Getting research into policy in health – The GRIP-Health project

For many, the idea that health policy should be informed by evidence is an obvious goal. And indeed, the global health community has widely called for increased use or uptake of research and evidence, in health policymaking | LSE Health and Social Care Blog

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However, a vast majority of these calls have been made without explicit recognition of the decidedly political nature of policymaking, and without consideration of how this may affect the use of evidence to inform decisions.

Indeed, calls for ‘evidence-based’ policymaking have become ubiquitous in recent years, applied in social sectors such as health, education, crime prevention and many others. Many have seen these calls deriving from the successes of the ‘evidence based medicine’ movement – a movement that has helped to ensure that clinical practice is informed by rigorous assessments of evidence of effects of different treatment options.

The GRIP-Health research programme was funded by the European Research Council to bring an explicitly political lens to the study of evidence use for health policymaking in low, middle and high income countries. It draws particularly on policy studies theories to consider how the nature of the policy process, the politicised features of health decisions, and the existing institutional arrangements for policymaking in different countries all can work to shape which evidence is utilised, and how it is utilised to inform or shape health policy decisions.

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Fresh thinking about the evidence needed for a healthier UK

The Health Foundation is working with Dr Harry Rutter from the London School of Hygiene and Tropical Medicine to develop a new model of evidence that will inform public health research, policy and practice. 

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As part of this work Dr Rutter and co-authors from the Health Foundation have published a new Viewpoint paper – The need for a complex systems model of evidence for public health – in The Lancet, which outlines the need for new approaches to designing and evaluating population-level interventions to improve health.

Key points

  • We are faced with many big health challenges in our society. Their complex nature is an ongoing problem for public health research and policy.
  • Such challenges often involve multiple factors operating over many decades in systems that adapt as changes occur. For example, the distribution of obesity in a population might be impacted by changes to food, employment, transport or economic systems.
  • The traditional linear model of research is not suited to tackling these challenges. This is because it focuses largely on changes in individuals, not the population as a whole, and because it tends to look at isolated interventions rather than the contexts in which they take place.
  • There is growing recognition that we need a new evidence model that looks at public health problems, and our potential responses, in terms of a complex systems approach.

Full reference: Rutter, H. et al.  The need for a complex systems model of evidence for public health The Lancet, 13 June 2017

Related: Building a new system for the generation and use of public health evidence

 

Study on Hospital Administrators’ Beliefs and Attitudes toward the Practice of Evidence-Based Management

Guo, R. et al. (2016) Hospital Topics. 94(3-4) pp. 62-66

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The authors’ purpose was to explore hospital administrators’ beliefs and attitudes toward the practice of evidence-based management (EBMgt) and to identify the needs for EBMgt training programs. A cross-sectional, nonexperimental design was utilized. Survey data were analyzed using descriptive statistics and Spearman’s correlation. The results showed that hospital administrators had positive attitudes toward the practice of EBMgt. There was a significant correlation between attitudes and percentage of healthcare management decisions made using an evidence-based practice approach (p < .01). The study findings suggest EBMgt educational training programs would likely help hospital administrators adopt evidence-based practice in management decision-making.

Read the full abstract here

Be an Expert: Take Action with Evidence-Based Practice

Howe, C. J. & Close, S. Journal of Pediatric Nursing. Available online: 8 March 2016

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Image source: CFCF

Image shows the different levels of evidence:

Evidence-based practice (EBP) is a problem-solving approach to clinical decision-making that integrates the best available evidence with one’s own clinical expertise. As well, it incorporates patient values and preferences to improve health outcomes (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). The Institute of Medicine Roundtable on Evidence-Based Medicine (2009) set a goal that by the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, reflecting the best available evidence. Melnyk et al. (2014) established nursing competencies for EBP, highlighting the importance of EBP skills for practicing nurses.

Despite these directives, the use of EBP remains inconsistent in the practice setting. Significant obstacles to EBP include lack of time, lack of knowledge and skills, the inability to access research evidence, and the lack of support from colleagues and administration (Dogherty, Harrison, Graham, Vandyk, & Keeping-Burke, 2013). Many nurses, however, wish to learn and refine their EBP skills to optimize health care for their patients (Melnyk et al., 2012).

This column focuses on four essential EBP skills: 1) asking a practice question using the PICO method, 2) retrieving evidence from the literature, 3) appraising the evidence, and 4) synthesizing the evidence. Although there are several models of EBP in the literature (Schaffer, Sandau, & Diedrick, 2013), the Johns Hopkins Nursing EBP (JHNEBP) model offers a practical guide to the EBP process. The JHNEBP textbook by Dearholt and Dang (2012) proves easy to read and many of their EBP tools are available online.

Read the abstract here

Journal clubs to promote evidence based nursing practice

By rheale. BMJ Evidence-Based Nursing blog. 12 Feb, 16

This week’s EBN Twitter Chat, on Wednesday 17th February 2016 between 20:00 – 21:00 hrs (GMT), will focus on tips and tricks to facilitating nursing journal clubs. The Twitter Chat will be hosted by Dr. Stephen McKeever (@Stephen8McK) who is a Senior Lecturer in Children’s Nursing in the Department of Children’s Nursing at London South Bank University and an Honorary Research Nurse in the Nursing Research Department of The Royal Children’s Hospital, Melbourne, Australia. https://www.linkedin.com/in/stephen

 

2570464636_a888dd068b_zJournal clubs can be particularly useful in; keeping up-to-date on practice, improving reading habits and critical appraisal skills, facilitating learning and openness to evidence based practice principles, and promoting multidisciplinary cooperation 2 4. It is proposed that developing these skills can be effective in overcoming some of the often cited barriers to implementing of evidence based nursing practice 3.

Participation in a journal club, with all its inherent different levels of engagement, are all with merit. However, whilst some journal clubs can facilitate inter-professional collaboration, if nursing learning needs are not met 3 then nurses will disengage with the format. There is an increased potential for this to happen if the opportunities to discuss issues related to nursing practice are not offered. If these opportunities are provided however, it enables a clinical context, and appropriateness to a particular setting, to be derived and improvements in practice to be explored. Thus, in some circumstances the formation of a nursing focused journal club are warranted.

Read the full blog here

Health research into practice – the role of social media

Maloney, S. BMJ Clinical Evidence Blog | 4 Feb, 16

From our research we learned that 96% (n=810) of our health professional study participants felt that there was a role for social media in communicating research evidence, and that 80% of participants already used social media for professional purposes. With these overwhelming numbers we felt that there was no more point in looking at the acceptability of social media by health professionals – instead, it was time to focus on investigating how social media can impact on the translation of evidence to practice and on behaviour change.

At the time, we could not locate any published studies that reported an empirical evaluation of the impact and role of social media on translation of health research into practice. This was the catalyst for our investigation to explore the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice.

Outcomes of our trial included a significant shift in clinician attitudes toward social media, increase in knowledge exam results, and the majority of participants reporting a change in their clinical practices. Approximately 70% of the participants reported that receiving the social media posts increased their use of research evidence within their clinical practice.

The use of social media for improving the translation of evidence to practice is certainly not without its problems – however, our traditional methods are problematic also, such as the lag time for the publication process.

Given the expanding costs of medical education and professional development, both to the individual and to employers, I believe there are a number of focus areas for further research in this field. These include investigating the cost-effectiveness and cost-benefit of education practices, along with head to head comparisons of varying approaches available to social media for the translation of clinical evidence to practice.

Read the full blog here

Preoperative bathing or showering with skin antiseptics to prevent surgical site infection.

Webster J, Osborne S. Cochrane Database of Systematic Reviews 2015 Issue 2.

Surgical site infection is a serious complication of surgery and is usually associated with increased length of hospital stay for the patient, and also higher hospital costs. The use of an antiseptic solution for preoperative bathing or showering is widely practiced in the belief that it will help to prevent surgical site infections from developing. This review identified seven trials, with over 10,000 patients, that tested skin antiseptics (chlorhexidine solution) against normal soap or no presurgical washing. The review of these trials did not show clear evidence that the use of chlorhexidine solution before surgery was better than other wash products at preventing surgical site infections from developing after surgery.

 

View the full blog via Evidently Advent 2015: Preparing for surgery