Evidence-Based Medicine Breaking the Borders - The European Union as a Paradigm
Creators: name: Gartlehner, Gerald, MD
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2002

description: Evidence-based medicine has instigated a shift in medical paradigms over the last decade. Systematic reviews and meta-analyses in particular have a strong impact on the way we practice medicine today. Although evidence-based medicine focuses on results at an individual patient level, the assumption that an increase in the practicing of evidence-based medicine will lead to health improvements of the general population seems to be a causal chain. The influence of evidence-based medicine is continually extending beyond clinical decision- making to act as a foundation for health policy decisions. The European Union has realized the potential benefits of evidence-based health care. Under the umbrella of thee-Health initiative, the European Union plans to implement a telematic (telecommunication and informatics) health network by the end of 2004. The objective of this network is to facilitate information exchange and to provide databases of the best evidence available in health care. Health care providers and the general public will be able to access these databases through the internet free of charge. Evaluations of the network will have to focus on the extent and depth health care decision makers accept, use and apply not only the databases but clinical guidelines as well. The only substantial official publication of the EU regarding this program is a report by the European Commission on evidence-based health care. The document mentions three components to improve evidence-based health care in the European Union: (1) Evidence-based medicine; (2) Clinical practice guidelines and; (3) Health technology assessment. However, no official information about the structure of a telematic health network has become available yet. The challenge though is unique - to link 15 different health systems with 11 different languages. This paper first gives some background information about the practice of evidence-based medicine - a description of the status quo; a review of its development; and a critical appraisal of its usage - including benefits and risks of evidence-based medicine and a detailed look at its influence on health policy in general. Next, the paper provides an overview of the health systems of the European Union and the political and theoretical framework of a telematic health network. Based on these premises, a hypothetical structure of evidence-based databases is proposed. This concept takes the heterogeneity of the European Union into consideration and examines factors that will be crucial for the acceptance of evidence-based databases and clinical practice guidelines by health care decision makers. It discusses lessons that could be learned from existing databases on national and internationill levels. It also describes the necessity of a parallel evaluation program and outlines methods of evaluation that could be successfully used to assess the impact and effectiveness of the program and provide a base for cybernetic decision - making.