied to psychiatric practice. The article summarizes the five-step EBM model: (1) formulate the question; (2) search for answers; (3) appraise the evidence; (4) apply the results; and (5) assess the outcome. Resources (including Web sites) for further learning are provided.
Similar content being viewed by others
References
Borenstein D: Evidence-based psychiatry. Psychiatric News 36:3, 2001.
Department of Health and Human Services: Mental Health: A Report of the Surgeon General. Washington, DC, U.S. Department of Health and Human Services, 1999.
Drake RE, Goldman HH, Leff HS, et al: Implementing evidence-based practices in routine mental health settings. Psychiatric Services 52:179-182, 2001.
Lehman AF, Steinwachs DM, and the survey co-investigators of the PORT study: Patterns of usual care for schizophrenia: Initial results from the schizophrenia Patient Outcomes Research Team (PORT) client survey. Schizophrenia Bulletin 24:11-20, 1998.
Egger M, Smith GD, O'Rourke K: Rationale, potentials, and promise of systematic reviews, in Systematic Reviews in Health Care. Edited by Egger M, Smith GD, Altman DG. London, BMJ Books, 2001.
Haines A, Donald A: Making better use of research findings. BMJ 317:72-75, 1998.
Geddes JR, Game D, Jenkins NE, et al: What proportion of primary psychiatric interventions are based on evidence from randomised controlled trials? Quality in Health Care 5:215-217, 1996.
Greenhalgh T: How to Read a Paper: The Basics of Evidence Based Medicine, 2nd ed. London, BMJ Books, 2001.
Geddes JR, Harrison PJ: Closing the gap between research and practice. British Journal of Psychiatry 171:220-225, 1997.
Wennberg JE: Unwarranted variations in healthcare delivery: Implications for academic medical centers. BMJ 325:961-964, 2002.
Gray GE: Evidence-based medicine: An introduction for psychiatrists. Journal of Psychiatric Practice 8:5-13, 2002.
Haynes RB, Sackett DL, Gray JA, et al: Transferring evidence from research into practice, 2: Getting the evidence straight. ACP Journal Club 126:A14-A16, 1997.
Collins R, MacMahon S: Reliable assessment of the effects of treatment on mortality and major morbidity, I: Clinical trials. Lancet 357:373-380, 2001.
Sackett DL, Strauss SE, Richardson WS, et al: Evidence-Based Medicine: How to Practice and Teach EBM, 2nd ed. New York, Churchill Livingstone, 2000.
Grol R: Improving the quality of medical care: Building bridges among professional pride, payer profit, and patient satisfaction. JAMA 286:2578-2585, 2001.
Haines A, Donald A (Editors): Getting Research Findings into Practice, 2nd ed. London, BMJ Books, 2002.
Dawes M: Preface, in Evidence-Based Practice: A Primer for Health Professionals. Edited by Dawes M, Davies P, Gray A, et al. New York, Churchill Livingstone, 1999.
Sackett DL, Rosenberg WMC, Gray JAM, et al: Evidence-based medicine: What it is and what it isn't. BMJ 312:71-72, 1996.
Haynes RB, Devereaux PJ, Guyatt GH: Physicians' and patients' choices in evidence based practice. BMJ 324:1350, 2002.
Straus SE, McAlister FA: Evidence-based medicine: A commentary on common criticisms. Canadian Medical Association Journal 163:837-841, 2000.
Lipman T: Evidence-based practice in general practice and primary care, in Evidence-Based Practice: A Critical Appraisal. Edited by Trinder L, Reynolds S. Oxford, UK, Blackwell Science, 2000.
Trinder L: A critical appraisal of evidence-based practice, in Evidence-Based Practice: A Critical Appraisal. Edited by Trinder L, Reynolds S. Oxford, Blackwell Science, 2000.
Hope T: Evidence-based patient choice and psychiatry. Evidence-Based Mental Health 5:100-101, 2002.
Guyatt GH, Haynes RB, Jaeschke RZ, et al: Users' guides to the medical literature: XXV. Evidence-based medicine: Principles for applying the users' guides to patient care. JAMA 284:1290-1296, 2000.
Guyatt G: Preface, in Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Care. Edited by Guyatt G, Rennie D. Chicago, AMA Press, 2002.
Evidence-Based Medicine Working Group: Evidence-based medicine: A new approach to the teaching of medicine. JAMA 268:2420-2425, 1992.
Guyatt G, Rennie D (Editors): Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Care. Chicago, AMA Press, 2002.
Baker M, Kleijnen J: The drive towards evidence-based health care, in Evidence-Based Counseling and Psychological Therapies: Research and Applications. Edited by Rowland N, Goss S. Philadelphia, Routledge, 2000.
Ferguson B, Russell I: Towards evidence-based health care, in Evidence-Based Counseling and Psychological Therapies: Research and Applications. Edited by Rowland N, Goss S. Philadelphia, Routledge, 2000.
Barton S: Using clinical evidence. BMJ 322:503-504, 2001.
Trinder L, Reynolds S (Editors): Evidence-Based Practice: A Critical Appraisal. Edited by Trinder L. Oxford, UK, Blackwell Science, 2000.
Accreditation Council for Graduate Medical Education: General competencies [ACGME Outcome Project web site]. 2001. Available at: http://www.acgme.org/outcome/. Accessed June 5, 2002.
Bilsker D, Goldner EM: Evidence-based psychiatry. Canadian Journal of Psychiatry 40:97-101, 1995.
Geddes J: Evidence-based practice in mental health, in Evidence-Based Practice: A Critical Appraisal. Edited by Trinder L, Reynolds S. Oxford, UK, Blackwell Science, 2000.
Goss S, Rowland N: Getting evidence into practice, in Evidence-Based Counseling and Psychological Therapies: Research and Applications. Edited by Rowland N, Goss S. Philadelphia, Routledge, 2000.
Geddes J, Carney S: Recent advances in evidence-based psychiatry. Canadian Journal of Psychiatry 46:403-406, 2001.
Geddes J, Reynolds S, Streiner D, et al: Evidence based practice in mental health. BMJ 315:1483-1484, 1997.
Mace C, Moorey S, Roberts B (Editors): Evidence in the Psychological Therapies: A Critical Guide for Practitioners. Philadelphia, Brunner-Routledge, 2001.
Torrey WC, Drake RE, Dixon L, et al: Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services 52:45-50, 2001.
Gray GE: Concise Guide to Evidence-Based Psychiatry. Washington, DC, American Psychiatric Publishing, 2003.
Phillips B, Ball C, Sackett D, et al: Levels of evidence and grades of recommendations [Centre for Evidence-Based Medicine web site]. May 2001. Available at http://minerva/minervation.com/cebm/docs/levels.html. Accessed October 16, 2002.
Lacchetti C, Guyatt G: Therapy and validity: Surprising results of randomized controlled trials. in Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Care. Edited by Guyatt G, Rennie D. Chicago, AMA Press, 2002.
Antman EM, Lau J, Kupelnick B, et al: A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts: Treatments for myocardial infarction. JAMA 268:240-248, 1992.
Haynes RB: Of studies, summaries, synopses, and systems: The "4S" evolution of services for finding current best evidence. Evidence-Based Mental Health 4:37-39, 2001.
Dearness KL, Tomlin A: Development of the National electronic Library for Mental Health: Providing evidence-based information for all. Health Information and Libraries Journal 18:167-174, 2001.
Guyatt G, Haynes B, Jaeschke R, et al: Introduction: The philosophy of evidence-based medicine, in Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Care. Edited by Guyatt G, Rennie D. Chicago, AMA Press, 2002.
American Psychiatric Association: Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2002. Washington, DC, American Psychiatric Association, 2002.
Antes G, Oxman AD for the Cochrane Collaboration: The Cochrane Collaboration in the 20th Century, in Systematic Reviews in Health Care: Meta-Analysis in Context. Edited by Egger M, Smith GD, Altman DG. London, BMJ Books, 2001.
Dawes M, Davies P, Gray A, et al (Editors): Evidence-Based Practice: A Primer for Health Professionals. New York, Churchill Livingstone, 1999.
Ball C: Evidence-based medicine on the wards: Report from an evidence-based minion. Evidence-Based Medicine 3:101-103, 1998.
Ely JW, Osheroff JA, Ebell MH, et al: Obstacles to answering doctors' questions about patient care with evidence: Qualitative study. BMJ 324:710-713, 2002.
Young JM, Ward JE: Evidence-based medicine in general practice: Beliefs and barriers among Australian GPs. Journal of Evaluation in Clinical Practice 7:201-210, 2001.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gray, G.E., Pinson, L.A. Evidence-Based Medicine and Psychiatric Practice. Psychiatr Q 74, 387–399 (2003). https://doi.org/10.1023/A:1026091611425
Issue Date:
DOI: https://doi.org/10.1023/A:1026091611425