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    Leveraging the evidence for patient care today

    Critically review studies, and keep patient values and preferences in mind

    Times are changing, and the amount of information coming at us from all directions can easily be overwhelming. This information—whether true or false—is unrelenting and has increased in magnitude over the past five years. Part of it may be the natural progression of one’s career and the expansion of one’s network, but most of it is just the sheer volume that is at our fingertips.

    Research and patient experience

    As I reflect on my everyday practice of seeing patients, teaching, and learning, I’ve come to realize that I need to make two things my priority: Keeping up to date on the latest research, and putting myself in my patients’ shoes.

    Related: How to use technology to improve patient care

    What we learned in optometry school is great; however, being efficient and effective in practice is going to pay much higher dividends. But without backing up how we diagnose and treat patients with research and evidence, we put ourselves at risk. Patient-reported outcomes (PROs) make what we do impactful because they are what the patient wants and experiences in the real world.

    Each patient sits down in our chairs not having been enrolled into a study with inclusion and exclusion criteria. They come as they are—from one side of the train tracks, maybe not having eaten lunch that day, or worrying about her sick child. Yes, we stand on the research evidence, but it’s with compassion that we customize the care we deliver to every patient. From this place, it allows our care to actually be creative, rewarding, and fun.


    Considering bias

    Last summer, I had the opportunity to attend the Evidence Based Clinical Practice (EBCP) program at McMaster University near Toronto. Many recognize this as the birthplace of EBCP and have incorporated its teaching styles, such as team-based learning and using intentional pauses during lectures. There are valid concerns regarding if this method is actually feasible and whether it can translate easily into everyday practice. My opinion is a resounding yes!

    Related: Two-way communication is essential to patient care

    There are systematic approaches in evaluating risk of bias. I believe we are intuitively aware of things such as measurement bias, investigator bias (company sponsorship?), recall bias, and just overall weakness in subject recruitment and study design. Are researchers’ results clinically significant? Or are the results statistically significant only because they enrolled thousands of subjects?

    A new tool I learned was the idea of a funnel plot and how it helps assess the risk of publication bias. Academic institutions—whether or not they collaborate with companies—may not always publish negative or non-results. Without being in the know, clinicians may never catch wind of this. When we pull the highest Level I evidence of randomized controlled trials (RCTs) and systematic reviews of those RCTs, we can become suspicious when funnel plots do not show an equal distribution around the effect size.

    Justin Kwan, OD, FAAO
    Dr. Kwan received his doctor of optometry degree from the University of California, Berkeley, School of Optometry. His areas of interest ...


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