Evidence-based decision making in occupational health.

Evidence-based medicine (EBM) is founded on the appealing paradigm of promoting the identification, appraisal and application of the best practices in health care, supporting doctors in the decision making process. The continuous development of health care presents a solid ground for more effective practices; however, research findings in the health services suggest that there is a gap between evidence and practice [1]. EBM has raised awareness among practitioners and decision makers, but the approach is not followed in everyday practice for several reasons. These include the complex literature organization, its irrelevance to clinical practice, the difficulty in applying its results to the individual patient and the barrier to change. As a consequence, ineffective practices are performed for several reasons, including over-reliance on a surrogate outcome, the love of a wrong pathophysiological model and the need to do something [2]. So far, health service research in occupational health has not provided relevant information about the appro-priateness of usual practices. However, there is a growing awareness and pressure that a decision in occupational health practice should be supported by the best available evidence in order to maximize the outcome. In the past few years, Occupational Medicine has hosted papers and editorials dealing with this intriguing topic [3 – 5] supporting the need to transfer scientific evidence into daily practice. However, as for general practitioners, several obstacles exist when approaching problems according to the EBM principles: lacking skill in formulating answerable questions, insufficient time required to find information and scarce capacity of integrating evidence to make decisions. Like health care professionals, occupational health professionals must rely on the best available evidence supporting the appropriateness of diagnostic tests and preventive or clinical interventions. Therefore, like in health care, scientific literature is a crucial element of the evidence-based decision making process. The appropri-ateness of the practice is one of the key elements of any intervention, as was stated 20 years ago by the International Labour Office [6], who suggested that quality-oriented services founded on sound evidence-based practice should be supplied. The principles of EBM can be adapted in occupational health practice, whose evidence-based decision process can be defined as the current best evidence in making decisions [7]. The decision process consists of an approach requiring the conscientious (to apply the best evidence when possible), judicious (to use recommendation for patients/workers/community), explicit (to transparently demonstrate the reliability of each decision) integration of relevant scientific evidence relating …