Evidence-Based Health and Healthcare - Report Example

EVIDENCE-BASED HEALTH AND HEALTHCARE By Presented August 19, Introduction The current trend in healthcare now seems to be geared towards evidence-based practice. With the different types of treatment available for patients, health professionals are hard put to come up with the best treatment to be applied to patients. Hence, we saw the introduction of evidence-based practice. However, the veracity of this type of treatment has not been fully established for some health professionals. Consequently, many of them still support the traditional methods of clinical practice. This paper now seeks to answer whether or not better evidence means better public health. It shall critically discuss and provide some examples of how research has been used to improve population health outcomes. This paper is being conducted in the hope of enabling a better understanding of evidence-based practice and its application in healthcare. Discussion Evidence-based practice is the “process of systematically finding, appraising, and using contemporaneous clinical and community research findings as the basis for decisions in public health” (University of Michigan, 2005, p.1). The overall concept behind evidence-based practice is on delivering the best intervention for the management of health. In effect, it relies on sifting through evidence, proof of practice, effectiveness and applying best practices to the healthcare practice. Evidence-based practice also focuses on information literacy which starts with first asking the question and recognizing the need for information; next, by acquiring or locating such information; then by appraising the information or evaluating it; and lastly, by applying and using it effectively (Stanford University, n.d, p. 13). Evidence-based practice is founded on the concept of an educational paradigm which allows the learner to set-up the agenda. It also focuses on applying, not so much on acquiring knowledge. In any case, it does not place much value on authority, instead, it emphasizes on the independent review of the evidence (Stanford University, n.d, p. 21). Evidence-based practice is one which very much relies on original researches, summaries, critiques, commentaries, systematic reviews, meta-analyses, guidelines, and comprehensive knowledge bases (University of Michigan, 2005, p. 1). Through such materials, evidence and information is gathered for the purpose of building the body of evidence for practice. Through the process of critical research, evidence is refined and made better. As knowledge undergoes the process of refinement – from knowledge creation to knowledge synthesis – it becomes more distilled (Bick & Graham, 2010, p. 79). This distillation process ensures that only the best or the better evidence gets through and is eventually applied in practice. The highest quality of knowledge is therefore used and established in evidence-based practice and such knowledge is designed to make the most impact on healthcare (Public Health, 2005). In the interest of funnelling knowledge and evidence, evidence-based practice undergoes various levels of intensity and reliability. The levels of evidence-based practice start off with editorials and expert opinion, followed by case series and case reports. Case control studies and cohort studies then follow, and then randomized control trials, and finally topped off by systematic reviews (University of Illinois, n.d.). The different levels of evidence-based practice represent the quality of research with systematic reviews having the best quality, and editorials and expert opinions having the lowest quality and lowest reliability in the practice (University of Illinois, n.d). The process which evidence-based practice goes through in order to achieve reliability and quality as a basis for practice is thorough and analytical. In most fields of health practice, different practitioners recognize the fact that in “making evidence-based decisions for patient care, it is essential to select the highest level research design available for the specific question of interest” (University of Illinois, n.d). Through evidence-based practice, better evidence is established and possibly improved patient outcomes are achieved. Better evidence means better public health because better patient outcomes can be established through evidence and research. In a paper by McGrath (2002, p. 73), the significant impact of evidence-based practice was established when two treatments for edentulous patients were compared. The two treatments included the conventional treatment and the second treatment was the use of dental implants. After the conduct of a randomised controlled trail in a hospital setting, the study was able to establish that patients who received implant treatment experienced more progress in their oral health, as compared to those who underwent conventional treatment (Awad, Locker, Korner, & Feine, 2000, p. 1659). Through this evidence, a better precedent for achieving better patient outcomes have been set – guiding health professionals into better alternatives to patient care. In the field of child welfare, research has established the more beneficial options in relation to child welfare. For children’s mental and physical health, the traditions and policies have been geared towards the IFPS programs (intensive family preservation programs). A review by Littell & Mawr (2009, p. 8) sought to compare the multi-systemic therapy program in relation to the IFPS program. The review was able to establish that the MST was not better or worse than the IFPS program. In terms of kinship foster care, results indicated that children placed with relatives exhibited better developmental and mental health outcomes (Littell & Mawr, 2009, p. 8). The paper was in effect, able to establish that the traditional and expected results in child care may not consistently be repeated. Through research, in this case, decision makers were given comprehensive, reliable, and unbiased data in order to make well-informed choices (Littell & Mawr, 2009, p. 8). Through evidence-based practice and research, better health and child welfare has been secured for the children under foster care. Inasmuch as research has also established the best treatments and interventions, it has also helped to identify potentially ineffective treatments. Hoagwood and colleagues (et.al., 2001, p. 1179) were able to identify ineffective interventions for peer-based, group-based interventions among high-risk adolescents. For example, insufficient evidence was seen in support of non-behavioural psychotherapies for children with disruptive behaviour disorders (Hoagwood, et.al., 2001, p. 1179). In a study by Pelham (et.al., 1998, p. 190), the authors did not find any empirical studies which assessed the effectiveness of psychosocial remedies for ADHD, including the much touted individual and play therapy. Moreover, even as cognitive therapy for ADHD children has been used and preferred throughout the years, such studies were unable to show any clinical benefits (Abikoff & Gittelman, 1985, p. 953). In further assessing preferred interventions for children placed in group homes, evidence-based research was able to establish that children did not continue the progress they gained while in group homes on to their return to the community (Kirigin, Braukmann, & Atwater, 1982, p. 1). This strongly indicates the need to review group homes as an option for foster children. Evidence-based practice and research is an important tool in improving health because it helps weed out potentially stale and ineffective interventions – refocusing the attention of the practitioners towards improving the quality of evidence obtained (Hoagwood, et.al., 2001, p. 1179). In considering the escalating costs of cancer treatment, evidence based practice and research are important tools in narrowing down the more specifically applicable modes of treatment. Aetna, Inc., was able to establish that by following the guidelines of evidence-based practice, the overall cost of treatment was reduced by atleast 35 percent (Goodman, 2010). With evidence-based practice and research, more specifically appropriate treatments were fashioned for each patient and when each treatment protocol was followed by the physicians, better patient outcomes were gained (Goodman, 2010). Research was also able to point out to physicians how important it is for them to veer away from “off the shelf” therapies because these therapies may end up being toxic and harmful to patients (Goodman, 2010). Moreover, evidence-based practice has directed funding to the more applicable and more effective treatments for patients. Strong support for these treatments has been recommended to patients. Consequently, research has directed innovation and has helped in the reduction of economic inefficiencies. A study by Estabrooks (1998, p. 31) sought to assess the value of evidence-based practice in the nursing practice. The author was able to establish that while evidence-based practice is not the only remedy which can work well for patients, when used with prudence, it can relieve nurses of their ignorance and “at the very least, help [them] to do no harm” (Estabrooks, 1998, p. 31). With a proper understanding and concept behind evidence-based practice, it becomes a tool which can bring forth improved patient outcomes and better health care services. The very crux of evidence-based practice is research and when research is used as a tool for the application of treatment, not as a tool for the entry into exclusive medical clubs, it becomes an invaluable instrument in any medical professional’s arsenal. In terms of palliative care Qaseem (et.al., 2008, p. 141), evidence-based practice and research are important instruments because they establish evidence to improve palliative care for pain, dyspnoea, and depression. Patient’s end-of-life experiences can totally devastate and worsen patient’s overall condition. But the use of appropriate and individually applicable interventions can reduce patients’ burdens. Systematic reviews reveal strong recommendations on the regular assessment of patients for pain, dyspnoea, and depression; pain therapies, including the use of NSAIDs, opioids, barbiturates, and bisphosphates; therapies to manage dyspnoea including the use of opioids and oxygen; therapies for depression including tricyclic antidepressants, SSRAs and other psychiatric interventions; and the arrangement of advance directives (Qaseem, et.al., 2008, p. 141). Through research, although recovery may not at all be possible for palliative care patients, their physical and emotional burdens are, at the very least, reduced and managed. In a study by Bahr and Smith (2006, p. 102) the authors sought to evaluate the utilization of evidence-based alcohol withdrawal protocol in improving patient outcomes. Research on interventions for alcohol-withdrawal was carried out after an initial evaluation revealed no existing evidence-based treatments within mental health institutions. The study revealed the need to standardize care for patients undergoing alcohol withdrawal (Bahr & Smith, 2006, p. 102). Research was able to establish the importance of implementing alcohol withdrawal protocol with the end goal of decreasing medication utilization; decreasing incidence of delirium tremors; reducing transfers to ICUs and length of stays; and using tools which adhere to protocol (Bahr & Smith, 2006, p. 102). Evidence-based practice established the importance of close monitoring of the patient undergoing alcohol withdrawal and of applying evidence-supported treatments to ensure the timely delivery of efficient health care. In considering the value and impact of evidence-based practice and research in the care of obese children and adolescents, best practice recommendations are conceptualized by various researchers. A study by Flynn and colleagues (2006, p. 7) sought to come up with recommendations based on synthesized evidence to address the problem of childhood obesity. The study revealed that there is a lack of programming in order to address the needs of groups of children and youth. Even as immigrants new to developed nations show more vulnerability to the dangers of a largely obese society, no programs have been implemented in order to cover their needs (Flynn, et.al., 2006, p. 7). Programmes for children 0 to 6 years of age have also been lacking after systematic research was conducted. Such gaps in the programme are important concerns because the pre-school years are critical to the prevention of obesity (Flynn, et.al., 2006, p. 7). Gaps in knowledge were also revealed during the review and that there are limited interventions made available in homes and community settings. This shortage of programmes has limited the understanding of the interventions in the community setting, and has prevented the implementation of individual and patient-centred interventions. Flynn (et.al., 2006, p. 7) therefore has been prompted to recommend more evidence and research to support the programmes which are more specific to the needs of the obese children and adolescents. Conclusion Better evidence means better health because with refined and critically-reviewed evidence, more appropriate and more patient-centred interventions can be implemented to patients. Consequently, with better interventions, better health can be ensured. In the field of health care, the different processes involved in evidence-based practice undergo a scholarly and analytical process which eventually allows a more focused and specific treatment programme to be implemented. Nursing care, child welfare, dental care, mental health care, alcoholic withdrawal, and childhood obesity are some of the aspects of healthcare where evidence-based practice and research have proven invaluable. Research has elevated healthcare interventions into more reliable options of care, allowing for better patient outcomes to be achieved. Works Cited Abikoff, H. & Gittelman, R., 1985, Hyperactive children treated with stimulants: is cognitive training a useful adjunct? Archives of General Psychiatry, volume 42, pp. 953-961 Awad, M., Locker, D., Korner, N., & Feine, J., 2000, Measuring the effect of intra-oral implant rehabilitation on health related quality of life in a randomised controlled trial, Evidence-based dentistry, viewed 17 August 2010 from http://www.nature.com/ebd/journal/v3/n3/pdf/6400115a.pdf Bahr, S. & Smith, J., 2007, Improving Patient Outcomes Utilizing an Evidence-Based Alcohol Withdrawal Protocol, The Journal for Advanced Nursing Practice, volume 21, number 2, pp. 102-107 Bick, D. & Graham, I., 2010, Evaluating the Impact of Implementing Evidence-Based Practice, UK: John Wiley & Sons Estabrooks, C., 1998, Will Evidence-based Nursing Practice Make Practice Perfect?, Canadian Journal of Nursing Research, volume 30, number 1, pp. 15-36, viewed 17 August 2010 from http://digital.library.mcgill.ca/cjnr/pdfs/CJNR_Vol_30_Issue_01_Art_01.pdf Flynn, M., McNeil, D., Maloff, B., Mutasing, D., Wu, M., Ford, C. & Tough, S., 2005, Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations, Obesity Reviews, volume 7, pp. 7-66. 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