Evidence-Based Healthcare - Assignment Example

al affiliation Evidence-based medicine is the process of reviewing, appraising and using research to provide the desired clinical care to patients. The aim of this paper is to discuss evidence-based practises and how the healthcare providers can use them to provide quality healthcare to patients. This document looks at the clinical guidelines that are set out for the care providers, the challenges they face in meeting them, and their reactions to the new guidelines. There are many challenges faced by healthcare providers, both generic and particular problems, but recommendations for such problems will be given and hopefully they will be addressed and will help to deliver the desired healthcare outcomes. This paper discusses the strengths and the weakness of the evidence-based method. This paper also discusses the future and current state of clinical guidelines and the limitations of the guidelines as well. Evidence-based medicine is about solving clinical problems, it does this through a process of bringing together the best evidence of clinical experience and patient values. Introduction Clinical efficacy is a critical assessment of anything you do which is aimed at making a change in practice as a result of having a positive outcome. The main purpose is to improve patient and care experience. Clinical effectiveness measures outcomes on an individual patient level. Clinical effectiveness studies help healthcare professionals to understand how to design treatments based on patient variation rather than cost. Clinical effectiveness is about the right people, doing the right thing, the right way, in the right place, at the right time with the right result (Graham 1996). Background In the context of my practice as a podiatrist, the right person would primarily be well-trained and a member of the Health and Care Professions Council (HCPC), with knowledge of the new advances in podiatry, such as local anaesthesia, nail surgery, diabetic feet and gait analysis. All the above specialities need extended training such as Continuing Professional Development. Clinical effectiveness doing the right thing is aimed at making clinical practice more accurately based on the use of investigations that have been proven to be effective relative to the specific patient needs (Graham 1996). To do things in the right way it is necessary to have a well-trained and competent work-force that has clear responsibilities and works together in this new era of podiatry to deliver the best value healthcare possible. The right result refers to the maximization of health effects, which can be expressed in terms of improvement in the health quality of life. Developing appraisal skills should be central to any continuing professional development program for podiatrists (Muir-Gray 2001). The implications of the evidence are that it has some influence over interventions between the patient and health practitioner and the podiatrist has control over the endpoints, these being the outcome for the patient. In addition evidence has a greater internal validity. Appraisal is a systematic process used to identify the strengths and weakness of a research article in order to assess the usefulness and validity of research findings. The most important components of a critical appraisal are an evaluation of the appropriateness of the study design for the research question and careful assessment of the key methodological features of the model (Muir-Gray 2001). Other factors that should also be considered include the suitability of the statistical methods, and their interpretation, potential conflicts of interest and the relevance of the research. Appraisals are a useful method of collecting evidence. They should be in line with the interests of the individuals participating in the research and also the main purpose of conducting the study to avoid conflicting interests (Chambers and Boath 2001). In appraisals patients may give appropriate feedback as they are not under any supervision, hence the chances of biased information are little as this is a personal affair. In order to rely on an appraisal as a way to recommend healthcare, one should consider who, how and when the performance was appraised (Wilkinson 2001). Performance appraisal involves evaluating peoples’ competence and efficiency at work so one should consider the work ethics of the people who participated to avoid biased information. Evidence-based practice, is another tool that can be used to make sure that patients get the best possible care. Randomized controlled trials (RCTs) are a critical component of the evidence base for contemporary medical practice, however this design is not feasible or appropriate for all questions (Bury and Mead 1998). Depending on the question posed, especially in situations in which an RCT is either not possible or is impractical, other study designs may be superior. RCTs are considered the gold standard for the assessment of whether a treatment or intervention is efficient, or whether treatment works under ideal conditions. However, RCTs have several other limitations such as the fact that their greater external validity may not be inclusive of finer details in care provided for patients. This study design mainly requires a large sample size which may not be possible in all circumstances as the necessary numbers of volunteers for a research study are not always available. RCTs are time-consuming, especially because of the large scale data collection that they involve and this makes them very cost ineffective meaning they are expensive (Ades et al. 1999). An RCT is a study design that requires a specified enrolment procedure, but this depends on the question posed. They are designed to answer one or a small number of issues about treatment efficiency that cover a small scope, and hence are not appropriate when tackling questions that are beyond treatment efficiency in a large population. This method cannot be used alone to achieve an efficient study and there is the need to incorporate other methods. Components that influence research findings from a statistical test include the sample size which is the number of patients or nurses that contributed in the research; the larger the sample size the better as it reflects the truth of the question. RCTs are placed high in the ranking of hierarchy of evidence. However, with regards to clinical guidelines systematic reviews with meta-analyses, rather than RCTs, are regarded as the highest level of research evidence. Guidelines are systematically developed statements to assist clinicians to make decisions about appropriate healthcare for specific clinical circumstances. Clinical guidelines affect practice all the time where different protocols or therapy guidelines can be applied in particular circumstances (Bury and Mead 1998). The purpose of guidelines in practice is to make evidence-based standards explicit and accessible. Guidelines use a combination of both evidence and experience to educate patients and practitioners and also to recommend assessment and the management of patients in clinical situations. These guidelines require to be appraised critically just like other individual research studies and they are not meant to replace the skills and clinical judgements of the clinicians, but rather to advance or upgrade what they already know (Bury and Mead 1998). Guidelines are developed systematically to assist health practitioners in deciding on the best care for patients. The use of clinical guidelines aims to support the development (Manly and Fineout-Overholt 2005), implementation and evaluation of guidelines, and to improve patient orientation and public involvement. Clinical guidelines will soon be computerized and made compulsory for all practitioners to learn and practise so as to enhance the healthcare for the patients. Guidelines will then be implemented for all clinicians and patients will be sensitized on these as well to ensure they receive the best possible treatment. Some autonomy is essential, but too much can negatively affect the efficiency. Podiatrists and other healthcare providers are now implementing guidelines for assessment and management of foot ulcers for people with diabetes. Podiatrists find guidelines invaluable for the development of policies, procedures, protocols, educational programs and assessments to assist individuals and organizations to implement the best practice (Ryle et al. 2011). Significant barriers experienced in implementation of clinical guidelines include adapting to changes in the standard practises, resistance from other workers and distrust of the evidence or research conducted that led to the development of such guidelines (Spallek et al. 2010). Some of the guidelines contradict the scientific background in my practise, however after a while of practising and getting support from the management and other professionals I gradually adapted to the change. There are several drivers for effective evidence-based practise, some of which are: support from the management on the clinical methods, staff performance appraisal; training of staff and new recruits; and close supervision to ensure criteria are strictly followed to ensure quality healthcare (Wilkinson 2001). Issues in my health setting include negligence in which practitioners cause damage during their work, hence not attaining the desired standard of healthcare (Muldoon et al 1998). Negligence can be dealt with by making everyone accountable for their actions and ensuring they take responsibility. Lack of support from the management on clinical guidelines is a major drawback in my healthcare centre and this could be addressed by incorporating staff in decisions made in the organization. SWOT is a useful technique for understanding the strengths and weakness, and for identifying both the opportunities that exist and the threats faced. Knowing the weakness of our work as clinicians, we can manage to eliminate risks. Strengths and weakness are often internal to our clinics, while opportunities and threats relate to external factors. Some of the strengths of evidence-based practise include oncology that depends on scientific evidence, and also that evidence-based practise supports team-based work (Melnyk and Fineout-Overholt 2005). Weaknesses include the changes needed in systems that may not be accepted well by the practitioners, and also that the samples collected may not be sufficient to make effective conclusions based on the study. Opportunities include the training of current staff or the training of new recruits to the current tasks and new clinical practises (Ades et al. 1999). It is also an opportunity to interact with different patients and healthcare practitioners to gain feedback on the healthcare standards. Threats associated with evidence-based practise are that other research design methods may prove to be better in answering certain research questions. Conclusion Healthcare organizations depend on the professionalism and work drive of healthcare practitioners. As these organizations are primarily concerned with providing healthcare they should also be focused on the quality of healthcare provided. Performance in healthcare is improved when the goals and expectations are clearly defined and the feedback is given in good time. Evidence-based practise is involved in decreasing the risks experienced in healthcare and improving the outcomes of the patients. Evidence-based practise uses the current best evidence from research to improve decisions made on patient care in order to improve the outcomes. Reference List ADES, A. E., SCULPHER, M. J., GIBB, D. M., GUPTA, R. and RATCLIFFE, J., 1999. Cost effectiveness analysis of antenatal HIV screening in United Kingdom. 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SPALLEK, H., SONG, M., POLK D. E., BEKHUIS, T., FRANTSSVE-HAWLEY, J., and ARAVAMUDHAN, K., 2010. Barriers to Implementing evidence-based clinical guidelines: A survey of early adopters. Pub Med Journal. 10 (4), pp. 195-206. WILKINSON, S., 2001. Consultant appraisal scheme: barriers and success factors Clinician in Management. Vol.10 no. 1, pp. 12–14. Read More