Exploring evidence-based occupational therapy

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Exploring evidence-based occupational therapy Powered By Docstoc
					   Dr M Clare Taylor
Coventry University, UK
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   Evidence-based practice
   Evidence-informed practice
   Evidence-inspired practice




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   Evidence-based practice




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Evidence-based medicine
 The conscientious, explicit and judicious use
  of current best evidence in making decisions
  about the care of individual patients
                                       Sackett et al, 1996: 71




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Evidence-based health care
 An approach to decision-making in which the
  clinicians uses the best evidence available, in
  consultation with the patient, to decide upon
  the option that suits the patient best
                                        Gray, 2001: 17




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   Evidence-informed practice
   Evidence-inspired practice




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   Evidence-informed practice
       The practice of a range of professionals whose
        decisions are grounded in a sound knowledge of
        the needs of service users. This knowledge is
        informed by the best available evidence of what is
        effective, the practice wisdom of professionals
        and the experience and views of service users.
                                   Research in Practice, 2005: 14




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   Evidence-inspired practice
       Does it work?
       How well does it work?
       How does it work?

                                             Michie & Abraham, 2004




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Evidence-based occupational therapy (EBOT)
 Client-centred enablement of occupation
  based on client information and a critical
  review of relevant research, expert
  consensus and past experience
                  CAOT, ACOTUP, ACOTRO, & PAC, 1999




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So, what really is evidence-based/
  informed/inspired practice?

   Doing the right things right
                                     Gray, 2001: 20
   Asking the ‘right’ questions
                                       Cusick, 2001
Supported by appropriate, sound, evidence




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   Evidence-based practice
       Health care
       Simple interventions
       Hierarchy of evidence
         Emphasis on RCTs & SRs
   Evidence-informed practice
     Social care
     Complex, multi-faceted interventions
     A variety of evidence
     The consumer voice



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   Evidence-based                         Evidence-informed
        hierarchy                                range
     Guidelines                             Organisational
     Systematic reviews                      knowledge
     RCTs                                   Practitioner
                                              knowledge
     Other experiments
                                             User knowledge
     Descriptive
                                             Research knowledge
     Expert consensus
                                             Policy knowledge
     Respected opinion



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   Different questions need different types of
    evidence

   All evidence needs to be critically appraised
    and reviewed




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   Perceived barriers
     Lack of appraisal skills
     EBP is a low departmental priority
     Limited management support
     Lack of time
     Limited awareness of and access to research
     Isolation from like minded colleagues
     How to apply evidence in practice?




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   Inspire and inform ‘EBP champions’
   Educate and support the ‘early adopters’
   Find ways of translating the evidence:
       CAPs
       CATs




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Critically Appraised Papers
 Structured summary of a
  published paper
 Critical commentary of the
  strength of the evidence
  and its application
        by a clinician




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Critically Appraised Topic
 Short summary of evidence

 Less rigorous that a
  systematic review
 ‘Clinical’ question

 Overview of the search

 Appraisal of the papers

 Summary of the best
  evidence

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   Creating the evidence
   Using the evidence




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   Intervention effectiveness
       Sound designs
       Clear, relevant, outcome measures
       Clearly defined interventions
   Service user perspectives
   Practitioner knowledge
       Critical reflection on practice




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ask -> find -> appraise -> act -> evaluate
 Individual
       Be a critical consumer of evidence
   Group
       Start a journal club
   Department/organisation
       Develop an EB culture
                               informed by Walter et al, 2004




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   EBOT strategy &                             Journal clubs
    mission statement                           EB reflection & supervision
        Give people time
    
                                                Action learning sets
    SWOT analysis
                                                 Developing EB case studies

                                            
       Identify EBOT
        knowledge & skills, &                   EB audit
        any gaps                                Developing an EB resource
       Workshops to develop                     file/library
        specific EBP skills, e.g.:
                                                Developing or using EB
         searching
         appraisal
                                                 guidelines


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   Pre-contemplation
       No plans to change
   Contemplation
       Thinking about change
   Preparation
       Seeking information
   Action
       Process of learning & change
   Maintenance
       Permanent change
                                   Prochaska & DiClemente, 1983

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Types of people:
 Innovators
       Often isolated and distrusted
   Early adopters
       Opinion leaders and champions
   Early majority
       Traditional views, but able to change
   Late majority
       Reluctant to change
   Laggards
       Change has to be forced on them
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   Asking the ‘right’ questions
   Finding and using a variety of evidence to
    inform decision-making

   Critically exploring the role of OT for today
    & tomorrow




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           P=MxC
               B

           P = performance
           M = motivation
           C = competence
           B = barriers
                     Gray, 2001: 13




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                What are YOU
                 going to o to
                 become a more
                 evidence-based
                 OT?
                    Locally?
                    Nationally?
                    Internationally?




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Tusen takk for deres oppmerksomhet




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                                     31
    Dr M Clare Taylor
m.c.taylor@coventry.ac.uk
  +44 (0)24 7688 7068

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posted:10/13/2012
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