Evidence-informed health: Post-COVID-19 lessons


Head of Medical Decision and Health Quality, UpHill Health

M.D., Lisbon Faculty of Medicine, 2010. Ph.D., Medicine/Immunology, Lisbon Faculty of Medicine, 2018. PGDip.,

Health Management, Católica Lisbon School of Business and Economics, 2019. Internal Medicine Specialist.

Assistant Professor, Lisbon Faculty of Medicine. Director, Health Quality Department, Directorate-General of

Health, 2018-2022. Chair, COVID-19 National Immunization Technical Advisory Group, 2020-2022. Author of

more than 100 communications, articles, and book chapters.

The COVID-19 pandemic has challenged the practice of high-quality evidence-based medicine (EBM) due to two major reasons: uncertainty due to the lack of evidence available, and the sense of urgency that emerged. How could healthcare agencies take this opportunity to shift from EBM to evidence informed decision-making (EIDM) in health? Which role do clinical standards and real-world evidence play in this shift?

Clinical standards are one of the available instruments to disseminate EBM, which is currently defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”.

Traditional knowledge translation models, understood as “the exchange, synthesis, and effective communication of reliable and relevant research results (…) so that effective interventions are used more widely”, typically take many years of research. In a pandemic, which by its very nature develops and evolves rapidly, the great challenge is how to speed up this process, which is not at all compatible with the classical methodologies, not only because of speed but also because of uncertainty.

The future – and already the present – belongs to hybrid models, able to incorporate distinct types of evidence: scientific (codified) evidence – both from clinical trial and RWE-, tacit (also known as colloquial evidence, since it often includes opinions, expertise, lessons learned, organizational tradition of policymakers, clinicians, patients, or citizens), global and local evidence. A structured assessment is still required as the basis for EIDM, but it is not enough. Development of living guidelines incorporating Real World Data (RWD)/Real World Evidence (RWE), and data on values, available resources (including digital) and organizational factors are a way forward to face rapidly evolving scientific knowledge and a critical need to ensure compliance.

Indeed, the pandemics changed the lenses through which healthcare professionals look to clinical standards: from a purely economic perspective bounding individual decision-making to a useful tool to approach a new condition surrounded by uncertainty.

Perhaps like no other major event in recent memory, the pandemic has exposed synergies between science and policy, as scientists have played a key role in providing scientific advice to national and local governments on what to do at each moment.

Therefore, the post COVID-19 brought to the fore evidence-based policymaking (EBP), as a discourse of methods that inform the policy process, advocates a more rigorous, and systematic approach, on the premise that policy decisions should be better informed by available evidence and should include rational analysis. On this matter, a Global Commission on Evidence to Address Societal Challenges led by McMaster University made a wakeup call for decisive action by multiple stakeholders to ensure that evidence is consistently used to address societal challenges.

The lessons learned from people engaged with decision making for the COVID-19 pandemic need to be disseminated as a heritage for future public health emergencies. In this article, we focused on clinical standards as a tool to support evidence-informed decision, which asks for a revision of their development and dissemination process.



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