1. look at a 2012 Choosing Wisely (Links to an external site.)Links to an external site. where physician organizations are suggesting fewer tests unless they are evidence based. This is EBM in action!
2. Watch the video the NNT explained (Links to an external site.)Links to an external site., and review the definition of ‘generic’ (Links to an external site.)Links to an external site..
3. please review the EBM (Evidence-Based Medicine) section of the Informatics Education Resource Center (Links to an external site.)Links to an external site.
4. Next, please go to the National Guideline Clearing House (Links to an external site.)Links to an external site. and note the search field. Type in "type 2 diabetes," and see how many returns you have (500+). Now select the "Advanced Search" option and study the multiple filters to refine your search. You can select anything you like. This should reduce the choices significantly. Now look at a few CPGs and see if they are easy to read, recent, evidence-based and include a summary.
Also check out two web-based calculators that are related to CPGs
FRAX (Links to an external site.)Links to an external site. calculates the 10 year risk of a fracture in men and women based on bone mineral density (BMD). Try plugging in some information and see what the risk is. Example: woman, aged 65, weighs 110, height 5’4", previous fracture, a smoker and drinker. The machine used was Hologic and her bone mineral density result was .5 gm/cm2. Now calculate the 10 year risk. What did you get? Can you see how a large organization might use EBM, a calculator and drug costs to decide on the best therapy? Could this be automatically calculated with an EHR?
National Cholesterol Education Program (Links to an external site.)Links to an external site. online calculator determines the 10 year risk of heart attacks and death. Calculate your own risk. Was it less than 10%? Should you be on a baby aspirin if it only benefits those people at risk of heart disease >20% over 10 years? This calculator is based on these prevention guidelines (Links to an external site.)Links to an external site.
5. then utilize the resources and the lecture material above to address the following problems & upload the your answers in a Word doc or pdf to the Dropbox labeled "Module 2, Part 1 Dropbox (EBM Problems)" no later than the last day of the Module.
Review the NNT & COPE Example Problem and then complete Problems 1 below, and provide any additional feedback regarding what you have learned.
Make sure you include all actual calculations/math for full credit.
Go to Epocrates Online (Links to an external site.)Links to an external site. (**if you are unable to find costs at this site, you can use another site, for example, Walgreens, but you must indicate which site and cite and reference the website in your answer), and determine the cost of the drugs in the following problems.
plavix 75mgA representative from Bristol Myers Squibb (note that two large drug companies market this drug) visits your office and tells you that Plavix® (the generic name is clopidogrel) decreases cardiovascular events by 8.7% compared to aspirin. That sure sounds good to you, as you have lots of elderly patients at risk and many are already on aspirin. The brochure quotes the CAPRIE study, and you decide to investigate further. In this 1996 study patients on Plavix® experienced cardiovascular events 9.78% of the time compared to 10.64% of the time with aspirin. Plavix® was approved by the FDA based on this one study.
What % is the Experimental Event Rate (EER)?
What % is the Control Event Rate (CER)?
What is the Absolute Risk Reduction (ARR)?
Calculate the NNT – use 100 as the numerator. Do not worry about a negative or minus sign result. Example: 1.1-2.2 = 1.1 and not -1.1 when calculating NNT.
How much does Plavix® cost monthly?
How much does the generic, Clopidogrel, cost monthly?
How much does the low dose (81 mg) aspirin cost monthly?
The dosage for all of these drugs is 1 tablet taken once a day.
Do the COPE Cost of Preventing Event (COPE) (Links to an external site.)Links to an external site.(pg 331 in textbook) calculations for Plavix, the generic, and aspirin (3 separate calculations) – you may use 1 year as the time interval.
What does the COPE calculation tell you?
Which drug would you be more likely to prescribe and why.
Be sure to include your actual calculations/math