A Brief History of Evidence-based Practice

A Brief History of Evidence-based Practice

The roots of evidence-based practice are in evidence-based medicine. The history of evidence-based medicine has been well documented and includes primitive experiments to test the effectiveness of practices such as bloodletting (Claridge and Fabian, 2005). 
In 1972, Archie Cochrane pointed out the importance of properly testing the effectiveness of health care strategies, and stressed the role of randomised controlled studies to provide evidence on which health care is based. The term "evidence-based medicine" was introduced by Guyatt et al in 1992 to shift the emphasis in clinical decision making from "intuition, unsystematic clinical experience, and pathophysiologic rationale" to scientific, clinically relevant research.
An early photograph of bloodletting, from Wikimedia Commons, courtesy of the Burns Archive.

The formalized concept was embraced by many, but also elicited some criticisms, including that evidence-based medicine relies too heavily on research. It was still being described by some as a “new approach” almost twenty years later (Selvaraj et al, 2010), suggesting that it has taken some time to become integrated into the medical profession worldwide.  

In 1996, Sackett et al explained evidence-based clinical decision making as a combination of not only research evidence but also clinical expertise, taking into account the patient’s preferences. Clinical expertise was defined as the “proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice”.
Since then, evidence-based decision making has been widely accepted by allied health areas (nursing, dentistry, speech pathology, psychology, social work, public health and many others). In 2003, a statement on evidence-based practice was prepared by the delegates of the Evidence-based Health Care Teachers and Developers conference. The conference was held in Sicily, and the statement is known as the Sicily Statement (Dawes et al, 2005). It helped to introduce the broader concept of evidence-based decision making to health care generally.

Health care practitioners work in a range of clinical environments that are likely to influence decision making using EBP. In 2009, Satterfield et al developed a transdisciplinary model for evidence-based practice. This model depicts the three core components of EBP (best available research evidence, clinical expertise and patient’s preferences) within the broader clinical or organizational context. In a sense, the organizational context is a fourth EBP component.


From Satterfield et al (2009) Toward a Transdisciplinary Model of Evidence-based Practice. Millbank Quarterly 87(2): 368-390. (With permission)


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