Evidence-based Medicine and Patient-centered Care: Cross-Disciplinary Challenges and Healthcare Information Technology-enabled Solutions

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Published: Jun 30, 2011
DOI: https://doi.org/10.5750/ijpcm.v1i2.69

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Roopa Raman
Department of Management, Clemson University, South Carolina, United States of America

Abstract

Despite considerable promise, the pursuit of evidence-based medicine in a patient-centered care context faces special challenges stemming from the cross-disciplinary nature of this context; these challenges have thus far remained underexplored. This paper reports an in-depth qualitative research study in a large urban hospital system to investigate and characterize these challenges and to identify ways in which healthcare information technologies can help overcome and characterize them. The findings show that healthcare providers spanning different professions and hierarchical levels in the organization have varied views of what evidence-based medicine is and the value they expect it to provide in patient-centered care. These perceptive differences create problems in interdisciplinary collaboration when evidence-based medicine is pursued in patient-centered care contexts. Healthcare information technologies, such as electronic medical records and associated decision support technologies, help alleviate these challenges by fulfilling multiple roles, such as enabling compliance monitoring and behavior modification, patient-centric education and cross-functional communication. Challenges arising from healthcare information technologies in the pursuit of evidence-based medicine in patient-centered care contexts are also uncovered. Several implications, emerging from this study, for improving the use of evidence-based medicine in patient-centered care, are discussed.

Article Details

Issue
Vol. 1 No. 2 (2011): June
Section
Regular Articles
Author Biography

Roopa Raman, Department of Management, Clemson University, South Carolina, United States of America

Assistant Professor, Department of Management, Clemson University, South Carolina, United States of America  

References

. Davidoff, F., Haynes, B. and Sackett, D., Smith, R. (1995). Evidence based medicine. British Medical Journal 310(6987), 1085-1086.

. Dickersin, K., Straus, S.E. and Bero, L.A. (2007). Evidence based medicine: increasing, not dictating, choice. British Medical Journal 334(suppl_1), s10.

. Druss, B. (2005). Evidence based medicine: does it make a difference?: Use wisely. British Medical Journal 330(7482), 92.

. Freeman, A.C. and Sweeney, K. (2001). Why general practitioners do not implement evidence: Qualitative study. British Medical Journal 323, 1100-1114.

. Gilson, L. (2003). Trust and the development of health care as a social institution. Social Science & Medicine 56(7), 1453-1468.

. Mayer, J. and Piterman, L. (1999). The attitudes of Australian GPs to evidence-based medicine: A focus group study. Family Practice 16, 627-632.

. Prosser, H., Almond, S. and Walley, T. (2003). Influences on GPs’ decision to prescribe new drugs - the importance of who says what. Family Practice 20, 61-68.

. Bamford, T. (2011). The team approach in person-centred health care: the social work perspective, The International Journal of Person Centered Medicine 1(1), 23–26.

. Mezzich, J.E. (2011). Building person-centered medicine through dialogue and partnerships: perspective from the international network for person-centered medicine. The International Journal of Person Centered Medicine 1(1), 10–13.

. Miles, A. and Mezzich, J.E. (2011). Advancing the global communication of scholarship and research for personalized healthcare: The International Journal of Person Centered Medicine. The International Journal of Person Centered Medicine 1(1), 1–5.

. Buetow, S. (2011). Person-centred care: bridging current models of the clinician patient relationship. International Journal of Person Centered Medicine 1(1), 196–203.

. Stewart, M., Brown, J. B., Weston, W. W., McWhinney, I. R., McWilliam, C. L. and Freeman, T.R., eds. (1995). Patient-Centered Medicine. Transforming the clinical method. Thousand Oaks: Sage Publications.

. Mead, N.and Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science & Medicine 51, 1087-1110.

. Stewart, M. (2001). Towards a global definition of patient centred care. British Medical Journal 322, 444-445.

. Shields, L., Mamun, A. A., Pereira, S., O’Nions, P. and Chaney, G. (2011). Measuring family centred care: working with children and their parents in a tertiary hospital. International Journal of Person Centered Medicine 1(1), 155–160.

. Davidoff, F. and Case, K. (1995). Evidence-based medicine: why all the fuss? Annals of Internal Medicine 122, 727.

. Sackett, D., Rosenberg, W., Muir, G.J., Haynes, R. and Richardson, W. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal 312, 71–72.

. Sackett, D. and Rosenberg, W. (1995). On the need for evidence-based medicine. Journal of the Royal Society of Medicine 88, 620–624.

. Tilburt, J.C. (2008). Evidence-based medicine beyond the bedside: keeping an eye on context. Journal of Evaluation in Clinical Practice 14, 721–725.

. Tonelli, M.R. (2006). Integrating evidence into clinical practice: an alternative to evidence-based approaches. Journal of Evaluation in Clinical Practice 12(3), 248–256.

. McAlister, F.A., Graham, I., Karr, G.W. and Laupacis, A. (1999). Evidence-based medicine and the practicing clinician. Journal of General Internal Medicine 14, 236-242.

. Djulbegovic, B., Morris, L. and Lyman, G.H. (2000). Evidentiary challenges to evidence-based medicine. Journal of Evaluation in Clinical Practice 6(2), 99–109.

. Miles, A., Polychronis, A. and Grey, J.E. (2006). The evidence-based health care debate – 2006. Where are we now? Journal of Evaluation in Clinical Practice 12(3), 239–247.

. Miles, A. and Loughlin, M. (2006). Continuing the evidence-based health care debate in 2006. The progress and price of EBM. Journal of Evaluation in Clinical Practice 12(4), 385–398.

. McKenna, H., Ashton, S. and Keeney, S. (2004). Barriers to evidence based practice in primary care: A review of the literature. International Journal of Nursing Studies 41, 369–378.

. Lipman, T. (2004). The doctor, his patient, and the computerized evidence-based guideline. Journal of Evaluation in Clinical Practice 10(2), 163–176.

. Buetow, S., Upshur, R., Miles, A. and Loughlin, M. (2006). Taking stock of evidence-based medicine: opportunities for its continuing evolution. Journal of Evaluation in Clinical Practice 12(4), 399–404.

. Miles, A., Loughlin, M. and Polychronis, A. (2007). Medicine and evidence: knowledge and action in clinical practice. Journal of Evaluation in Clinical Practice 13, 481–503.

. Nunn, R. (2008). Evidence-based medicine and limits to the literature search. Journal of Evaluation in Clinical Practice 14, 672–678.

. Buetow, S. (2002). Beyond evidence-based medicine: bridge-building a medicine of meaning. Journal of Evaluation in Clinical Practice 8(2), 103–108.

. Shuval, K., Shachak, A., Linn, S., Brezis, M. and Reis, S. (2007). Evaluating primary care doctors’ evidence-based medicine skills in a busy clinical setting. Journal of Evaluation in Clinical Practice 13, 576–580.

. Shahar, E. (1998). Evidence-based medicine: a new paradigm or the Emperor’s new clothes? Journal of Evaluation in Clinical Practice 4(4), 277–282.

. Uijen, A., Schers, H. and van Weel, C. (2011). Person Centered Medicine and the Primary Care Team – securing continuity of care. The International Journal of Person Centered Medicine 1(1), 18–19.

. Miles, A. (2011). Tailoring care to individuals and populations within resource-poor settings: A review and commentary on the World Health Organisation Report People-Centred Care in Low and Middle Income Countries. The International Journal of Person Centered Medicine 1(1), 113–118.

. Buetow, S.A. (2005). To care is to co-provide. Annals of Family Medicine 3(6), 553–555.

. Cassell, E.J. (2000). The principles of the Belmont Report revisited: how have respect for persons, beneficence, and justice been applied to clinical medicine? Hastings Center Report 4, 12-21.

. Joshi, K. and De Crescenzo, N. (2008). Informing personalized medicine. Drug Discovery & Development 11(7), 14–18.

. Stead, W.W. (2010) Electronic health records. Information Knowledge Systems Management 8(1–4), 119–143.

. Davies, E.A., Madden, P., Coupland, V.H., Griffin, M. and Richardson, A. (2011). Comparing breast and lung cancer patients’ experiences at a UK Cancer Centre: implications for improving care and moves towards a person centered model of clinical practice. The International Journal of Person Centered Medicine 1(1), 177–189.

. Milne, D., Sheeran, L., Dryden, T., Mileshkin, L. and Aranda, S. (2011). Care requirements of patients with advanced cancer within a specialist centre – moving to person-centered approaches. The International Journal of Person Centered Medicine 1(1), 167–176.

. Monajemi, A. and Rikers, R.M.J.P. (2011). The role of patient management in medical expertise development: Extending the contemporary theory. The International Journal of Person Centered Medicine 1(1), 161–166.

. Davenport, T. H. and Glaser, J. (2002). Just-in-time delivery comes to knowledge management. Harvard Business Review 80(7), 107-111.

. Jaffe, C., Hammond, W.E., Quinn, J. and Dolin, R.H. (2009). Healthcare IT standards and the standards development process: lessons learned from health level 7. Intel Technology Journal 13(3), 58–79.

. Mechanic, D. (2002). Socio-cultural implications of changing organizational technologies in the provision of care. Social Science & Medicine 564, 459-467.

. Pelino, D. (2008). Hospitals have collected mountains of patient and clinical data--now what? Healthcare Financial Management 62(9), 142–144.

. Neupert, P. (2009). Re-inventing healthcare. Health Management Technology 30(3), 8–25.

. Hoffmann, L. (2009). Implementing electronic medical records. Communications of the Association of Computing Machinery 52(11), 18–20.

. Miles, M.B. and Huberman, A.M. (1994). Qualitative data analysis: An expanded sourcebook. Thousand Oaks: Sage Publications.

. Yin, R.K. (2003). Case Study Research: Design and Methods. Thousand Oaks: Sage Publications.

. Hay, M.C., Weisner, T.S., Subramanian, S., Duan, N., Niedzinski, E.J. and Kravitz, R.L. (2008). Harnessing experience: exploring the gap between evidence-based medicine and clinical practice. Journal of Evaluation inClinical Practice 14, 707–713.

. Montori, V. and Guyatt, G. (2002). What is evidence-based medicine? Endocrinology and Metabolism Clinics of North America 31, 521–526.

. Pape, T. (2003). Evidence-based nursing practice: to infinity and beyond. Journal of Continuing Education in Nursing 34, 154–161.

. Sullivan, F.M. and MacNaughton, R.J. (1996). Evidence in consultations: interpreted and individualized. Lancet 348, 941–943.

. Parker, L.E., Ritchie, M.J., Kirchner, J.E. and Owen, R.R. (2009). Balancing health care evidence and art to meet clinical needs: policymakers’ perspectives. Journal of Evaluation in Clinical Practice 15, 970–975