Information Mastery: A Practical Approach to Evidence-Based Care Course Directors: Allen Shaughnessy, PharmD, MMedEd David Slawson, MD Tufts Health Care Institute Tufts University School of Medicine November 10-12, 2011 Boston, Massachusetts

Information Mastery: A Practical Approach to Evidence-Based Care The Basics of Information Mastery

3 How we acquire and use information Where did you get the information from to make that snap decision? If you had had time (and interest), what would you have done to make sure you had the right answer?

4 Evidence and Decision-Making Most decisions are based on what we think is the evidence, not what we know is the evidence We use brief reading and talking to other people as our information sources No one has time to appraise all of the evidence

This workshop has been presented in: Most of the US Canada Israel Saudi Arabia England Wales Hong Kong Taiwan Denmark 5

6 Where are we going? EBM applied to everyday practice Main message of conference: Not all evidence is ready for clinical application How to distinguish must-know from nice-to-know information How to identify information that may not be valid Sources of information vary in their usefulness EBM at the point of care requires the use of appropriate information tools The future of healthcare relies on the appropriate use of resources Avoiding underuse, overuse, misuse

7 How we will get there? Concepts, practice, modeling Introduction of the ideas behind EBM and information mastery Practice applying the ideas Modeling different ways of teaching the material Modified problem-based learning Lecture presentations Hands-on practice Evaluating information Using EBM tools Day 3: Focus on teaching: curriculum approaches

The case: The patient is a 34-year-old woman with who has symptoms of mild depression. You consider pharmacologic treatment. She expresses a lot of doubt about the medicines you usually typically prescribe. So, rather than going to your usual first-line choice, you decide to do a quick search for information.

9 In your search, would you rather find a drug that: A.Has been studied in 5 randomized trials with 817 patients taking it for 8 weeks B.Since release has been taken by 40 million patients, though outcomes haven’t been tracked C.Has almost exclusively been studied in men with more severe depression than this woman D.Among other mechanisms, it blocks the effect of serotonin on the 5-HT 2C receptor E.Has demonstrated effectiveness in mild depression.

10 Focusing on outcomes that matter POE: Patient-oriented evidence mortality, morbidity, quality of life Live longer and/or better DOE: Disease-oriented evidence pathophysiology, pharmacology, etiology Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A Guidebook to the Medical Information Jungle. The Journal of Family Practice 1994;39(5):

11 Patient-oriented evidence contradicts disease- oriented evidence Disease-Oriented OutcomePatient-Oriented Outcome Intensive glucose lowering can decrease A1c Intensive glucose lowering does not decrease mortality Beta-carotene, Vit E are good antioxidants Neither prevents cancer or CV disease Erythropoeitin in patients with chronic renal failure increases Hemoglobin Erythropoietin increases mortality in patients with chronic renal failure

12 Determining whether information is relevant and does it matter? Does it address an outcome people care about (Patient-oriented evidence)? Is the intervention feasible? If it is true, will it require you to change your practice? Yes to all three – Patient-Oriented Evidence that Matters