Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part G Moving from Evidence to Action
Chapter 22.7. Changing Behavior to Apply Best Evidence in Practice
Deborah J. Cook, Richard J. Wall, Robbie Foy, Elie A. Akl, Gordon Guyatt, Holger J. Schünemann, Lee Green, J. Randall Curtis
Back to the Clinical ScenarioPart 3
beta-blocker, clinician behavior, data collection, evidence-based medicine, evidence-based practice, heparin, measures of outcome, myocardial infarction, observational studies, teaching issues, thromboprophylaxis, venous thromboembolism
"There are substantial gaps between best evidence and its
application in practice. Glasziou and Haynes3 estimated
that as few as 20% of effective interventions may
actually reach patients. Changing clinician behavior to ensure implementation
of best evidence in practice is challenging. In this chapter, we
do not outline how to critically appraise a specific type of study.
Instead, we outline 10 steps to achieve this goal (Table
22.7-1). Our approach is pragmatic, based not only on the published
evidence but also on our own experience.The goal of a project to change clinician behavior and implement best evidence can
be summarized using the patient/intervention/comparison/outcome (PICO)
format (see Chapter 3, What Is the Question?).
In this case, one can frame the question as follows: for clinicians
caring for hospitalized surgical patients (population), do behavior
change strategies (intervention), compared with no active implementation
(comparison), increase the use of appropriate heparin thromboprophylaxis
(outcome)? Many problems are framed in quality improvement literature
as so-called indicator conditions, a term used to reflect a state,
diagnosis, disease, or symptom for which there is sound
evidence about a beneficial intervention that is targeted for improvement.
The indicator condition in this case is general surgery.After rounds the next day, you meet with the medicine nurse manager.
She suggests that case management rounds could be a useful weekly
venue to focus on effective thromboprophylaxis. You then meet with
the pharmacy director, along with 2 pharmacy interns just starting
clinical placement on the surgical wards. They envision exciting
opportunities for their department, asking whether you could supervise
aspects of this project as part of a pharmacy internship program. ..."
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