EXPERIENCE is the knowledge or skill that we get from doing, seeing, or feeling things. Evidence is the available body of facts or information indicating whether a belief or proposition is true or valid. For public health interventions, evidence typically refers to the effectiveness of an intervention in achieving an outcome that will create lasting changes in the health of the population. This evidence is usually published in scientific literature such as in professional journals, books, or government reports. There are several major types including: documentary evidence, digital evidence, demonstrative evidence, exculpatory evidence, physical evidence, prima facie evidence, scientific evidence, and testimony.
World Health Organization (WHO) defined Traditional Medicine (TM) as the skills and practices based on the health practices, approaches, knowledge and beliefs from various cultures, whether explicable or not, incorporating plant, animal-and mineral- derived medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination in the maintenance of health and well-being to prevent, diagnose, improve or treat physical and mental illness.
Evidence-Based Practice (EBP) provides the health professional to be able to understand the relationships between research and strength of evidence, to access and appraise evidence and to determine its applicability with regard to a particular patient’s context and wishes.
The practice of evidence— based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Individual clinical expertise means the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.
It cannot be denied that there are some limitations in TM to explain every single thing under scientific terms as some practices go beyond the scientific field. But there are still many practices needed to promote into EBP for those clinical experiences and skills acquired from clinical practices must be proved with evidence when the whole world is demanding standardization and international harmonization.
For that to happen, all-inclusive TM domain needs to work together. There is a famous quote by the 35th President of the United States of America, John F. Kennedy, “Do not ask what your country do for you; ask what you can do for your country”. Likewise, please do not ask what TM domain do for you; ask what you can do for the promotion of TM domain.
EBP is much more important in the 21st Century as it provides standards that have the potential to provide the best medical care at the lowest cost. The advantage of EBP is that knowledge gained from large clinical trials is applied directly to patient care. The use of EBP promotes consistency in individual patient treatments that assume optimal clinical outcomes and improved quality of life.
Evidence based practice (EBP) is 'the integration of best research evidence with clinical expertise and patient values' which when applied by practitioners will ultimately lead to improved patient outcome.
There are 5 steps in implementing EBP; Ask, Acquire, Appraise, Apply, Audit.
1. Ask- Formulate an answerableable question
One of the fundamental skills required for EBP is the asking of well-built clinical questions. By formulating an answerable question you to focus your efforts specifically on what matters. These questions are usually triggered by patient encounters which generate questions about the diagnosis, therapy, prognosis or aetiology.
2. Acquire- Find the best available evidence
The second step is to find the relevant evidence. This step involves identifying search terms which will be found in your carefully constructed question from step one; selecting resources in which to perform your search such as PubMed and Cochrane Library; and formulating an effective search strategy using a combination of MESH terms and limitations of the results.
3. Appraise- Appraise the evidence
It is important to be skilled in critical appraisal so that you can further filter out studies that may seem interesting but are weak. Use a simple critical appraisal method that will answer these questions: What question did the study address? Were the methods valid? What are the results? How do the results apply to your practice?
4. Apply- Implement the evidence
Individual clinical decisions can then be made by combining the best available evidence with your clinical expertise and your patients’ values. These clinical decisions should then be implemented into your practice which can then be justified as evidence—based.
5. Audit- Evaluate the outcome
The final step in the process is to evaluate the effectiveness and efficacy of your decision in direct relation to your patient. Was the application of the new information effective? Should this new information continue to be applied to practice? How could any of the 5 processes involved in the clinical decision-making process be improved the next time a question is asked?
EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence. EBP promotes an attitude of inquiry in health professionals and starts us thinking about: Why am I doing this in this way? Is there evidence that can guide me to do this in a more effective way? As health professionals, part of providing a professional service are ensuring that our practice is informed by the best available evidence. EBP also plays a role in ensuring that finite health resources are used wisely and that relevant evidence is considered when decisions are made about funding health services.
In the report of WHO-CIPIH (Commission on Intellectual Property Rights, Innovation and Public Health) Study Nine on TM, the report emphasizes the need to give basic respect and recognition to TM, more thrust on TM practices, philosophies and basic principles and not just medicines; evidence-based research at all levels of preclinical and clinical stages should be strengthened and supported; increased safety and quality harmonization; global guidelines on policy and regulations, validation mechanisms and TM networking research; innovative and apt methodologies supported by common protocols or guidelines on TM research need to be developed; traditional practices, healers and ecosystem should not be exploited during bioprospecting, WHO and bodies like Convention on Biological Diversity (CBD) should work together to emphasize importance of health related issues at the backdrop of biodiversity; improved financing TM education, research, practice and a road map to strengthen its reach; strengthening existing and create new state-of-theart- facilities for evidence-based research; human resource development; world class institutions/ colleges should be established in every country where there is strong TM presence; globally trained TM practitioners; develop more WHO Collaborating Centers of TM in countries where it has major presence; undertake or sponsor detailed studies related to TM impact on public health.
While the World is marching to the Universal Health Coverage (UHC), EBP is much more important as it becomes the global issue. So it necessitates improving experience to evidence-based traditional medicine as the world is demanding international harmonization. In the one hand, we need to think globally and locally and in the other, it should also be practical, doable and thinkable. Therefore, it is time to promote those knowledge, skills and experiences gained from clinical experiences and practices into standardized clinical evidence to provide the most effective care to the community.
References;
1. The Importance and Impact of Evidence Based Medicine, Sonya J.Lewis and Burton I. Orland, Journal of Managed Care Pharmacy, 2004
2. Traditional Medicine: Modern Approach for Affordable Global Health, Bhushan Patwardhan, WHO-CIPIH Study Nine on TM, 2005
3. The Role of Experience in an Evidence-Based Practice, Gordon Guyatt, MD and Mark Tonelli, MD discussed on June 13, 2012
4. https://www.healthcatalyst.com
5. Cambridge English Dictionary for Advanced Learners, 4th Edition
(Dr.Than Lwin Tun, May Thazin & Honey Soe ) (Ministry of Health and Sports)
