Steve Brine MP (Parliamentary Under Secretary of State for Public Health and Primary Care) has commissioned Public Health England (PHE) to review the evidence for dependence on, and withdrawal from, prescribed medicines.
PHE will carry out a public-health focused review of commonly prescribed medicines, authorised for adults who have non-cancer pain, anxiety, insomnia or depression.
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
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.
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.
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.
Guo, R. et al. (2016) Hospital Topics. 94(3-4) pp. 62-66
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.
Howe, C. J. & Close, S. Journal of Pediatric Nursing. Available online: 8 March 2016
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.
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
Journal 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.