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School of Dentistry: Evidence-Based Practice: PICO

Four Elements of the Clinical Question

PICO: A mnemonic device to help formulate a clinical question and search strategy by identifying key concepts. 

P Patient/Population/Problem Describe your patient or the problem - be specific
I Intervention/Indicator Treatment, cause, prognostic factor, etc.
C Comparison/Control Compared to another treatment or standard of care (optional)
O Outcome Improvement or negative effects?

Patient

What are their most important characteristics?

  • primary problem
  • disease state
  • co-existing condition

Describe your patient specifically:

  • Sex
  • Age
  • Ethnicity
  • Socioeconomic factors

ALWAYS include this piece in your search.

Intervention

What do you want to do for the patient?

  • Order a test
  • Prescribe a drug
  • Order a procedure

Other considerations:

  • Main intervention
  • Prognostic factors
  • Exposures

Almost always include this piece in your search.

Comparison

What is the alternate intervention, if any?

  • A different drug
  • No medication
  • A Placebo
  • A different test
  • A different procedure

It is less common to include this piece in a search

Outcome

What are you hoping to achieve, measure, or change for the patient?

  • Alleviate symptoms
  • Improve test results
  • Reduce adverse events
  • Improve function

Could also be the result NOT desired.

Sometimes include this piece in your search.

Example Questions

1. Does hand washing (intervention) reduce (outcome) hospital-acquired infection (problem)?

2. Is vitamin C supplementation (intervention) as effective as Zinc supplementation (comparison) in reducing the length of a cold (outcome) in adult females (patient)?