Evidence-based practice

Evidence based practice (EBP) is an approach to care wherein professionals use the best evidence possible, i.e. the most appropriate information available, to make clinical decisions for individual patients. EBP promotes the collection, interpretation, and integration of valid, important and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments and facilitate cost-effective care.

This involves complex and conscientious decision-making which is based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever changing and involves uncertainties and probabilities. Ultimately EBP is the formalization of the care process that the best clinicians have practiced for generations – from the country “Doc” who knew his patients to the practitioner who knew his patients over decades.

Evidence-based practice (EBP) develops individualized guidelines of best practices to inform the improvement of whatever professional task is at hand. Evidence-based practice is a philosophical approach that is in opposition to rules of thumb, folklore, and tradition. Examples of a reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information.

Evidence-based design and development decisions are made after reviewing information from repeated rigorous data gathering instead of relying on rules, single observations, or custom. Evidence-based medicine and evidence-based nursing practice are the two largest fields employing this approach. In psychiatry and community mental health, evidence-based practice guides have been created by such organizations as the Substance Abuse and Mental Health Services Administration and the Robert Wood Johnson Foundation, in conjunction with the National Alliance on Mental Illness.

This model of care has been studied for 30 year in universities and is gradually making its way into the public sector. It effectively moves away from the old “medical model” (You have a disease, take this pill.) to a “evidence presented model” using the patient as the starting point in diagnosis. EBPs are being employed in the fields of health care, juvenile justice, mental health and social services among others.

Key elements in using the best evidence to guide the practice of any professional include the development of questions using research-based evidence, the level and types of evidence to be used, and the assessment of effectiveness after completing the task or effort. One obvious problem with EBP in any field is the use of poor quality, contradictory, or incomplete evidence. Evidence-based practice continues to be a developing body of work for professions as diverse as education, psychology, economics, nursing, social work and architecture.

According to Norcross et al. (2006) "the burgeoning evidence based practice movement in mental health attempts to identity, implement, and disseminate treatments that have been proven demonstrably effective according to the empirical evidence". However, Norcross et al. (2006) also state that perhaps it is more useful to identify what does not work. They conducted a survey rating experts opinions of "not at all discredited" to "certainly discredited" for a range of treatments. Examples of almost certainly discredited psychotherapies included: angel therapy, the use of pyramid structures, orgone therapy, crystal healing, and past lives therapy. One limitation of this poll was that the experts selected were slanted towards Cognitive behavior therapies and they did not have adequate knowledge of intergrative and elective psychotheuptic methods. It was recommended that future polls take this into consideration, though the researchers concluded that the study does identify the dark side or "quack factor" of modern mental health practice.

External links

• Evidence Based Practice Definitions
• [1] - The Joanna Briggs Institute - International Collaborative on Evidence-based Practice in Nursing.
• Evidence Communicate leading research in order to promote international cooperation and evidence-based treatments
• Evidence based Practice clinic intitiatives
• Evidence Based Practice studies at the University of Massachusetts