Integrating evidence based medicine into routine clinical practice: seven years' experience at the Hospital for Tropical Diseases, London.
OBJECTIVE
Introduction and evaluation of evidence based medicine (EBM) into routine hospital practice.


METHODS
Routine EBM meetings introduced in 1997.


METHODS
Review of outcomes of meetings from 1997 to 2004, focusing on their effect on clinical practice.


METHODS
Referral centre for tropical and domestic infectious diseases. KEY MEASURE FOR IMPROVEMENT: Outcome of meetings, classified as resulting in a change in practice; confirmation or clarification of existing practice; identification of a need for more evidence; and outcome unclear.


RESULTS
Examples include a change from inpatient to day case treatment of New World cutaneous leishmaniasis; development of guidelines on the treatment of coinfection with visceral leishmaniasis and HIV; and identification of the need for more data on the efficacy and toxicity of atovaquone-proguanil (Malarone) compared with quinine plus sulfadoxine-pyrimethamine (Fansidar) in the treatment of uncomplicated falciparum malaria, which resulted in a clinical trial being set up.


CONCLUSIONS
Incorporation of EBM meetings into our routine practice has resulted in treatment guidelines being more closely based on published evidence and improvements to care of patients. Written summaries of the meetings are important to facilitate change.
Lockwood
Diana
D
Hospital for Tropical Diseases, University College London Hospitals NHS Trust, Mortimer Market Centre, London WC1E 6AU.
Armstrong
Margaret
M
Grant
Alison
A
D003253:Consultants; D019317:Evidence-Based Medicine; D008131:London; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000592:standards; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000458:organization & administration* / Q000592:standards; D014330:Tropical Medicine / Q000458:organization & administration* / Q000592:standards