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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.
The U.S. Preventive Services TaskForce (USPSTF) recommends againstteaching 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 re-
uptake 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
Stage 1Agree best
practice
Stage 4Review
achievementtowards best
practice
Stage 5Disseminate improvements
and reviewaction plan
Stage 3Produce and
implementaction planaimed atachieving
best practice
Stage 2Assess clinicalarea against best practice
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 LeadersOpinion leaders are people who are seen aslikeable, 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 MaterialsDistribution 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.
ConferencesParticipation 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 Feedbacksummary 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