Evidence-based practice: reflections from five European case studies

Abstract

Key message(s). Evidence-based practice (EBP) needs to draw on a wide range of evidence that is not only based on randomized controlled trials. . The location of practice (acute, community or primary care) needs to be carefully considered when using EBP. . Inter-and intraprofessional relations need to be carefully considered in relation to EBP. Related LJPC papersToon and Thomas (both in this issue). Why this matters to meThrough our European study, we have learnt that the nature of evidence is a contested term that can both bring different professionals together, for example, within stroke units, or harm professional relationships, for example, between stroke units and primary and community care. For evidence-based practice to have a positive impact on patients, it needs to be used as an inclusive endeavour rather than an exclusive one. ABSTRACTBackground Evidence-based practice (EBP) is now the accepted orthodoxy in clinical practice and developed from evidence-based medicine. EBP is based on a specific type of evidence that is derived from studies based on randomised controlled trials (RCT). This type of evidence is suited to acute medical care and is more problematic for other clinicians such as nurses and therapists, particularly when they are situated within community or primary care settings. Setting Five stroke care services in England (2), Sweden (2) and Poland (1). Aims To reflect on the evidence gained from these case studies to shed light on various aspects of EBP. This paper focuses on three key issues: (1) the importance of context for evidence, (2) the nature of knowledge, and (3) professional hierarchies. Methods Five qualitative case studies into stroke care were carried out in England, Sweden and Poland. One hundred and twenty semi-structured interviews were carried out with a range of healthcare staff who provided specialised and non-

Understanding context in healthcare research and development

“…This conclusion is the same as that reached by Baeja when examining research into stroke care in Europe. 2 The idea that illuminating complex situations needs inquiry to be participatory, multiperspective and build communities challenges the hallowed idea of 'objective' research, in which the researcher is purposefully separated from the object of study. The logic of the authors is irresistible -a single snapshot cannot see much of what is going on in a complex evolving situation, so researchers need to use a variety of different kinds of snapshots, coupled with a locally understood narrative that together can illuminate more of the unfolding story.…”

“…LJPC readers who enjoyed reading reflections by Toon and Baeja, on the value of evidence-based practice when researching ethical issues 1 and stroke services, 2 will enjoy reading a landmark paper in the Annals of Family Medicine called 'Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters'. 3 The paper was written by EA Bayliss and 18 co-authorsit has 99 high-quality references, and documents the conclusion of 45 experts from a broad range of disciplines about how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCCs).…”

What is evidence?

“…Many systematic reviews only include randomised controlled trials (RCTs), the 'gold standard' of EBM, as described in a partner paper in this issue of LJPC. 3 It is a small, but logically dubious jump from seeing controlled trials as the best evidence on which to base clinical actions, to the view that no other evidence is valid. This logically false jump is widespread both within medicine and in society at large.…”