Evidence‐based practice in primary care: past, present and future

Benech, Irene; Rgn, Allson E. Wilson; Dowell, Anthony

doi:10.1111/j.1365-2753.1996.tb00055.x

Cited by 17 publications

(6 citation statements)

References 48 publications

(22 reference statements)

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“…The question is how to adapt academic research on evidence-based practices (EBP) to concrete situations "outside the laboratory" and embed them in the real world. This touches on the topic of "practice based evidence" (PBE) which is about developing evidence from real-life practices (32)(33)(34). Despite vast scientific knowledge, there are seemingly challenges and bottlenecks in moving from trial to practice.…”

Section: Introductionmentioning

confidence: 99%

Introducing Progressive Strength Training Program in Singapore's Elder Care Settings

Björkgren¹,

Borg²,

Tan³

et al. 2021

Front. Med.

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The use of progressive strength training among the elderly has become an accepted part of evidence-based practice for preventive and rehabilitative care. Exercise is undoubtedly one of the pillars for resilient aging. While research has shown impressive outcomes from strength training, the challenge remains to get elderly persons to exercise. Here we describe a Finnish-Singaporean cross-national project that provides a unique opportunity to evaluate the implementation of strength training in settings where it had previously not been applied. We report from the first 2 years of implementation using assessment data and surveys directed to frontline therapists responsible for the implementation. The strength training concept was progressively implemented in 24 elder care locations in Singapore including residential homes, day rehab/care centers, and senior activity centers. Each location was provided with training, support, gym equipment and technology solutions. It remained for individual sites to enroll elderly to the program, to perform assessments, and to direct the progressive strength training. Based on data from the first 2 years of implementation, improvements in lower body muscle strength were found in Leg Curl (ave 11.1–48.8%), Leg Extension (ave 10.2–24.0%) and Hip Abduction/Hip Adduction (ave 7.0–15.8%). Of the trained therapists, 95% strongly agreed or agreed to some extent that the implementation had been successful. The practice-based evidence from the project has demonstrated that it is feasible to implement progressive strength training in real life settings, using technology. While the implementation initially required handholding and support, the approach yielded consistent improvement rates in muscle strength comparable to results from randomized clinical trials (meta-analysis studies). Significant improvement rates in muscle strength were found in all three types of sites, demonstrating that gym training can be employed broadly in elder care. The Senior Activity Centers offer an interesting model for reaching seniors with preventive actions at an early stage. The data support a 3-month training as an effective intervention of introducing strength training in elder care settings, promoting healthy aging.

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Section: Introductionmentioning

confidence: 99%

Introducing Progressive Strength Training Program in Singapore's Elder Care Settings

Björkgren¹,

Borg²,

Tan³

et al. 2021

Front. Med.

View full text Add to dashboard Cite

show abstract

“…This move towards increased systematic care of patients with chronic diseases has been partially driven by more general changes in the nature of medical work. The work of Cochrane (1999) advocating the application of evidence from randomised controlled trials to the practice of medicine has been extended into the area of chronic disease management (Benech et al 1996). Harrison (2002) has called this translation of evidence from randomised controlled trials into sets of normative guidelines that rapidly become the accepted ‘gold standard’ of care ‘scientific‐bureaucratic’ medicine.…”

Section: Introductionmentioning

confidence: 99%

National Service Frameworks and UK general practitioners: street‐level bureaucrats at work?

Checkland

2004

Sociology Health & Illness

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This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well-established sociological perspectives of deprofessionalisation and proletarianisation, this paper takes a view of general practice as work, and uses the ideas of Lipsky to analyse practice-level responses to some of these changes. In addition to evidence-based clinical guidelines, National Service Frameworks, introduced by the UK government in 1997, also specify detailed models of service provision that health care providers are expected to follow. As part of a larger study examining the impact of National Service Frameworks in general practice, the response of three practices to the first four NSFs were explored. The failure of NSFs to make a significant impact is compared to the practices' positive responses to purely clinical guidelines such as those developed by the British Hypertension Society. Lipsky's concept of public service workers as 'street-level bureaucrats' is discussed and used as a framework within which to view these findings.

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“…Physicians in primary care often wrestle with the applicability of RCT results obtained in tertiary and secondary centers 26. Often, primary care patients suffer numerous comorbidities that would have been exclusion criteria in the very studies that examine the efficacy of the therapies relevant to them 27…”

Section: Will the Results Be Applicable?mentioning

confidence: 99%

Planning a clinical research study

Chan

Jönsson²,

Bhandari

2007

Indian J Orthop

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Evidence‐based practice in primary care: past, present and future

Abstract: As in other health care specialities, evidence-based practice is beginning to have an impact on the philosophy and workings of primary care. Some

Cited by 17 publications

References 48 publications

Introducing Progressive Strength Training Program in Singapore's Elder Care Settings

Introducing Progressive Strength Training Program in Singapore's Elder Care Settings

National Service Frameworks and UK general practitioners: street‐level bureaucrats at work?

Planning a clinical research study

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