Week 11 - Implementing evidence in clinical practice and communicating with healthcare stakeholders

Apart of Introduction to Evidence Based Practice and Research in Health Sciences at UniSA

What is the evidence-practice gap (EGP)?

Refers to the discrepancies between established evidence-based practices and what is actually implemented in clinical practice.

Why does the EGP exist and what is the consequence of the EGP?

• This exists because it can take up to 17 years for research to reach practice where only 14% of this research reaches the target audience and 18% of clinicians and administrators practice EBP. This is because they value peers and experts over research evidence.

• The consequences are up to 45% of patients do not receive recommended care and between 20-25% patients receive diagnostic tests or medications, which are not evidence based, unnecessary, and potentially harmful.

How is soft collar for whiplash affected by the EPG?

It is already a poorly managed injury with a great deal of variability and using soft collars has poor outcomes and prolonged symptoms. However, this is still continuously used to treat whiplashes because of historical practices and patient expectations (e.g. wanting to show injury to get time off work).

How is hand washing affected by the EPG?

It is an important health practice and has been recognised since 1800 however, compliance is very poor where physicians overestimate their own hand hygiene and other barriers such as patients themselves.

What are the two major aspects of barriers to EBP?

• Barriers to EBP (embedding the key processes of EBP in everyday practice)

• Barriers to Evidence Implementation and Change (implementing a desired change in current practice for a particular patient group)

What are three barriers to EBP?

• Characteristics of the practitioner

• Characteristics of the setting

• Characteristics of the research

What are seven barriers to evidence implementation?

• Patient

• EBP process

• Team issues

• Care process

• Management support

• Time/facilities/cost

• Health system

What are five consistently effective approaches to implement EBP into healthcare?

• Educational outreach visits

• Decision support systems

• Reminders

• Interactive educational meetings

• Multifaceted approaches

What are ten things to consider when implementing EBP into healthcare?

• Change takes time

• Preparation

• Seeking evidence

• Working with key stakeholders

• Building effective relationships with consumers

• Using different teaching and learning strategies

• Defining targets and create ownership through engagement

• Programs to support change at all levels

• Using local support, peers, and experts

• Working in a receptive environment and leadership to young professionals

Who are consider stakeholders in healthcare (seven points)?

• Patient/client/consumer

• Family and community

• Health professionals

• Referrers

• Funders and administrators

• Policymakers (e.g. politicians and bureaucrats)

• Media

What is knowledge translation?

Process and strategy that can lead to increased utilisation of research findings and improved outcomes for health care stakeholders.

What three models are related to knowledge translation?

• Push-pull model

• Two communities

• Exchange models

Push-pull model

A model which involves two strategies, pushing the research evidence to stakeholders and assuming ignorance is at the root of this and pulling demands from stakeholders who seek information that is highly credible.

Two communities

A concept where researchers from different communities generate different research evidence and use research evidence, which can lead to misunderstandings and misconceptions about each other.

Exchange model

A concept which focuses on forming and building relationships through regular dialogue and interaction, which helps stakeholders understand research evidence and improve their research knowledge.

What are five barriers to knowledge translation?

• Resistance to research evidence

• Assume stakeholders have no ability to engage with research evidence

• Entrenched beliefs and historical culture

• Assume everyone will understand you and the information presented

• Additional time and resources are needed

What is the importance of patient-centred care in EBP?

To involve the patient/client and any family and friends to participate and inform decision-making with the clinician.

What are three challenges with patient-centred care?

• Availability of evidence

• If patients want to contribute to decision making

• How dynamic and evolving the health professional-client relationship is

What are four opportunities that arise from patient-centred care?

• To consider patient as a whole

• Value and ask for their contribution

• Provide honest, unbiased, and clear information

• Ensure patients understand the information

What are three key communication strategies in healthcare when communicating with stakeholders?

• Be clear that key messages are audience specific because different stakeholders have different interests

• These messages need to be relevant and relate to the stakeholders and consider 'what's in it for them?'

• Use multifaceted and interactive approaches