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ESA 4 - HaDSoc > Evidence-Based Practice > Flashcards

Evidence-Based Practice Flashcards

1
Q

What should heatlh service delivery be based on?

A

The best available evidence

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2
Q

What is the best evidence based on?

A

The findings of rigorously conduced research

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3
Q

What does the evidence that health service delivery should be based on concern?

A
  • Effectiveness
  • Cost-effectiveness
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4
Q

What needs evidence regarding effectiveness?

A
  • Drugs
  • Practices
  • Interventions
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5
Q

Why does the health service need best evidence regarding cost-effectiveness?

A

In a system with finite resources, should be considered where money can be spent ot gain maximum utility

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6
Q

What is the problem with ineffective and inappropriate interventions?

A

They waste resources that could be used more effectively

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7
Q

What do variations in treatment cause?

A

Inequities

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8
Q

What are practices influenced too much by?

A
  • Professional opinion
  • Clinical fashion
  • Historical practice and precedent
  • Organisational and social culture
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9
Q

What has research shown that clinicians often do regarding evidence-based practice?

A
  • Persisted in using interventions that are ineffective
  • Failed to take up other interventions known to be effective
  • Tolerated huge variations in practice
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10
Q

What sets out the principles of evidence-based practice?

A

Archie Cochrane’s book, Effectiveness and efficiency; random reflections of health services

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11
Q

What did Archie Cochrane’s book say?

A
  • Criticised medical profession for failing to take account of research
  • Caller for register of all RCTs
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12
Q

What resulted from Archie Cochranes call for a register of all RCTs?

A

Group in Oxford lead by Iain Chalmers responeded to this, and produced a register of all RCTs in obstetrics and gynacology, becoming the first ‘Cochrane Centre’

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13
Q

What did Iain Chalmers Cochrange centre contain?

A

Systematic reviews and meta-analyses of data and evidence produced by RCTs

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14
Q

What followed from Iain Chalmers Cochrane Centre?

A

Other Cochrane Centres were set up elsewhere

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15
Q

What does evidence based practice involve?

A

The integration of individual clinical expertise with the best available external clinical evidence from systematic research

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16
Q

What is evidence based practice also known as?

A

Evidence-based healthcare and evidence-based medicine

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17
Q

Where have systematic reviews and meta-analyses become very important?

A

In informing evidence base

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18
Q

What do doctors need, regarding systemic reviews and meta-analyses?

A

Need to have an understanding of these methods and be able to critically appraise them

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19
Q

Why are systematic reviews and meta-analyses needed?

A
  • Some traditional, ‘narrative’ literature reviews may be biased and subjective
  • Not easy to see how studies were identified for review
  • Quality of studies variable and sometimes poor
  • Systematic reviews are useful to help address clinical uncertainty
  • Systematic reviews can highlight gaps in research/poor quality research
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20
Q

Why are systematic reviews useful to clinicians?

A
  • By appraising and integrating findings, they offer both quality control and increased certainty
  • They offer authoritative, generalisable, and up-to-date conclusions
  • They save clinicians from having to locate and appraise the studies for themselves
  • They may reduce delay between research discoveries and implementation
  • They can help prevent biased decisions being made
  • They can be relatively easily converted to guidelines and recommendations
21
Q

Why do doctors need to be able to access systematic reviews?

A

To appraise them and be satisfied about the quality of the evidence

22
Q

How is assessment of the quality of evidence easiest and best done?

A

Using a ‘critical appraisal tool’ or instrument

23
Q

What do critical appraisal tools do?

A

Suggest the things to took for, and the questions to ask of, research articles

24
Q

Where can evidence be found?

A
  • Medical journals
  • Cochrane Collaboration
  • Centre for Reviews and Dissemination
  • NIHR Dissemination Centre
  • NIHR Health Technology Assessment Programme
25
Q

What is the advantage of medical journals?

A

They are ruptable and peer reviewed

26
Q

What do medical journals often publish?

A

Systematic reviews

27
Q

What are EBP-specific journals?

A

A more recent phenomenon that focus on critical appraisal and dissemination of research findings relevant to population health

28
Q

What does the Cochrane library include?

A

Links to databases and other resources

29
Q

Who is in charge of the Centre for Reviews and Dissemination?

A

The University of York

30
Q

What is the Centre for Reviews and Dissemination?

A

A national centre to lead the review, management, and dissemination of research findings relevant to population health

31
Q

What does the NIHR Dissemination Centre do?

A

Critically appraises the latest health research from both within NIHR and other research organisations to identify the most reliable, relevant, and significant findings

32
Q

What does the NIHR Health Technology Assessment Programme do?

A

Aims to produce high quality research information on the costs, effectiveness, and broader impact of health technologies

33
Q

What does the NIHR Health Technology Assessment Programme include?

A

Primary research and systematic reviews

34
Q

On what basis has the evidence-based practice movement been criticised?

A
  • Practical criticisms around possibility of evidence based practice
  • Philosophical criticisms around desirability of evidence-based practice
35
Q

What are the practical cricisms around the possibility of evidence based practice?

A
  • May be an impossible task to create and maintain systematic reviews across all specialities
  • May be challenging and expensive to disseminate and implement findings
  • RCTs are seen as the gold standard, but not always feasible or even necessary/desirable
  • Choice of outcomes are often very biomedical
  • Requires good faith on the part of the pharmacuteical companies
36
Q

What is the result of the choice of outcomes of evidence-based practice being very biomedical?

A

May limit the interventions which are trialled, and therefore which are funded

37
Q

What are the philosophical critcisms around desirability of evidence-based practice?

A
  • Does not align with most doctors modes of reasoning
  • Aggregate, population-level outcomes don’t mean that the intervention will work for an individual
  • Potential of EBM (or it’s implementation, e.g. through NICE or clinical governance) to create ‘unreflective rule followers’ out of professionals
  • Might be understoof as a means of legitimising rationing
  • Professional responsibility/autonomy
38
Q

What is the problem with EBM being seen as a means to legitimise rationing?

A

Potential to undermine trust in doctor-patient relationship, and ultimately the NHS

39
Q

What are the limitations of evidence-based practice?

A
  • Many ineffective practices continue
  • Some effective practices are not implemeted
  • Existence of evidence does not ensure implementation of evidence based practice
40
Q

Why doesn’t existence of evidence ensure that implementation of EBP?

A
  • Evidence exists, but doctors don’t know about it
  • Doctors know about the evidence, but don’t use it
  • Organisational systems cannot support innervation
  • Commissioning decisions reflect different priorities
  • Resources not available to implement changes
41
Q

Why may doctors not know about existing evidence?

A
  • Dissemination may be ineffective
  • Doctors aren’t incentivised to keep up to date
42
Q

Why may doctors not use evidence that they know about?

A
  • Habit
  • Organisational culture
  • Professional judgement
43
Q

Why can’t organisational systems support innervation?

A

Because managers lack ‘clout’ to invoke changes

44
Q

What is meant by commissioning decisions reflecting different priorities?

A

What if patients want something else?

45
Q

What kind of resources are not available to implement change?

A
  • Financial
  • Human
46
Q

What is the problem with changing management?

A

A complicated and demanding process

47
Q

What are the widespread changes in healthcare due to?

A

Partly due to policies such as clinical governance and establishment of Care Quality Commission and NICE

48
Q

What are NHS organisations legally obliged to do, regarding NICE?

A

Follow NICE guidelines within 3 months

49
Q

Why may the problem of being reluctant to fund things for which the evidence is poor become more prominent?

A

Because of the increasing austerity in the NHS

ESA 4 - HaDSoc (13 decks)

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