Karen Dahlquist MSN, DNPc, FNP-BC June 4, 2010 Catching Up on Evidence Based Practice

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

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Ultimate Goal

Where to search?

Source: HealthLinks, University of Washington:

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 re- uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD DOI: / CD 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.: CD DOI: / CD pub4

Movers Needed

Buyers Needed

Stage 1 Agree best practice Stage 2 Assess clinical area against best practice Stage 3 Produce and implement action plan aimed at achieving best practice Stage 4 Review achievement towards best practice Stage 5 Disseminate improvements and review action plan

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