Evidence-Based Practice A CRITICAL APPRAISAL Edited by Liz Trinder with Shirley Reynolds Black weI I Science Evidence-Based Practice A CRITICAL APPRAISAL Evidence-Based Practice A CRITICAL APPRAISAL Edited by Liz Trinder with Shirley Reynolds Black weI I Science 02 000 by Blackwell Science Ltd, a Blackwell Publishing company Editorial Offices: Blackwell Science Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Tel: +44 (0) 1865 776868 Blackwell Publishing Inc., 350 Main Street, Maldkn, MA 02148-5020, USA Tel: +1 781 388 8250 Blackwell Scicnce Asia Pty, 550 Swanston Street, Carlton, Victoria 3053, Australia Tel: +61 (0)3 8359 101 1 The right of the Author to be identified as the Author of this Work has been asserted in accordance with the UK Copyright, Designs, and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs, and Patents Act 1988, without the prior permission of the publisher. First published 2000 6 2006 ISBN-10: 0-632-05058-6 ISBN-13: 978-0-632-05058-1 Library of Congress Cataloging-in-Publication Data Evidence-based practice: a critical appraisal/edited by Liz Trinder with Shirley Reynolds. p.; cm. Includes bibliographical references and index. ISBN 0-632-05058-6 (pbk.) 1. Evidence-based medicine. 2. Primary care (medicine) I. Trinder, Liz. 11. Reynolds, Shirley [DNLM: 1. Evidence-Based Medicine. WB 102 E934 20001 RA 427. E935 2000 362.1 - dc21 99-059641 A catalogue record for this title is available from the British Library Set in 10/12.5pt Palatino by DP Photosetting, Aylesbury, Bucks Printed and bound in India by Replika Press Pvt. Ltd. The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. For further information on Blackwell Publishing, visit our website: w ww.blackwellpublishing.com Contents List of Contributors vi 1 Introduction: the Context of Evidence-Based Practice 1 Liz Trinder 2 The Anatomy of Evidence-Based Practice: Principles and Methods 17 Shirley Reynolds 3 Evidence-Based Practice in General Practice and Primary Care 35 Toby L ipman 4 Evidence-Based Practice in Mental Health 66 John Geddes 5 Evidence-Based Public Health 89 J. A. Muir Gray 6 Evidence-Based Nursing Practice 111 Richard Blomfield and Sally Hardy 7 Evidence-Based Practice in Social Work and Probation 138 Liz Trinder 8 Evidence-Based Practice in Education and the Contribution of Educational Research 163 Martyn Hammersley 9 Evidence-Based Human Resource Management 184 Rob Briner 10 A Critical Appraisal of Evidence-Based Practice 212 Liz Trinder lndex 242 V List of Contributors Richard Blomfield, RGN BA(Hons), MA Lecturer in Nursing, School of Nursing and Midwifery, University of East Anglia Rob B. Briner, BSc, MSc, PhD Senior Lecturer in Organizational Psy- chology, Birkbeck College, University of London, London John R. Geddes, MD, MRCPsych Senior Clinical Research Fellow and Honorary Consultant Psychiatrist, Dept of Psychiatry, University of Oxford J. A. Muir Grey, CBE, MD Director, Institute of Health Sciences, Uni- versity of Oxford Martyn Hammersley, BSc, MA, PhD Professor of Educational and Social Research, School of Education, The Open University, Milton Keynes Sally E. Hardy, RGN, RMN, BA(Hons), MSc Lecturer, Schools of Health (Nursing & Midwifery), University of East Anglia, Norwich Toby Lipman, MBBS, MRCGP General Practitioner and NHSE Northern and Yorkshire Research Training Fellow, Westerhope Medical Group, Newcastle-upon-Tyne Shirley A. Reynolds, BSc, MSc, C Clin Psychol, PhD Senior Lecturer in Clinical Psychology/Co-Director Doctoral Programme in Clinical Psy- chology, School of Health Policy and Practice, University of East Anglia, Norwich Liz Trinder, BA, PhD Lecturer in Social Work Research, School of Social Work, University of East Anglia, Norwich vi Chapter 1 Introduction: the Context of Evidence-Based Practice Liz Trinder Introduction The emergence of evidence-based practice has to be one of the success stories of the 1990s. In the space of ten years the movement has had a significant impact on health care and policy. In the UK there are centres, amongst others, for evidence-based medicine, evidence-based child services and mental health services. This organisational framework has been accom- panied by a panoply of practice manuals, journals and newsletters, toolkits and software packages, websites and e-mail discussion groups. The depth of influence within UK medicine has been paralleled by a breadth of expansion internationally. The movement has rapidly become a global phenomenon transcending national boundaries. An international network to support the development of evidence-based medicine has developed swiftly in the form of the Cochrane Collaboration, which now has centres in the UK and continental Europe, North and South America, Africa, Asia and Australasia. Although the emergence of evidence-based medicine has been rapid and dramatic, just as extraordi nary has been the adoption of the key concepts of evidence-based medicine in other disciplines and professions under the generic title of evidence-based practice. Over the last few years evidence- based approaches have been developed in most health fields, including evidence-based dentistry, nursing, public health, physiotherapy and mental health. Progress has not stopped there: uniquely it would appear that an approach originating in medicine is being advocated and adopted in more distant fields of professional activity, including social work, pro- bation, education and human resource management. The purpose of this book is to stand back from the flurry of excitement and activity that has accompanied the development of evidence-based practice, and to take stock of what has occurred and what challenges remain for the diverse fields of professional activity that have engaged or are beginning to engage with evidence-based practice. The book aims to address three major questions: 1 2 Evidence-Based Practice (1) What is evidence-based practice? The roots of evidence-based practice can be found in the emergence of evidence-based medicine in the early 1990s. Chapter 2 provides an intro- duction to the core concepts, processes and procedures of evidence-based medicine and should be a starting point for those who are unfamiliar with its basic principles. Over the last few years many other disciplines within and outside of medicine have adopted the 'evidence-based' tag and can therefore be considered under the generic title of 'evidence-based practice'. The book as a whole presents individual case studies to show how evidence-based practice is being developed within primary care, mental health, public health, nursing, social work and probation, education and human resource management. Each case study outlines what evidence- based practice initiatives are being developed within particular disciplines and how evidence-based practice is being defined or interpreted. One of the strengths of the case-study approach is that it makes it pos- sible to compare and contrast the varied stages of development, and varied interpretations, of the concept of evidence-based practice across the disci- plines. What becomes apparent is that in the disciplines closest to hospital medicine (general practice, mental health, public health) the development of evidence-based practice both appears to most closely resemble the original formulation of evidence-based medicine, as well as to have pro- gressed furthest. Elsewhere, the notion of evidence-based practice has been subject to considerable reinterpretation (most notably in social work and probation) and, despite the presence of some powerful advocates, has met with a higher degree of ambivalence or resistance. The appropriateness of this variation is considered in Chapter 10. (2) What are the strengths and weaknesses of evidence-based practice? Although the rise and expansion of evidence-based practice has been spectacular, it has been accompanied by considerable criticism from opponents, both in medicine and in other fields. Supporters and advocates of evidence-based practice claim that the approach results in the best practice and the best use of resources. In contrast, opponents have coun- tered with claims that evidence-based practice is a covert method of rationing resources, is overly simplistic and constrains professional autonomy. In particular, critics have pointed out that there is no evidence that evidence-based practice actually works. Contributors were therefore asked, in the case studies chosen, to outline the responses to evidence- based practice in their discipline from practitioners, managers, researchers and consumers, as well as to provide their personal perspectives on the relevance and helpfulness of evidence-based practice. What is immediately apparent is that there is limited consensus on the merits of evidence-based