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The 6 steps of evidence-based medicine: action plans and changing clinical practice through journal clubs
  1. Karen Kearley, MsC, MB ChB
  1. Centre for Evidence-Based Medicine
 University of Oxford, Oxford, UK

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    The integration of research evidence into clinical practice is a complex process, which can be slow and difficult.1 As a general practitioner, trying to keep up-to-date across a wide spectrum of clinical conditions often seems overwhelming. However, in the past year, setting up a monthly multidisciplinary journal club has led to significant progress in several clinical areas. Collective problem solving and adding “Establish an action plan” to the traditional 5-step model of evidence-based medicine have enabled our primary healthcare team to move from evidence to action, fast-tracking through the stages from awareness to adherence.1–3

    Here I describe an example from 1 of our journal clubs and reflect on some key factors that have facilitated change in our clinical practice.

    CLINICAL SCENARIO

    We chose a clinical problem that we all recognised: poorly controlled asthma. The trigger case was Matt, a likeable somewhat chaotic teenager with moderate asthma, who despite a thorough understanding of his condition, a written action plan, and an interest in team sports, overused his blue inhaler (salbutamol) while forgetting to take the brown inhaler (corticosteroid). This resulted in him experiencing exercise-induced symptoms, upper-respiratory-tract-infection–related asthma exacerbations leading to absence from school, and regular night wakening.

    We wanted to know how common this problem was: a brief audit of our practice showed that around 20% of our patients with asthma who were prescribed maintenance inhaled corticosteroids (ICSs) were using ⩾12 blue short-acting β agonist (SABA) inhalers each year—equivalent to >6 puffs/day. We were surprised and disappointed that so many of our asthmatic patients were not as well controlled as we had thought.

    Therefore we asked: In patients with asthma who have failed to engage with their recommended management plan and who overuse inhaled SABA and underuse ICSs, what interventions can improve symptom control and adherence?

    A …

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