Healthcare and Medicine Reference
Evidence-based community medicine and public health (EBPH) 71-73 means
◾ “The application of best available evidence in setting public health poli-
cies and priorities. … Evidence-based public health is an approach that
makes informed, explicit use of validated studies to arrive to judicious
decisions on public health policies and best practices.” 5
◾ “The process of systematically finding, appraising and using contempo-
raneous clinical and community research findings as the basis for deci-
sions in public health.” 72
◾ “The conscientious, explicit and judicious use of current best evidence
in making decisions about the care of communities and populations in
the domain of health protection, disease prevention, and health mainte-
nance and improvement (health promotion).” 72
Evidence-based healthcare 74 as formulated by Muir Gray integrates in its
concept both clinical and community medicine, care, and public health.
The EBM-driven initial steps of both clinical and community medicines
are the following:
1. Formulation of a clear clinical or community medicine question from a
patient or community problem which has to be answered.
2. Searching the literature for relevant sources of information (i.e., evidence).
3. Critical appraisal (analysis, evaluation, and grading) of the original and
integrated evidence. Its main points include most often the relevance of the
evidence to user's issue and setting, objectivity of evidence presented, clar-
ity of a bias-free methodology, justification of conclusion about evidence
presented, confidence about findings (evidence) presented, and applicabil-
ity to particular individuals, site, setting, practice, rules, and culture.
For example, critical appraisal of a cause-effect study brings answers
to several questions such as
− Are we dealing with a questionable and uncertain problem?
− How well is the problem defined?
− Was the question to be answered properly formulated?
− Was the search for evidence (other studies) adequate and complete?
− What is the design of an etiological study? How valid is it?
− Are biostatistical considerations such as sampling or analysis and
epidemiological considerations such as exposure to possible multiple
causes adequately handled and answered?