SNUG202 Evidence Based Practice

Introduction:

The medical industry is constantly changing as there is a newer and more advanced development of interventions being researched every day. The development of newer techniques is to help and ensure that there is a progression in the medical field wherein the interventions that are being applied are helpful in faster recovery and enhancing the quality of life for the patients. There is a need for new effective methods that need to be used to routinely embed the high-quality clinical evidence into the everyday work that they are doing. However, it has been proven that it is difficult to embed these changes. There has been an international programme of research trying for many years now to meet this challenge (Chauhan et al., 2017). This can be initiated by the changes in the behaviour of the clinicians. This paper aims to discuss the methods adopted for clinician behaviour change that will adopt the new techniques and evidence-based practices for medical practice in the health care industry.

Discussion:

Part A: Educational outreach

Title appropriateness and abstract information:

The title of this systematic review is "Changing prescribing behaviours with educational outreach: an overview of evidence and practice". This is a suitable title as it has associated with the studies that have been conducted on educational outreach. It has also specified that the change in behaviours of physicians has been noted to be a difficult challenge to change. The abstract of the paper has been divided into the background, methods, results and conclusion. These are the headings that need to be a part of the abstract (Fawaz, Hamdan-Mansour & Tassi, 2018). The abstract in this paper is clear and has systematically discussed the important issue that needs to be studied. The background has stated that the physicians and general practitioners provide interventions and prescription of medications. There is a need for behaviour change required for them to adapt to the newer practices that will help improve the patients' better health outcomes. The abstract briefly discusses the methodology of the paper and the different types of papers that have been added, along with the details of the results that were identified. The paper has successfully analyzed the papers that were added and described a conclusion.

Research design:

The research design that has been followed in this study is the systematic review. In this research, the included studies were added from authentic scientific databases such as EMBASE, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, MEDLINE, PsycINFO, CINAHL and International Pharmaceutical Abstracts. There were proper search terms that were used to identify the papers to be included in the study.  There was a thorough screening of all articles specific to the research question. All articles were then uploaded to covidence, and an online software used to remove duplicate articles after screening the abstract. The research design was appropriate for the study. Many scientific and medical research studies have used systematic reviews as a research design to collect information specific to their question.

Research question:

The research question was to determine if the application of educational programs such as educational outreach effectively changes the behaviours of doctors and physicians to adopt newer evidence-based practices in their practices. There is a need for this study as it has been noted that there are many new evidence-based practices that are being formed today. However, the implementation of these practices among the health care workers is not noted to be high. The main reason for not adopting newer methods is that they are trained and set in one type of practice and find it difficult to shift practice. There is an inappropriate use of prescribed medications, especially opioids and analgesics, which can be harmful to the patient and fatal if not handled properly. Therefore, providing them with educational outreach will help them adapt and learn to implement newer practice techniques (Leach, Hofmeyer & Bobridge, 2016).

Results:

The strategy that has been considered to be most effective in helping to change the uptake of evidence-based practices is the use of educational outreach and training, according to the research carried out. There has been a substantial amount of contribution from education and training in changing the clinical decision-making, quality of care and patient outcomes, which has been well-documented. The use of education has impacted the research training as it was previously poorly established. Certain components were found to be effective in professional development, and they increase the optimization of prescriptions, and the screening rate of diseases was enhanced (Dombrowski et al., 2016). The result of using education as a strategy has been well studied, and most of the reports have stated that this strategy has produced some good outcomes concerning the health professionals as they have implemented the evidence-based practices in their practices and made the modification of ensuring that there are good health outcomes that are derived from these changes. These deliberate changes are tough to make as health care professionals. However, they have taken it upon themselves to produce good results.  

Part B: Audit and Feedback

Authors of the paper:

Title appropriateness and abstract information:

The title of this theory-based study is "Health professionals' perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units". This is a suitable title as it is a complete study on audit and feedback as a strategy that can be utilized in health care. The abstract of the paper has a distinct background, methods, results and conclusion. The abstract provides a descriptive background on health care professionals behaviour and the inability to change behaviours in adapting the new evidence-based practices.

Research design:

This was a clustered randomized trial done in an online laboratory experiment that the Control Theory guided with 72 intensive care professionals from 21 units. There was an electronic audit and feedback of the ICU caregivers' performance, and the median performance was measured. The average work and practices that were performed were the ones that the doctors and physicians were following since their training days, and there was not much change in their practices.  

Research question:

The question was to determine the impact of audit and feedback as a mechanism that will help in the behaviour change in the physicians to adopt the evidence-based practices for the better health outcomes of the patients. Additional studies have stated that there is a need for audit and feedback to be used as a strategy for evidence-based practices (Kredo et al., 2018). There is a need to research audit and feedback as behaviour changing modules (Payne & Hysong, 2016).

Results:

Health professionals have become motivated to change by audits and feedbacks that they have received that show their clinical practice is inconsistent with desired practice. Taking the feedback and audits that have proved to be advantageous in improving the quality of life and the quality of care provided. Implementing the newer evidence-based practices can be done at minimal cost in the cases where data is available beforehand. It was concluded that the audit and feedback had helped the professionals to work on the aspects that can be improved. Many health care professionals have good intentions for improvement (Jamtvedt, Flottorp & Ivers, 2019). There is a need to consider this strategy as an effective one that will help in changing the clinician's behaviour.     

Conclusion:

The health care industry is always changing and adapting to newer and modern evidence-based practices. Health care professionals are mostly aware of these changes. However, they have been apprehensive and unwilling to change their set ways and try the new different evidence-based practices that need to be implemented as studies have shown that these practices, when implemented, can help in treating the patients and providing them with better health outcomes. Patients require better care that will provide them with a chance at faster recovery and enhanced quality of care that will help the patients feel better and back to normal faster. Health care professionals should implement evidence-based practices. The behaviour change has been noted best by using audit and feedback strategy and educational training.  

References:

Chauhan, B. F., Jeyaraman, M. M., Mann, A. S., Lys, J., Skidmore, B., Sibley, K. M., Abou-Setta, A. M., & Zarychanski, R. (2017). Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implementation science : IS, 12(1), 3. https://doi.org/10.1186/s13012-016-0538-8

Dombrowski, S. U., Campbell, P., Frost, H., Pollock, A., McLellan, J., MacGillivray, S., Gavine, A., Maxwell, M., O'Carroll, R., Cheyne, H., Presseau, J., & Williams, B. (2016). Interventions for sustained healthcare professional behaviour change: a protocol for an overview of reviews. Systematic reviews, 5(1), 173. https://doi.org/10.1186/s13643-016-0355-9

Fawaz, M. A., Hamdan-Mansour, A. M., & Tassi, A. (2018). Challenges facing nursing education in the advanced healthcare environment. International journal of Africa nursing sciences, 9, 105-110. https://doi.org/10.1016/j.ijans.2018.10.005

Gude, W. T., Roos-Blom, M. J., van der Veer, S. N., Dongelmans, D. A., de Jonge, E., Francis, J. J., ... & de Keizer, N. F. (2018). Health professionals' perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units. Implementation Science, 13(1), 1-11. https://doi.org/10.1186/s13012-018-0727-8

Jamtvedt, G., Flottorp, S., & Ivers, N. (2019). Audit and feedback as a quality strategy. Improving healthcare quality in Europe, 265. https://www.ncbi.nlm.nih.gov/books/NBK549284/

Kredo, T., Cooper, S., Abrams, A., Muller, J., Volmink, J., & Atkins, S. (2018). Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa. BMC health services research, 18(1), 965. https://doi.org/10.1186/s12913-018-3778-2

Kunstler, B. E., Lennox, A., & Bragge, P. (2019). Changing prescribing behaviours with educational outreach: an overview of evidence and practice. BMC medical education, 19(1), 1-20. https://doi.org/10.1186/s12909-019-1735-3

Leach, M. J., Hofmeyer, A., & Bobridge, A. (2016). The impact of research education on student nurse attitude, skill and uptake of evidence‐based practice: a descriptive longitudinal survey. Journal of clinical nursing, 25(1-2), 194-203. https://doi.org/10.1111/jocn.13103

Payne, V. L., & Hysong, S. J. (2016). Model depicting aspects of audit and feedback that impact physicians' acceptance of clinical performance feedback. BMC Health Services Research, 16(1), 1-12. https://doi.org/10.1186/s12913-016-1486-3

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