Project Methodology 5
The importance of relating clinical practice more closely to evidence, including research evidence, is increasingly influencing the thinking of health-care professionals across the world and this is changing the whole culture of information use in support of patient care. It has been shown that, where evidence is used in a methodical and properly considered way, it can change clinical practice and affect patient outcomes[i].
There is a firm commitment to improve the funding of the NHS through additional expenditure and reorganisation so as to focus resources onto care delivery[ii]. Nevertheless, choices between competing priorities and forms of treatment will still be required. Given the limited time available to health professionals[iii], the frequency with which they require information[iv] and the emerging importance of clinical governance[v],[vi], these decisions need to be informed by the presentation of current and valid information which is both concise and readily accessible.
Background to the Health Evidence Bulletins - Wales
The original Protocols for Investment in Health Gain, written in the early 1990s, suggested areas where the introduction, or more widespread use, of certain practices could lead to worthwhile improvements in health for the people of Wales. The documents also highlighted current practices which were of questionable value. Twelve subject areas were covered.
Influential commentators, whilst welcoming the Protocols in principle, noted that the statements contained in the documents were not always clearly linked to the evidence[vii]. As new approaches to clinical effectiveness and evidence-based practice began to emerge a review of the Protocols was proposed by the Chief Medical Officer. This resulted in the Health Evidence Bulletins - Wales Project which began in June 1995 to prepare clear statements classified according to internationally recognised systems with a precise indication, for each statement, of the sources and type of evidence.
The Bulletins act as signposts to the best current evidence across a broad range of evidence types and subject areas. Where evidence from randomised controlled trials (and systematic reviews/meta-analyses derived from such trials) is available, it is included. However, many health issues do not easily lend themselves to investigation, or have not yet been studied, by randomised controlled trial. In these cases, high quality evidence has been sought within the other evidence types. A substantial part of this evidence, much of it qualitative, is particularly relevant to nurses and the professions allied to medicine, and within the primary care sector[viii].
The Methodology used in the project is presented in two sections. The first outlines the stages in the process from defining the task to disseminating the resultant Bulletins. The second section (the Appendices) contains the documents (search strategies, critical appraisal check-lists etc.) developed to support the process. This Methodology 5 has been adapted from earlier Methodologies[ix] by drawing on the experiences of all those who have worked on the project. Specific comments on the Project Methodology have been received from Margot Greer, Dinah Roberts and David Fone of the National Public Health Service for Wales (NPHS) and their help is gratefully acknowledged. The Project is co-ordinated at the Division of Information Services, UWCM under the direction of Dr William Ritchie (NPHS).
[ii] Ham, C. The future of the NHS. British Medical Journal. 1996; 313: 1277-1278
[iii] Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine. How to practice and teach EBM. New York: Churchill Livingstone, 1997 pp. 8-9
[iv] Smith R. What clinical information do doctors need? British Medical Journal. 1996; 313: 1062-1068
[vi] Putting Patients First. Framework Document. Cardiff: National Assembly for Wales, 1999
[vii] Gabbay J, Stevens A. Towards investing in health gain (editorial). British Medical Journal. 1994; 308: 1117-1118
[viii] Jacobson LD, Edwards AGK, Branier SK, Butler CC. Evidence-based medicine and general practice. British Journal of General Practice. 1997; 47: 449-452
[ix] Barker J. Project for the enhancement of the Welsh Protocols for Investment in Health Gain: Project Methodology. Cardiff: Duthie Library UWCM, 1996; Weightman AL, Barker J, Lancaster J. Health Evidence Bulletins Wales. Project Methodology 3. Cardiff: University of Wales College of Medicine, 2000; WeightmanAL, Barker J, Lancaster J. Health Evidence Bulletins Wales. Project Methodology 4. Cardiff. University of Wales College of Medicine, 2001.
AIMS AND OBJECTIVES
It is anticipated that the Bulletins will be of value in a wide variety of settings:
To assist Local Health Boards and the Welsh Assembly Government with the planning and commissioning of health care;
To inform clinical practice;
To identify areas for further research;
In continuing education and audit; and
In the development of educational curriculae.