1 Evidence-Based Public Health: Finding and Appraising Relevant Resources Medical Library Association Continuing Education Course May 21, 2004

2 Course Objectives 1.Understand the characteristics of evidence- based public health. 2.Be informed about the variety of resources available for evidence-based health practice. 3.Gain an awareness of tools available for collection management. 4.Know how to respond to information questions typical of those posed by public health workers, students and researchers, and know the types of resources available to help answer questions. 5.Identify types of evidence and methodologies for appraising the public health literature.

3 Objective 1 Understand the characteristics of evidence-based public health What is Evidence-Based Public Health (EBPH)? Why is EBPH important? How does public health practice relate medical practice?

4 Example: Injury Prevention

5 Definition of Evidence-Based Public Health “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement.” Source: Jenicek M. Epidemiology, evidenced-based medicine, and evidence-based public health. J Epidemiol. Dec 1997;7(4):

6 Definition of Evidence-Based Public Health, cont. “the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models.” Source: Brownson RC, Gurney JG, Land GH. Evidence-based decision making in public health. J Public Health Manag Pract. Sep 1999;5(5):86-97.

7 Evidence-Based Practice Requires integrating practitioner expertise with the best evidence from systematic research. Involves finding and selecting resources that are credible, relevant, and applicable to practice.

8 Process of Evidence-Based Practice 1.Define the problem: convert information needs into focused questions. 2.Find the best evidence from the literature. 3.Critically appraise the evidence for validity and relevance. 4.Apply the evidence to practice. 5.Evaluate the results. Adopted from: Sackett DL, Rosenberg WM. The need for evidence-based medicine. J R Soc Med. Nov 1995;88(11): Sibbald WJ. Some opinions on the future of evidence-based medicine. Crit Care Clin. 1998;14(3):

9 Why Evidence-Based Practice? So much information, too little time Need high quality, filtered information to make informed decisions Value of scientific knowledge for decision making Decisions should not be based only on intuition, opinion or anecdotal information

10 Need for Evidence-Based Public Health Government downsizing - limited resources Need to justify actions and demonstrate benefits of public health interventions Decisions often made by politicians with limited health backgrounds

11 From Public Health Professionals: “Some things have simply always been done a certain way – are common practice, but there is really no research to back it up.”

12 From Public Health Professionals: “I make a lot of decisions about how money is going to be spent, and I would like to always be able to back it up and say that this is proven, or evidence- based.”

13 From Public Health Professionals: “Politics always overlays decision-making on everything that is not evidence-based in the public health world. Everything we do is imbued with political priorities and funding decisions.”

14 The Evidence-Based Movement EBM → EBPH How does public health relate to medicine?

15 Public Health: Health of Populations Medicine: Health of Individuals

16 Focus on populations Prevention & health promotion Environment & human behavior interventions Diverse workforce, variable education & certifications Social sciences integral; clinical sciences peripheral to education Observational studies: case- control & cohort studies Public Health Focus on individuals Diagnosis & treatment Clinical interventions Well-established profession, standardized education & certification Clinical sciences integral; social sciences less emphasized Experimental studies with control groups: RCTs. Medicine vs.

17 Interaction of Public Health & Medicine: Medical Care Section of APHA Medicine/Public Health Initiative AAMC-CDC Cooperative Agreement Collaboration on emerging health threats –Bioterrorism (anthrax, 2001) –Emerging infections (SARS, 2003) –Surveillance Technology: ability to quickly exchange information electronically Managed care: What can we afford? Public Health Medicine

18 10 Essential Services of Public Health Public Health Functions Project, U.S. Dept. of Health and Human Services

19 Evidence-Based Public Health Decisions for Public Health Practice Interventions Programs Policies Social values, Politics, Economics $ Expertise, Knowledge Best Evidence from Research

20 Objective 2 Be informed about the variety of resources available for evidence-based health practice What types of resources can be used to make evidence-based public health decisions? The classification of public health evidence: What are the knowledge domains of public health? What journal literature is associated with each public health knowledge domain? What bibliographic databases index public health information?

21 Sources of “Evidence” Journal literature Books Conference proceedings & abstracts Dissertations & theses Unpublished scientific papers Government reports (federal, state and local) Policy statements, laws & regulations Surveillance data Newsletters Teleconferences & webcasts Alert systems Listservs Internet sources Expert opinion

22 Evidence Pyramid From: The Medical Research Library of Brooklyn,

23 Models of Information: Sources of Evidence-Based Knowledge 1.Reports of Original Research 2.Summaries, Critiques and Commentaries 3.Systematic Reviews, Meta-Analyses, and Evidence-Based Guidelines 4.Comprehensive Knowledge Bases

24 1. Reports of Original Research Journal articles Book chapters Reports (government & other sources) Newsletter articles Conference proceedings and abstracts Bibliographic databases that cite the above Filtered searches of bibliographic databases

25 Original Research Article: Am J Public Health

26 Healthy People 2010 Information Access Project

27

28

29

30 2. Summaries, Critiques and Commentaries Narrative reviews and summaries of original studies Critiques of original studies Expert commentary based on original studies Structured abstracts of individual research articles

31

32

33

34

35 3. Systematic Reviews, Meta-Analyses, and Evidence-Based Guidelines Systematic reviews with explicit criteria Meta-analyses of data from original studies Evidence-based guidelines based on original studies, systematic reviews, and meta-analyses

36 Cochrane Review Abstract

37 Full Cochrane Review (from Ovid by subscription)

38

39

40 Summary of Findings

41 Link from Guide to Community Preventive Services: American Journal of Preventive Medicine

42 4. Comprehensive Knowledge Bases Searchable online textbooks with up-to- date information Collections of multiple online resources –Journal articles –E-textbook chapters –Guidelines –Recommendations –Patient handouts –Images –Multiple databases with integrated searching –Internet links to related sources

43

44 Graphic from UpToDate: Chest X-ray of SARS patient

45

46 The Classification of Public Health Evidence: What are the Knowledge Domains of Public Health? The field of public health is very broad and diverse There are multiple disciplines (knowledge domains) within the field of public health

47 The Public Health Workforce Epidemiologists Statisticians Environmental Engineers Animal Control Officers Sanitarians Food Scientists Industrial Hygienists Health Care Administrators Health Economists Politicians Social Workers Mental Health Workers Substance Abuse Counselors Doctors Nurses Teachers Disaster Relief Workers Nutritionists Lab Technicians

48 Sources Used to Identify the Knowledge Domains of Public Health Public health accreditation criteria Public health associations Government health agencies National health objectives Public health occupational categories Public health literature Public health subject headings from NLM and LOC

49 General Public Health Epidemiology Biostatistics Vital Statistics & Surveillance Environmental Health Occupational Health Health Services Administration Social & Behavioral Sciences Health Promotion & Education Community Health Maternal & Child Health Public Health Nursing Disaster Control & Emergency Services Communicable Diseases HIV/AIDS Nutrition Chronic Diseases Public Health Laboratory Sciences Public Health Informatics Global Health Identified Knowledge Domains Public Health

50 Sources Used to Identify Public Health Journals 1.CDC Information Center 2.Healthy People 2010 Information Access Project 3.Core Public Health Journal Project 4.ISI’s Journal Citation Reports 5.Public health subject experts

51 Public Health Journal Collection Knowledge Domain Online Access Price Impact Factor Databases Indexed In Table of Contents Alerts

52 Public Health Bibliographic Databases CDC Information Center Public health librarians Abstracting and indexing services for key public health journals Journals and newsletters listservs Public health websites Public health subject experts

53 Public Health Bibliographic Databases – Access free or by subscription only? – Who produced the database? – What topics are covered? – What kinds of materials are indexed?

54 Future Endeavors Continue to identify public health journals, databases and evidence-based resources Update lists with new information Continue study of the information needs and access preferences of public health practitioners

55 The Project’s Website