Evidence-Based Medicine

EVIDENCE-BASED MEDICINE

‘Evidence-based medicine’ is the new buzz term used to describe that which virtually all prescribers have been striving for throughout their professional lives. With better evidence from large clinical trials, there is increasing information to suggest that additions of several more medicines to the base package of treat-ment can result in better outcomes. What is not known is the effect of adopting this approach in real life. Will patients comply with all the additional medicines or will they attempt to reduce and rationalise the number of pills they have to take? If the latter, will they take the most important ones or will they take a random selection such that they end up worse off than before? So far, the large databases have been used primarily to study the effects of medicines on patients. They have rarely been used to study prescribers’ or patients’ behaviour. For obvious reasons, this area is complex. It could also be perceived as being potentially threat-ening to the very practitioners who supply the data in the first place! Nevertheless, these problems could easily be surmounted by ensuring adequate anonymi-sation for prescribers, and indeed this has been a feature of some of the large databases throughout their existence. Practitioners have nothing to fear about such developments if they are conducted in an inquir-ing mode rather than in a potentially inquisitorial mode. Indeed, they could learn substantial amounts from them. Guidelines and other advice from central sources now have the potential for considerable influ-ence on prescribing decisions. Multipurpose databases are well placed to allow study of the sequelae of this trend. This includes not only drug utilisation studies linked to cost containment strategies, but also much needed outcome studies that might tell if such advice has any real clinical benefit for patients.