實證實務五步驟之應用與相關議題：實證競賽分析初探

Application of and Concerns Regarding the Five Steps of Evidence-Based Practice: Analysis of an Evidence-Based Health Care Competition

本研究透過醫策會臨床應用組的實證醫學競賽當中，評審委員針對參賽團隊所提供之評論、意見與建議，探討實證實務應用與五步驟之相關議題。以臨床應用組之評分重點為依據，共計五位評審委員針對近20 組參賽團隊、近百位參賽成員於實證實務問、查、讀、用、審等五步驟之文字意見以內容分析法進行分析。參賽團隊成員專業背景多元化，在五步驟當中，以嚴格評讀的評論與建議最多，其次為形成聚焦問題，而臨床應用與成效評值之意見較少。嚴格評讀當中以研究方法、效度與結果評讀之正確性為主；而形成聚焦問題則強調釐清預期結果。本研究亦提供實證醫學新近發展的三個主要方向，以期健康照護專業人員能及早建構相關知識與技能，以更有效落實實證實務於臨床照護當中。

This study investigated the clinical application of and the concerns regarding evidencebased practice. Feedback and comments were collected from five examining committee members of an evidence-based medicine competition held in Taiwan and subjected to content analysis. Approximately 20 teams and 100 members with varied professional backgrounds participated in this competition. Of the fi ve steps of evidence-based practice, most comments were received for“ critical appraisal,” followed by for “forming a focused question”; comments on “clinical application” and “evaluation and assessment” were relatively fewer. A critical appraisal of the research method and its validity and the importance of the outcome were the leading comments regarding critical appraisal, the third step in evidence-based practice. The major concern regarding forming a focused question was clarification of the expected outcome. Three directions for the future development of evidence-based practice were provided to health care professionals for knowledge and skill development for effectively implementing evidence-based practice.