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Catching Up
on
Evidence Based Practice
Karen Dahlquist MSN, DNPc, FNP-BC
June 4, 2010
Upon completion of this presentation, you
will be able to:
1.Identify a rationale for introducing EBP into the
college health setting.
2.Identify web sites to begin a basic search of
systematic reviews and guidelines that are
applicable to the clinical setting.
3.Apply basic strategies to introduce EBP into the
clinical setting.
Barriers
*
Ultimate Goal
Where to search?
Source: HealthLinks, University of Washington: http://healthlinks.washington.edu/ebp/ebptools.html
The U.S. Preventive Services Task
Force (USPSTF) recommends against
teaching breast self-examination (BSE).
USPSTF 12/2009
The USPSTF recommends against
routine screening for testicular cancer in
asymptomatic adolescent and adult
males.
National Guideline Clearinghouse:2/04
The USPSTF recommends against
routine screening of asymptomatic
adolescents for idiopathic scoliosis.
AHRQ: 6/04
Selective serotonin re-uptake inhibitors
(SSRIs) versus placebo for obsessive
compulsive disorder (OCD)
SSRIs are more effective than placebo for
OCD, at least in the short-term, although
there are differences between the adverse
effects of individual SSRI drugs. The
longer term efficacy and tolerability of
different SSRI drugs for OCD has yet to be
established.
Soomro GM, Altman DG, Rajagopal S, Oakley Browne M. Selective serotonin reuptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD).
Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001765. DOI:
10.1002/14651858.CD001765.pub3
Psychological therapies for people with
generalised anxiety disorder
Psychological therapy based on Cognitive Behavioral
Therapy (CBT) principles is effective in reducing anxiety
symptoms for short-term treatment of GAD. The body of
evidence comparing CBT with other psychological
therapies is small and heterogeneous, which precludes
drawing conclusions about which psychological therapy
is more effective. Further studies examining non-CBT
models are required to inform health care policy on the
most appropriate forms of psychological therapy in
treating GAD.
Hunot V, Churchill R, Teixeira V, Silva de Lima M. Psychological therapies for generalised
anxiety disorder. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.:
CD001848. DOI: 10.1002/14651858.CD001848.pub4
http://www.joannabriggs.edu.au/pubs/best_practice.php
http://www.jbiconnect.org/
http://www.clinicalevidence.com
http://www.cochrane.org/reviews/index.htm
http://www.guidelines.gov
http://www.tripdatabase.com
http://ahrq.gov/clinic/uspstfix.htm
http://www.icsi.org/knowledge/
http://www.medicine.ox.ac.uk/bandolier/index.html
Movers Needed
Buyers Needed
Stage 5
Disseminate
improvements
and review
action plan
Stage 1
Agree best
practice
Stage 4
Review
achievement
towards best
practice
Stage 2
Assess clinical
area against
best practice
Stage 3
Produce and
implement
action plan
aimed at
achieving
best practice
What vehicles have
been used to move the
research along?
Local Consensus
Process
Inclusion of providers in discussions related to clinical
practice guidelines or research.
Marketing
Use of personal interviewing, group discussion, focus
groups or a survey of targeted providers to identify
barriers to change. Enlist ideas to overcome barriers.
Local Opinion Leaders
Opinion leaders are people who are seen as
likeable, trustworthy and influential. These leaders
can provide 1:1 or small group teaching,
community visits, or visit providers’ offices.
moderate evidence that opinion leaders promote EBP
The application to clinics and other settings is not clear as
most of the studies were in hospitals.
Gattellari et al. 2007
Educational Materials
Distribution of published or printed recommendations
materials for clinical care, such as clinical practice
guidelines, audiovisual materials, or electronic publications.
Grimshaw et al. (2001) - targeting behaviors and interventions
identified passive dissemination such as mailings to be generally
ineffective in changing provider implementation of research into
practice.
Arnold & Straus (2005) – no change or only small
Farmer et al. (2008) – PEM has a small beneficial effect on process
outcomes (not pt. outcomes) compared to no intervention.
Conferences
Participation of health care providers in conferences,
lectures, or workshops.
interactive educational meetings are more effective
than didactic lectures (Arnold & Straus, 2005).
effect is small comparable to audits & feedback and
educational outreach visits (Forsetlund et al., 2009).
Audit and Feedback
summary information about clinical performance.
Grimshaw et al. (2001) – variable effect
Arnold & Straus (2005) - no or small change in behavior
Young et al. (2006) – small to moderate effect
Educational Outreach
Visits
a trained person meets with providers in their
practice settings to provide information, with the
intent of changing the providers performance.
Arnold & Straus (2005) - mixed results
O’ Brien et al. (2007) – EOVs appear to improve
the care delivered to pts.
Reminders
(Manual or Computerized)
any intervention that prompts the health care
provider to perform a patient-or encounter
specific clinical action.
Arnold & Straus (2005) – mixed results
Durieux et al. (2008) – computer advice on correct
drug dosage decreased LOS but did not ↑ or ↓
the incidence of serious SEs such as stroke or
death
Patient-mediated
Interventions
Any intervention aimed at changing the
performance of health care providers where
specific information was sought from or given to
the patients: direct patient mailings, patient
counseling, or educational materials given to
patients or placed in waiting rooms.
Patient based interventions reduced
antibiotic use. (Arnold & Straus, 2005)
“Show me the money!”
CEA
Cost Effective Analysis
https://research.tufts-nemc.org/cear/Default.aspx