The role of evidence-based laboratory medicine in health service

Abstract

Evidence-based laboratory medicine (EBLM) is the use of the current best evidence of the utility of laboratory tests in making decisions about the care of individual patients. This practice means integrating laboratory and clinical experience with the last available external evidence from systematic research. It means that the definition of EBLM focuses on two key elements: experience and evidence from systematic research. Although the term evidence-based medicine (EBM) was created in Canada at Mc Master University by a group lad by Dr Gard Guyatt, there are various claims as to the origin of its practice. Regardless of its origins, many factors have come together over the past 30 years to drive the movement to EBM. One factor is those individual physicians, faced with numerous medical informations; the second factor is the global phenomenon of increasing health care costs and third is that patients who have generally more education, want the best in diagnostics and therapies. It means that evidence-based medicine has been driven by the need to cape with information overload, by costcontrol, and by public impatient for the best in diagnostics and treatment. Clinical guidelines care maps, and outcome measures are quality improvement tools for the appropriateness, efficiency and effectiveness of health services. Laboratory professionals must direct more effort to demonstrating the impact of laboratory tests on a greater variety of clinical outcomes. Evidence-based laboratory medicine aims to advise clinical diagnosis and management of disease through systematic researching and disseminating generalisible new knowledge that meets the standard of critical review on clinically effective practice of laboratory investigations. In laboratory medicine, the use of tests increases; new tests are constantly introduced, but "old" tests are seldom removed from the repertoire. This, together with limited public funds for the health care should underline the challenge for laboratory professionals to provide evidence for the utility of different tests. This practice means integrating laboratory and clinical experience with the best available external evidence from systematic research therefore, it is important that advice given by laboratory medicine professionals are sound and based on evidence in the pre-analytical, analytical, and post-analytical phases of the diagnostic process. This paper provides an insight into the rationale, methodology and the phases of the EBLM.Laboratorijska medicina zasnovana na dokazima (eng. evidence-based laboratory medicine, EBLM) koristi najbolje dokaze koji se dobijaju u vidu rezultata laboratorijskih testova da bi se donele odluke o zbrinjavanju svakog pojedinacnog pacijenta. Ovaj pristup je moguc jedino na osnovu objedinjavanja laboratorijskih i klinickih iskustava o nacinu lecenja koja proizilaze iz sistematskih istrazivanja u ovim oblastima. To znaci da se definicija EBLM zasniva na dva elementa: iskustvu i dokazima koji poticu iz sistematskih istrazivanja. Mada izraz medicina zasnovana na dokazima (eng. evidence-based medicine, EBM) potice sa kanadskog Mc Master univerziteta od grupe koju je predvodio Dr Garad Guyatt, mnogi polazu pravo na kreiranje ovog izraza i njegove sustine. Shodno ovome, brojni su faktori koji su poslednjih 30 godina uticali na formiranje misljenja i pokreta poznatog pod imenom i skrecenicom EBM. Jedan od faktora je da se svaki lekar susrece s brojnim medicinskim informacijama koje poticu iz razlicitih izvora, drugi faktor je globalni fenomen povecavanja troskova lecenja, a treci je da su pacijenti danas i sami dovoljno edukovani da zahtevaju najbolju dijagnostiku i lecenje. To znaci da se medicina koja se zasniva na dokazima mora oslanjati na sve tri napred navedene pretpostavke. Protokoli koji se pripremaju za lecenje obolelih moraju uzeti u obzir efikasnost i efektivnost zdravstvene sluzbe. Da bi se ovo ostvarilo laboratorijski strucnjaci moraju pazljivo odabirati laboratorijske testove, pomocu kojih ce se dobiti najvise klinickih informacija. Prema tome, laboratorijska medicina zasnovana na dokazima ima za cilj da podrzava klinicku dijagnozu i zbrinjavanje oboljenja primenom novih znanja koja dovode do standardne procedure koja ce omoguciti laboratorijsko ispitivanje. U laboratorijskoj medicini broj testova se stalno povecava; uvode se novi testovi, medjutim stari testovi se retko skidaju s programa. S obzirom na to da su troskovi zdravstvenih fondova ograniceni, to namece potrebu izbora onih testova koji ce pruziti najvise dijagnostickih informacija. One moraju biti zasnovane i proizvedene u laboratoriji koja je osigurala dobru laboratorijsku praksu u pre-analitickoj, post-analitic koj i analitickoj fazi laboratorijskog dijagnostickog procesa. Shodno navedenom ovde se opisuje izbor, metodologija i faze laboratorijske medicine zasnovane na dokazima.