Dr M Clare Taylor Coventry University, UK. Takk for at jeg ble invitert til å snakke på denne...
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Transcript of Dr M Clare Taylor Coventry University, UK. Takk for at jeg ble invitert til å snakke på denne...
Dr M Clare TaylorCoventry University, UK
Takk for at jeg ble invitert til å snakke på denne
konferansen
exploring EBOT 2
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Evidence-based practice Evidence-informed practice Evidence-inspired practice
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Evidence-based practice
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Evidence-based medicine The conscientious, explicit and judicious
use of current best evidence in making decisions about the care of individual patients
Sackett et al, 1996: 71
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Evidence-based health care An approach to decision-making in which
the clinicians uses the best evidence available, in consultation with the patient, to decide upon the option that suits the patient best
Gray, 2001: 17
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Evidence-informed practice Evidence-inspired practice
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Evidence-informed practice The practice of a range of professionals whose
decisions are grounded in a sound knowledge of the needs of service users. This knowledge is informed by the best available evidence of what is effective, the practice wisdom of professionals and the experience and views of service users.
Research in Practice, 2005: 14
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Evidence-inspired practice Does it work? How well does it work? How does it work?
Michie & Abraham, 2004
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Evidence-based occupational therapy (EBOT)
Client-centred enablement of occupation based on client information and a critical review of relevant research, expert consensus and past experience
CAOT, ACOTUP, ACOTRO, & PAC, 1999
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So, what really is evidence-based/ informed/inspired practice?
Doing the right things rightGray, 2001: 20
Asking the ‘right’ questions Cusick, 2001
Supported by appropriate, sound, evidence
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Evidence-based practice Health care Simple interventions Hierarchy of evidence
Emphasis on RCTs & SRs Evidence-informed practice
Social care Complex, multi-faceted interventions A variety of evidence The consumer voice
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Evidence-basedhierarchy
Guidelines Systematic reviews RCTs Other experiments Descriptive Expert consensus Respected opinion
Evidence-informedrange
Organisational knowledge
Practitioner knowledge
User knowledge Research
knowledge Policy knowledge
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Different questions need different types of evidence
All evidence needs to be critically appraised and reviewed
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Perceived barriers Lack of appraisal skills EBP is a low departmental priority Limited management support Lack of time Limited awareness of and access to research Isolation from like minded colleagues How to apply evidence in practice?
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Inspire and inform ‘EBP champions’ Educate and support the ‘early adopters’ Find ways of translating the evidence:
CAPs CATs
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Critically Appraised Papers Structured summary of a
published paper Critical commentary of
the strength of the evidence and its application by a clinician
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Critically Appraised Topic Short summary of evidence Less rigorous that a
systematic review ‘Clinical’ question Overview of the search Appraisal of the papers Summary of the best
evidence
Creating the evidence Using the evidence
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Intervention effectiveness Sound designs Clear, relevant, outcome measures Clearly defined interventions
Service user perspectives Practitioner knowledge
Critical reflection on practice
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ask -> find -> appraise -> act -> evaluate
Individual Be a critical consumer of evidence
Group Start a journal club
Department/organisation Develop an EB culture
informed by Walter et al, 2004
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EBOT strategy & mission statement Give people time
SWOT analysis Identify EBOT
knowledge & skills, & any gaps
Workshops to develop specific EBP skills, e.g.: searching appraisal
Journal clubs EB reflection & supervision Action learning sets Developing EB case
studies EB audit Developing an EB resource
file/library Developing or using EB
guidelines
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Pre-contemplation No plans to change
Contemplation Thinking about change
Preparation Seeking information
Action Process of learning & change
Maintenance Permanent change
Prochaska & DiClemente, 1983
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Types of people: Innovators
Often isolated and distrusted Early adopters
Opinion leaders and champions Early majority
Traditional views, but able to change Late majority
Reluctant to change Laggards
Change has to be forced on them
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Asking the ‘right’ questions Finding and using a variety of evidence to
inform decision-making
Critically exploring the role of OT for today & tomorrow
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P = M x C B
P = performance M = motivation C = competence B = barriers
Gray, 2001: 13
What are YOU going to o to become a more evidence-based OT? Locally? Nationally? Internationally?
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Tusen takk for deres oppmerksomhet
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