Evidence Based Practice Its relevance and contribution to Social Work - Essay Example

Evidence Based Practice Its relevance and contribution to Social Work April 17, 2007 Evidence Based Practice (or EPB) is one of the methods to use information that is available in order to decide treatments for clinically ill patients. It becomes imperative in this case to actually attain correct information and take the right decisions. The paper discusses evidence based practice and talks about its relevance and contribution in social work. Five sources are appended in the end, in APA format. Evidence Based Practice Evidence Based Practice (or EPB) is primarily a tool that can be helpful in taking decisions for clinically ill patients and helping them. Evidence Based Practice basically provides a data regarding the concerned issue to the Social Workers about the related issue, human welfare, human services, related areas, social policy and community development. The practice can be used through the information available and taking effective decisions. In order to define evidence based practice, it can be aptly stated that EBP is a “conscientious, explicit, and judicious application of best research evidence to a range of domains: clinical examinations, diagnostic tests, prognostic markers, and the safety and efficacy of interventions whose purposes may be therapeutic, rehabilitative, or preventative, with therapeutic interventions understandably getting most of the attention.” (Gilgun, 2005) Social work involves not only safety, preventive intervention and other aspects, but also research in order to find better and more effective ways of diagnosis, examination and clinical help. The process is not as simple as it seems as it not only depends on the evidences present but on the circumstances or situation of the patient. There is no standardized procedure that could be applied to all patients, but it needs to be flexed as per the attendant’s requirements. This complexity makes it even harder for Social Workers to analyze the data and make complete sense of it. Despite making the ultimate decision with utmost concern and research, there are still certain uncertainties and improbabilities that need to be taken into account before making the decision. It is a method being used since the past many days in order to make the best decision possible for the doctor. This concept negates or overrules the notions of rule of thumb, tradition or folklore. Evidence Based Practice is dependent on repetitive research and data gathering rather than one time observations, rules or traditions. This concept is not a new phenomenon but has been studied in universities since the past three decades and is slowly but gradually paving its way into the public sector. It has been a revolution in the field of conventional medicine as it uses the patient as a starting point to the long process of diagnosis. Apart from psychiatry, the Evidence Based Practice is also being used in the field of health care, juvenile justice and social care. However, the separate clinical field based on Evidence Based Practice is known as Evidence based clinical practice (EBCP). “Evidence based clinical practice is an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best” (Gray, 1997). Evidence based clinical practice is no cook book for curing the patients, in fact it is a bottom up approach which uses patient as just the initial step towards the determination of the illness. The doctor is aware of the strength that each evidences holds in the cure of the patient’s illness. This practice is not an easy target to achieve but in fact requires the full fledge development of research department and other factors also function side by side in accordance with it. However, “there is a dearth of high quality research from which evidence-based guidelines can be drawn, but this offset by a wealth of clinical experience” (Goodair, 2005.) Evidence Based Practice has paved way for rationale in the procedure of cure rather than mere imposition of similar past practices on all analogous patients. The Evidence Based Practices, also known as Best Practices can be made even better if the research is designed with analysis behind it. The procedure just doesn’t stop at the diagnosis or control of the illness but also requires proper assessment of effectiveness after the completeness of the task. Since the entire task is based and revolves around evidence, therefore it is highly important for the evidence to be absolutely accurate and exact or else the relevance or correctness of the research would be doubtful. Hence, this is an emerging field which can be applied in many different genres and if paid proper attention to, would yield a highly beneficial result. However, cent percent of the critiques do not agree with it but “even those who doubt the value of an evidence-based approach are under increasing pressure from healthcare funding bodies who demand evidence of clinical effectiveness and healthcare consumers who are far better informed and much more questioning than ever before” (Foxlee, 2003.) Social Work – More Reflexive than Objective Evidence Based Ideas is basically based on ideas that are derived from optimal mannerism in a planned environment. There are two ways of assessing or evaluating an issue. The epistemic procedure that is involved in planning and psychological interference, it is said that heuristic devices are what make the decisions rather than the evidences themselves. However, the Heuristic model states that the decision making is reflexive, spontaneous, indeterminate, locally optimal and based on a limited rationality. It is claimed that social workers indulge into reflexive decision making rather than proving a point via rational process through evidences. However, the authenticity of something like decision making cannot be determined or is not subjected to control. The tendency of separation of Facts and Values in the Evidence Based Practice undermines the importance of judgement and understanding that is involved by the Social Workers. Schizophrenia and Evidence Based Practice Evidence Based Practices is highly utilized in the field of clinical diseases as well and Schizophrenia is a highly prevalent disorder commonly found among individuals in most part of the world. Schizophrenia is a mental disorder that creates the mutilation of reality due to dysfunctional social or occupational activities. A person diagnosed with Schizophrenia is expected to have unorganized thought processes and audible and visible hallucinations. Here are many reasons for its occurrence and there are many steps before it is actually diagnosed. Hence, it is not an ordinary disorder but something that needs to be taken into account with all the data at hand and research that can be done. Social Work has contributed a lot towards this disorder by catering to these people and Evidence based Practice has helped reduced the cost. It is an increasing concern in the society which needs to be addressed by the concerned authorities in the shortest time period possible. Young to old, people from all age group are affected by this mental illness from all race and geographical background. Evidence Based Research would help in the facilitation of provision of a better treatment to these patients and giving them a hope for a better and improved lifestyle if not completely cured. Since, before this practice, there has been numerous cases regarding this illness, therefore it shall not be difficult to accumulate evidences regarding Schizophrenia. Already there are linkages being developed between the two, that is, the disease and the Evidence Based Research for Schizophrenia. This kind of research has taken a strong hold in the psychiatric department and its research methodologies. “Evidence-based treatment is today’s clarion call for psychiatry. At its best, this standard leads to rejection or acceptance of treatments on the basis of scientific documentation of efficacy. In schizophrenia, this standard has almost eliminated treatment with psychotherapy to the exclusion of pharmacotherapy, and exploratory/insight-oriented psychotherapy and treatment based on psychogenic etiology have given way to psychosocial treatments with scientific documentation of efficacy” (Carpenter, 2001.) Due to the intricacies of this illness, it is considered to be a vast subject that constantly has a ground to be explored. This is an evolving field which requires deeper studies in order to create best possible curing prescription for the patient. Hence, it wouldn’t be inappropriate to state that this kind of research based on evidence is of high relevance in the field of psychiatry and more so Schizophrenia because it is a prevalent disease that has wide margin for deeper exploration. The reason for paying more attention to this mental illness especially is because it has a hope for giving the patient a close to normal lifestyle. We have had examples in the past pf Schizophrenic patients such as Sir John Nash who have gone on to won the Nobel Prize, hence being no less than any other intellectual being despite the haywire thinking and audible and visible hallucinations. Therefore, a little more attention to this field may lead it to even better results. Schizophrenia Patient Outcomes Research Team (PORT) Case Study based on Evidence Based Research There is a lot of work being done in this particular field of Psychiatry and Evidence Based Research. One such example of such research is the Schizophrenia Patient Outcomes Research Team (PORT), which a study to understand the different patterns of Schizophrenic Patients under the light of the scientific knowledge and the evidences present. The result of this prolonged and comprehensive study gives out the critical information which may improve the care and the quality of life that these patient can have. This is a layout to the clinicians; patients as well as their families a treatment plan in search of a better life. It determines the effectiveness as well as the cost effectiveness of the treatment being offered to the patients. In the course of this research, there were several facts disclosed which came as a shock to the field of medicine which has supposedly advanced a lot in the p0revious years. “The schizophrenia PORT identified room for improvement in the care of people with this devastating disease. Dr. Lehman and his team found that less than 50 percent of patients are receiving appropriate doses of antipsychotic medications. They also found gaps in the use and availability of psychosocial and vocational therapies and family interventions.” (Eisenberg, 1998). The foremost step was to identify quality evidence for the course of this research in order to gain quality results which may benefit the patient at the end of the entire research ordeal. It provides the way and methods of improvement between the gaps of what we usually do and what actually should be done for these patients. These ate the two steps that need to be done in order to reach to the third most important one, which is the provision of quality care to these patients. “The third step is the adoption and implementation of this evidence into all aspects of care for people with schizophrenia. This includes community-based care, family education and support, and proper medication. Dr. Lehman and his team emphasize the importance of therapies and interventions other than medication” (Eisenberg, 1998.) However, despite the findings, patients under each group cannot be generalized as a single category as each patient brings along individuality and needs to be dealt as per his or her personal characteristics. Hence, the findings help in the provision of better quality of care to these patients but even then each individual’s case needs to be analyzed separately rather than giving similar treatment to a particular kind of patients. Since the research was based on sample as the entire population was not feasible to examine, therefore there is always a margin of error available that should be kept in mind while making a decision based on this kind of Evidence Based Research. The patterns that were observed were considered to be substandard and with the advent of this research, new methods can be formulated. This was a step to fill the gap between the practice of what is being done substandard and what actually should be done for the patient’s betterment. Facilitation or Hindrance in the Implementation of Evidence Based Research As in every method, the Evidence Based Research also faces the dilemma of certain hindrances and there are several factors that pave way for its success as well. The foremost factor that gives it an edge over other methods is its authenticity. Since, it is based on evidences and relies of real world cases; therefore it takes into account all the practical factors and can be counted as a reliable source of Research. However the drawback includes that: “In addition to a paucity of data, another problem is that clinical trials are concerned with group effects, and what is best for the group may not be best for the individual. Clinical trials rely on narrowly defined outcome measures in selected patients, while the treating doctor must consider all aspects of each case without exclusion of complicated cases or those with uncertain diagnoses.” (Carpenter, 2001.) There are certain cases when the challenge of unavailability of data would be faced and since the entire research is based on evidences and reliable data therefore research is incomplete without it. Hence, in those times of lack of data, the evidence based research is not viable to depend upon as it may lead to inaccurate data. Along with that there is a big gap between the traditional way of handling these patients and now the new discoveries made. It has been found out that the traditional ways lag certain ways which were required to give these patients the best care for their speedy recovery. To make the doctors agree to their mistakes and adopt the new way may also act as hindrance in the way of its success. There is a difference in the decision making of those who rely on folklore ways and those who are updated with the new Evidence Based Research. “Clinicians make decisions for each individual patient. Group results from study cohorts are invaluable for primary treatment efficacy questions, but evidence-based therapeutics depends on knowledgeable and wise clinicians to translate data into individualized treatment” (Carpenter, 2001.) As discussed before, these patients suffering from such a disturbing disease have different characteristics depending on their personal traits, therefore they need to be handled individually making the latter method of reliance on Evidence Based Research for individual treatment more authentic than the prior one making it one of its other strengths. The research conducted is based on concrete methods of evaluations and the results are considered to be almost close to perfect since the calculation are based on algorithms rather than pure judgement. This non-involvement of personal opinion or judgement adds to its authenticity and therefore its strength. The medicine prescribed for the procedure for these patients are to promote efficacy among the Schizophrenic patients but the difficult part is the determination of the amount and duration of the medicine. The traditional ways however may prescribe to give similar kind of patients same dosages and group them into one category but the evidence based therapeutics make sure that despite of giving the same medicines they individualize it as per the patient’s individuality and personal traits in order to make the procedure more effective and fast for the patient’s high quality care. This is an example of its strength and a mean of its success in the future. Usefulness or Relevance Evidence Based Practice in Social Work “Social Work and Evidence-Based Practice will enable practitioners, managers and policy makers to deepen and coordinate their understanding of the key themes in evidence-based practice.” (Smith, 2004). This is the most reliable mean to authenticate the process of research as it is based on practical examples from the real world. It brings in the practical aspect rather than theoretical explanation and analysis of data. Due to the delicate handling that schizophrenic patients needs to go through, it is important that the procedure of their handling is properly researched in order to treat them in the most accurate manner possible. References Carpenter, W.T. (2001). Evidence-Based Treatment for First-Episode Schizophrenia? The American Journal of Psychiatry. 158:1771-1773. Eisenberg, J. (1998). Schizophrenia PORT Results Provide Evidence-based Treatment Information. National Press Club, Washington, DC. Foxlee, R E. (2003). Supporting evidence-based practice: continuing professional education for Australian health librarians. 9th Specials, Health and Law Libraries Conference. Herston Medical Library, University of Queensland, Brisbane, QLD. Gilgun, J. (2005.) The Four Cornerstones of Evidence-Based Practice in Social Work. Research on Social Work Practice 15; 52 Goodair, C. (2005) Focus: Evidence Based Research. Retrieved on 17 April 2007 from http://www.drugscope.org.uk/wip/7/PDFS/blogevidence.pdf Muir Gray JA. (1997). Evidence-based healthcare: how to make health policy and management decisions. London: Churchill Livingstone. Smith, D. (2004). Social Work and Evidence-Based Practice. ISBN: 9781843101567. Read More