Integrating evidence based medicine into routine clinical practice: seven years' experience at the Hospital for Tropical Diseases, London.

PROBLEM: Introduction and evaluation of evidence based medicine (EBM) into routine hospital practice. STRATEGY FOR CHANGE: Routine EBM meetings introduced in 1997. DESIGN: Review of outcomes of meetings from 1997 to 2004, focusing on their effect on clinical practice. SETTING: Referral centre for tropical and domestic infectious diseases. KEY MEASURE FOR IMPROVEMENT: Outcome of meetings, classified as resulting in a change in practice; confirmation or clarification of existing practice; identification of a need for more evidence; and outcome unclear. EFFECTS OF CHANGE: Examples include a change from inpatient to day case treatment of New World cutaneous leishmaniasis; development of guidelines on the treatment of coinfection with visceral leishmaniasis and HIV; and identification of the need for more data on the efficacy and toxicity of atovaquone-proguanil (Malarone) compared with quinine plus sulfadoxine-pyrimethamine (Fansidar) in the treatment of uncomplicated falciparum malaria, which resulted in a clinical trial being set up. LESSONS LEARNT: Incorporation of EBM meetings into our routine practice has resulted in treatment guidelines being more closely based on published evidence and improvements to care of patients. Written summaries of the meetings are important to facilitate change.