dr hazel roddam - norsklogopedlag.no · dr hazel roddam, 2013 19 exposure to research and ebp...

Dr Hazel Roddam

Dr Hazel Roddam, 2013 2

Is EBP for everyone?

“It is not expected that all (clinicians ) will be research-active,

but it is expected that all (clinicians)

will be active users of research”

Supporting Research and Development in the NHS (Culyer, 1994)

What is Evidence-Based Practice (EBP) ?

What are the inherent challenges of

embedding EBP into routine practice? What is Practice-Based Evidence (PBE)? ◦ Using routinely collected data ◦ Utilising appropriate research designs ◦ Developing skills & partnerships for PBE

Where are the opportunities for individuals

and professional associations?

Research

Client Clinician

Most used definition is:

“the integration of

best research evidence with clinical expertise

and patient values”

Sackett et al 1997

Anecdotes /testimonials

“The plural of anecdotes is not evidence” (Reilly 2010)

Media headlines Cost savings Expert opinion Intuition

◦ Trends in western medicine ◦ Political quality agendas ◦ Raised public expectations ◦ Regulation / guidance by Professional Associations ◦ Good clinical practice

◦When you are facing unfamiliar territory ◦When things are not working as you expect

1. Frame a clinically-focused question 2. Search for the best quality evidence 3. Appraise the evidence 4. Implement changes – if appropriate 5. Evaluate effectiveness of practice

(Sackett et al 1997)

Judging published research evidence against agreed quality criteria…

Demonstrating that you have critically evaluated a range of evidence sources and related them to your own practice…

9 Dr Hazel Roddam, 2013

◦ Is the research question clear? ◦Does the design match the question? ◦ Could the study be replicated? ◦What do the results mean? ◦ Is this relevant to my own clinical setting?

Learn new skills of searching & appraising Learn about research designs Gain confidence Focus on clinical questions Network with other colleagues Time to think!

Addressing the barriers to changing clinical practice

Measuring the impact of practice changes

Keeping updated with new evidence sources

Answers specific questions

Rigour

„greatest strength lies in the fact that it

removes bias‟ Reilly 2004

Does our practice work? Treatment efficacy Treatment effectiveness

How well does it work? Statistical significance Clinical significance

Is it worthwhile? Clinical effectiveness Cost effectiveness Client perceptions

Very clearly defines the protocol Ensures the conclusions are supported by the

results Acknowledges all the limitations of the study Emphasises the clinical applications Promotes implementation of the research

findings in clinical practice

Consistently reported barriers to EBP ◦ Personal views and attitudes ◦ Skills ◦ Time ◦ Access to research evidence ◦ Supportive context and culture ◦ Gaps in the research evidence base

Additional influences on our professional practice and decision-making

EBP has achieved nothing like the degree of acceptance by practising clinicians that it set out to achieve

30-40% of patients do not receive care according to

current scientific standards Miles et al 2007

20-25% of care provided is not needed or harmful Eccles et al 2005

Only 10-20% of interventions achieve change and many programmes result in no change at all Treweek 2005

Medics → Colleagues Upton & Upton 2006

Nurses → Nursing colleagues McCaughan et al 2005

Physiotherapists → Initial training. Turner & Whitfield 1999

SLTs → Colleagues & internet sources. Nail-Chiwetalu & Bernstein-Ratner 2007

Exposure to research and EBP during training

Highest degree held

Practicality Desire for learning

Experience

Bridges et al 2007; Zipoli & Kennedy 2005; Aaron 2004; Turner 2001

How do we achieve EBP?

“EBP requires change to habits, routines,

and sometimes personal and philosophical preferences and ideals”

(Skeat & Roddam 2010)

Establish a reading routine Selective reading, including pre-appraised

sources Use a structured checklist Discuss with colleagues Save & organise your notes

Creating a supportive context for EBP ◦ Equipping ourselves with EBP tools and resources ◦ Building evidence-based policies for practice ◦ Influence of leadership role ◦ Valuing good practice ◦ Support for innovative practice

Making the evidence work for us ◦ Building EBP networks ◦ Service user involvement ◦ Developing evidence-based clinical resources

It may be more helpful to consider EBP as a way of thinking,

rather than as a body of “facts”

McCurtin & Roddam, 2012

“The first step is to become

reflective and critical reviewers

of our own practice”

Pam Enderby (in Roddam & Skeat, 2010)

EBP Skills Experience 0-1-2-3

Confidence 0-1-2-3

Priority 0-1-2-3

Action plan

Effective strategies for keeping myself updated

Framing a specific question

Searching electronic databases

Critical appraisal

Implementing clinical change

Measuring clinical outcomes

In the next 6 months I will

Build my own skills by ... Help other colleagues by ...

Epidemiological data across all clinical populations incl. low incidence cases

Normative data Evidence-based assessments ◦ Validated on local populations

Evidence-based interventions ◦ Direct therapy interventions ◦ Indirect / training interventions ◦ Complex interventions

Evidence-based service planning Multi-disciplinary & cross-agency delivery of services

Patient/client experience and Quality of Life

Assumptions – or givens?

◦ Small scale ◦ Practitioner-led ◦ No external funding sources/sponsors ◦ Maximising use of routinely-collected

clinical data ◦ Limited range of research designs ◦ Empirical data collection

How many clients/patients do you/your service

How many clients/patients are identified on initial assessment as needing further input from you/your service?

How successful is the service you offer?

Types of “evidence” Systematic approaches to gathering evidence

Levels of evidence Models of research design Sample sizes / scale of research studies

Collaborative partnerships – clinicians and

academics Multi-professional partnerships

Types of “evidence”

◦ Evidence from systematic research ◦ Clinical expertise ◦ Patient views & preferences

(Dollaghan, 2007)

Systematic approaches to evidence gathering ◦ Research ◦ Clinical audit ◦ Service evaluation

Maximising the use of routinely collected clinical data

“Data rich but information poor”

Phase 1 ◦ Development of new intervention

Phase 2 ◦ Feasibility phase to pilot recruitment & outcome

measures

Phase 3 ◦ Evaluation of effectiveness (often randomised

controlled trial - RCT)

Phase 4 ◦ Implementation and long-term surveillance of

benefit/harm

Phase 1 ◦ Identification of new intervention - single case/s

Phase 2 ◦ Refinement of intervention components – multiple single

cases, small group designs

Phase 3 ◦ Efficacy study – ideal sample under optimal conditions

(often randomised controlled trial - RCT)

Phase 4 Effectiveness study – typical sample under typical conditions

Phase 5 ◦ Cost-effectiveness studies and cost-benefit analyses

Clinicians

Patients Academics

Inter-Professional Learning IPL ◦ Team Journal Clubs

Multi-professional evidence-based guidelines

for practice

Multi-professional small-scale studies

Collaborative patient/client involvement

Research skills Experience of research environment & research

processes Mentorship in specific research processes of

design, conduct, analysis and dissemination Collaborative research partnerships Support in workplace setting/s – leadership,

management, peer colleagues Funding sources for expenses/resources

Peer support ◦ Clinical research interest groups ◦ Virtual networks

Professional body ◦ Strategic plan ◦ Operational initiatives

Strategic research capacity building

Academic lead for research themes

Personal action-planning „doing things right‟ Skills matrix, strengths, experiences, interests Identify learning needs/skills gaps and possible

mentors Consider research degrees – but not essential Networking & collaborating – identify common

interests „match-making‟ Realistic, achievable start Be confident – don‟t undersell your professional

problem-solving skills

Publications & conference presentations ◦ Peer review ◦ Audience ◦ Timeliness ◦ Implications for strategic service planning ◦ Clinical bottom line

Reviews & secondary sources ◦ Systematic reviews ◦ Digests of pre-appraised sources

For your warm welcome & hospitality

For your interest today

Dr Hazel Roddam University of Central Lancashire,

Preston, UK

HRoddam@uclan.ac.uk

dr hazel roddam - norsklogopedlag.no · dr hazel roddam, 2013 19 exposure to research and ebp...

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