by Carol Jahn, RDH, MS"The whole of science is nothing more than a refinement of everyday thinking."
— Albert Einstein
The concept of using science to make decisions is not new. In fact, whether you graduated five months ago or 25 years ago, most of us were taught this basic tenet in dental hygiene school. So, why is evidence-based health care (EBHC) now receiving so much attention? The medical professions — both doctors and nurses — have embraced EBHC as a way to improve decision-making and ultimately patient outcomes.1 The endorsement of this approach has made EBHC the standard for healthcare professions in the United States and other countries.2 Both the American Dental Hygienists' Association (ADHA) and the American Dental Association (ADA) have policy statements on EBHC. They are highlighted in Table 1.
The currently recognized definition of evidence-based healthcare is: "integration of best research evidence with clinical expertise and patient values."2
According to the father of EBHC, David Sackett, MD, "When these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life."2"The great enemy of the truth is very often not the lie — deliberate, contrived, and dishonest ... but the myth — persistent, persuasive, and unrealistic."— John F. KennedyWhat this means is that evidence is not just used to help the practitioner make good decisions about patient care, but that educating the patient on the evidence about treatments, drugs, and devices can help them embrace better decisions about what is right for them. Perhaps, because the name emphasizes "evidence," many misinterpret or reject EBHC because they mistakenly believe the concept emphasizes research findings over experience. It does not. The definition of EBHC contains three equally important components:1• Best research evidence
• Clinical expertise
• Patient values
The practice of EBHC is not as simple as replacing one brand of product for another. It is more like losing weight — where constant commitment and personal change is required. To help your patients get the most benefit from EBHC, Dr. Sackett recommends the adoption of several personal goals:1
• Develop a mastery of the clinical skills of patient interviewing, health-history taking, and the physical exam. Without these, you cannot formulate a dental hygiene diagnosis or integrate patient values and expectations into the decision process.
• Embrace continuous, lifelong, self-directed learning. We live in the information age so without this, you will quickly become out-of-date.
• Maintain humility. Without it, you will never see the need for self-improvement and miss out on the advances taking place around you.
• Be enthusiastic. Change is going to happen regardless of the desire for it. It's better to enjoy the process than go "kicking and screaming."
The drive to practice evidence-based care in your office may not originate with the dentist-employer. That leadership role may need to be assumed by the dental hygienist. EBHC provides dental hygiene and dental hygienists a way to further develop professionally. It can lead to greater credibility and stature with all the stakeholders in dental hygiene: employers, patients, colleagues, public health departments, government agencies, and leaders to name a few. As difficult and overwhelming as EBHC may seem, it is a journey worth taking.
• Journal of Evidence-based Dental Practice, www.mosby.com/ jebdp, or (800) 654-2452; $69 per year
• Evidence-based Dentistry, www.nature.com/ebd, or (800) 747-3187; $56 per year
• Evidence-based Medicine: How to Practice and Teach EBM, Sackett D, Straus S, Richardson WS, Rosenberg W, Haynes RB (authors)
•Achieving Evidence-Based Practice: A Handbook for Practitioners, Hamer S, Collinson G (editors)
• Evidence-Based Clinical Practice: Concepts and Approaches, Geyman JP, Deyo RA, Ramsey SD (editors)
Carol Jahn, RDH, MS is the educational programs manager for Waterpik Technologies where she designs multimedia educational programs for dental professionals. She provides continuing education programs in the areas of periodontics, patient compliance, and diabetes. Carol may be reached by phone at (800) 525-2020 or by e-mail at cjahn@waterpik .com.References
1. Sackett DL et al. Evidence-based medicine: How to practice and teach EBM. 2000. London: Churchill Livingstone.
2. Ismail AI, Bader JD. Evidence-based dentistry in clinical practice. JADA 2004; 135: 78-83.
3. Jaeschke R et al. Evidence-based health care as a model for decision-making. J Evid Base Dent Pract 2004; 4:4-7.
4. Reekie D. The future of dentistry - the evidence-revolution. Br Dent J 1998;184:262-263.
5. Palmer J, Brice A. Information sourcing. In Hamer & Collinson (Eds) Achieving evidence-based practice: A handbook for practitioners. 1999 (1st ed. pp. 61-83) London: Bailliere Tindall.
6. Jahn C. Evidence for self-care products- Part II: Therapeutic mouthrinses and home irrigation. J Prac Hyg 2004;13:21-25.
7. Ponte PR et al. Making patient-centered care come alive: Achieving full integration of the patient's perspective. JONA 2003;33:82-90.
8. Johnson GK, Hill M. Start of the art review: Cigarette smoking and the periodontal patient. J Periodontol 2004;75:196-209.
9. Bowen DM, Forrest JL. Solving puzzling clinical questions. RDH 2003;23:3440,100.