BMJ has been championing EBM since David Sackett in his famous 1996 editorial (Evidence based medicine: what it is and what it isn't) set out the tenets of the movement - as an approach that “integrates the best external evidence with individual clinical expertise and patients’ choice".
Being evidence-based is embedded into BMJ company culture and is one of our five company values. BMJ is a founding member of the UK GRADE Network, and the international conference on evidence based healthcare, Evidence Live. Today, the BMJ Knowledge Centre’s team of in-house information specialists search the literature for high quality new and updated international guidelines and systematic reviews, as well as tailoring bespoke searches to support BMJ Best Practice topic updates.
Over recent years, the BMJ Knowledge Centre team has conducted extensive research with healthcare professionals around the world to understand how you use evidence to support your work. You told us you want a single source of evidence-based answers to important real-world clinical questions so you can make evidence-informed decisions in your clinical work. You need current, trustworthy evidence delivered quickly and succinctly at the point-of-care. You want simple presentation, transparency around evidence quality, and to be able to delve deeper to see further detail. This is exactly what we deliver.
Components of EBM
BMJ Best Practice processes support all three components of EBM: best available evidence; clinical expertise; and patient values and preferences.
Best available evidence
- Updates to BMJ Best Practice topics incorporate new best available evidence.
- Our in-house evidence and editorial teams collaborate with over 1,600 international expert contributors and over 2,500 peer reviewers, to ensure that BMJ Best Practice provides access to the most clinically relevant information possible.
Patient values and preferences
- BMJ Best Practice includes over 500 patient leaflets to make shared decision making easier.
- The leaflets are concise and clear, are written by specialist editors and reflect the evidence-based clinical information in BMJ Best Practice.
- Patient leaflets are reviewed by patients
- They are linked to relevant topics or can be browsed or searched for. All BMJ Best Practice condition topics have a ‘Patient discussion’ section, prompting the healthcare professional on patients' information needs.
Our robust evidence processes include:
- Routine scheduled topic updates
- Surveillance for new practice-changing evidence and for drug alerts
- Quality assurance.
Routine scheduled topic updates
We prioritise our most popular topics and those where there are rapid changes in research for more frequent routine updates. Where there is an exceptional need for important changes to be made particularly rapidly, such as during the Covid-19 pandemic, updates may occur on a weekly basis.
Updates for high priority topics start with a medical database literature search by our experienced information specialists, focussing on relevant systematic reviews and guidelines. Section editors, trained in critical appraisal, appraise the evidence and work with expert contributors to select new evidence for inclusion and to make changes to update the existing topic.
Our ongoing evidence surveillance process
In addition, topic updates may be triggered at any time by evidence retrieved from our ongoing surveillance process. This includes:
- Surveillance for high quality new and updated international guidelines, policy statements, and potentially practice-changing systematic reviews and randomised controlled trials
- Prompt evaluation of new evidence by our specialist section editors
- Continuous scanning and triaging of drug alerts by our inhouse pharmacists (see below)
- Monitoring and triaging of user/customer feedback by our specialist section editors.
Our inhouse pharmacists review drug alerts released by international drug regulatory agencies on a daily basis. This includes the Food and Drug Administration, European Medicines Agency, and the UK-based Medicines and Healthcare products Regulatory Agency, as well as other useful secondary sources. Important practice-changing alerts (e.g., drug withdrawals, drug dose updates, new contraindications) are prioritised for incorporation into relevant content. All drug doses in BMJ Best Practice are reviewed and approved by qualified, registered pharmacists with extensive experience in pharmacy practice.
All new BMJ Best Practice topics have external peer review by at least two leading international experts and practising clinicians.
All BMJ Best Practice topic content updates have internal peer review and sign-off by our in-house pharmacists and senior content editors.
Extensive customer research shows that you value the rapid delivery of practice-changing evidence that BMJ Best Practice offers at the point of care. Updates are prioritised as follows:
- Drug changes or withdrawals that may affect patient safety
- Evidence that changes practice
- Evidence that confirms current practice.
Further customer research has helped us to shape the way that we display evidence in BMJ Best Practice, with layers of content depending on the depth of information you require.
- Evidence tables with linked evidence scores
- Expandable evidence panels explaining the evidence behind key recommendations in some of our popular acute condition topics
- Visual reminders on important updates and embedded evidence features for quick access to important new research and guideline updates
- A unique expanded systematic review layer (Cochrane Clinical Answers)
- BMJ Rapid Recommendation citations with engaging infographics
- Clear referencing throughout topic content, with a separate Guidelines section. Key references are highlighted at the top of each topic reference list.
- More than 84,200 references embedded in text as popups (including links to Pubmed abstract/free-access full text) and in a separate reference list for each topic
- Over 7,350 high-quality guidelines in dedicated guidelines pages with links to full text and marked up in topics when new or updated.
- A separate Evidence section in clinical topics to group evidence on important clinical questions in a single place.
- Evidence-based medicine (EBM) toolkit, for those who want to learn, practice and discuss EBM.
Altogether these features make it easy and intuitive to access the evidence base for an intervention and assess how reliable it is, informing decisions and discussions about different treatment options with patients, colleagues and co-learners.