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Currently evidence based approaches have gained prominence in the fields of health and social care. A major motivation for the increased use of these approaches in the aforementioned areas is their ability to assist professionals in these disciplines make better and faster decisions in their every day practice. The inception of evidence-based practices in medicine is linked to a general practitioner named Archie Cochrane who was concerned that more often medical intervention is not based on the most current evidence.These approaches seek to reduce the gap between research and practice by emphasizing on the use of practical methods that make medical interventions to be efficacious. Advances in science, engineering, increasing technological advancements and social change due to globalization is likely to reinforce the use of evidence based approaches in health and social care practices now and in the near future.
The definition of evidence is contested because its meaning vary across the fields of health to social care. In health, the term is generally used to refer to findings from formal scientific research like randomized clinical trials (RCTs), perspectives assembled through the process of consulting with service providers, users and people who act as care givers and knowledge gained through experience. The term evidence is also frequently used to refer to theoretical frameworks used in different practice settings of health. In social care it is used to mean the impacts of particular social services in peoples well being or welfare (Shemmings, D&Shemmings, Y, 2003, p.111).
Lewis (2002, p.166-168) explains that the meaning of evidence in social care differs from that used in medicine because the concept of evidence based practice was first used in medicine and particularly in drug testing and in the development of similar interventions.Because of the nature of the model in the health sectors, it becomes difficult to set up Randomized Clinical trials in social services provision. She further notes that research in social care is mostly based on individual professional judgment which is often determined under complex circumstances.Therefore what can be regarded as evidence in social care research is subjective to the peoples views or interpretation of the research findings. Experiential knowledge gained through practice (practice wisdom) and experience influences greatly on how people interpret research findings.Factoring all these aspects, evidence in social care can be said to be a constitution of the research findings, practice wisdom and the experience of the person doing the interpretation of research findings.
According to Upshur, VanDenkerkhof and Goel (2001, para 1), evidence based health care approaches are mainly based on clinical epidemiology and internal medicine. They identify that evidence used in evidence based healthcare can be classified into four main types which are closely related. These classes of evidence include; Qualitative personal, Qualitative general, Quantitative General and Quantitative personal. The use of qualitative methods in clinical and biomedical research is relatively new compared to experimental and observational quantative methods that have been traditionally used in clinical and biomedical research. However qualitative methods have come to be widely accepted in medicine in the past ten years (Pope& Mays, 2006, p.3-4) Qualitative research in health care mainly seeks to establish the meanings people attach to social experiences. Findings are then integrated in various medical interventions. Personal qualitative evidence is derived through the use of qualitative methods to obtain information from specific individuals while general qualities evidence is got by using qualitative research methods to capture desired data or information from diverse groups of people.
Qualitative evidence has made it possible to assess and evaluate health services and emerging medical technologies.Qualitative evidence can be realized in a short time span because the process of planning and carrying out the research is actually shorter compared to quantitative researches which are often carried out in phases. The main weaknesses linked to the use of qualitative evidence are that processing of qualitative data is often cumbersome and difficult. Qualitative evidence is also limited to a small number of respondents because qualitative researches of ten involve small number of participants; some argue that qualitative evidence does not meet the statistically significant threshold like evidence derived from quantitative research(Pope &Mays, 2006, p.82)
Quantitative evidence is mainly obtained through quantitative studies and the major emphasis is on data that can be analyzed by using conventional statistical processes. The advantages of using quantitative evidence is that it is possible to investigate relationships between two or more variables through correlation research, establish causal relationships, their nature and significance through Quasi experimental studies and also establish causality of phenomena through experimental ,randomized controlled clinical studies( Grove,2005, p.25). Quantitative evidence takes little time to analyze and is easy to understand the processed data. It is possible to obtain quantitative evidence that is statistically significant and one that can meet a specific threshold because it is possible to include many people in quantitative studies.The main weaknesses of quantitative evidence is that most of the studies used to generate the evidence are carried out in phases and this takes time. The cost involved in undertaking quantitative research on a large scale is enormous. A good example is studies involved in the development and clinical trials of new drugs.
Various concerns regarding the use of evidence based practice in health and social are ingrained in the meaning of evidence in relation to social and health care settings. Conceptual problems revolve around questions whether evidence to inform practice can be trusted, whether evidence will always be applicable and whether evidence gathered from a large population can be generalized to individuals. Another conceptual concern is the objectivity of the data and practitioners and the question whether researchers are biased or not. A common conceptual argument has been that the processes of establishing outcome measures and evaluation are highly politicized and therefore not wholly credible (Shemmings, D&Shemmings, Y, 2003, p.115).
Similarly pragmatic concerns regarding how evidence should inform practice have been raised. One of them is the question whether the evidence will always be available, the availability a lot of evidence has raised concern that maybe the evidence is of poor quality.some people have argued that using pieces of information regarded as right while discarding those assumed to be wrong does not necessarily result in changes in practice. Some point out that good intervention can be disregarded simply because they produce enough evidence; this can be seen as a limitation to promoting creativity and innovation in practice. Finally, a pressing concern is whether evidence based practice would always take into consideration the other forms of knowledge acquisition (regarded more as unconventional) like practice wisdom, use of theoretical paradigms and feedback form users (Shemmings, D&Shemmings, Y, 2003, p.115).
Despite these challenges that make evidence based practice in health and social care seem like impossible, evidence based practice is associated with numerous benefits. Shemmings, D&Shemmings, Y, 2003, p.115) for example outline that evidence based practices have resulted in numerous benefits in social care provision. These benefits are; evidence based practice provides a simple means of evaluating research evidence; it has resulted in identification of research that directly addresses the concerns of service users and workers as well. Through acknowledgment that there different form of evidence and that some are better than others, managers and supervisors are able to integrate their professional judgment and experiences in decision making. The result of this integration made possible through evidence-based experience is enhanced decision making. In addition to the above, the approach has made decision making more explicit and open to questioning and examination. All these advantages have in turn been condensed into better social care services to all welfare users.
On the other hand, evidence based practice in health care has its own benefits. Taylor(2000, p.135)explains that evidence based practice in health care brings great benefits to the health professional, the department providing health services and to the patients as well. He continues to explain that through evidence based practice, health professionals are able to upgrade their knowledge in the area of practice. Professionals also become well versed in research methods and in practices. Evidence based practices also helps in building professional competence among health practitioners through improving their computer literacy and data management skills and encouraging practitioners to improve on their reading habits. Similarly, practitioners improve their management skills and become more confident in their practice. Departments offering health services gain through increased participation by employees in departmental activities that require team effort. Evidence based practice also creates frame works that help in group problem solving and enhances teaching and learning within the groups.
Evidence based practice in medicine has made it easier to address emerging clinical questions by enabling professional bodies involved in the management of health matters to make good decisions.it has for example provided a decision making frameworks that are being commonly used to facilitate the making of complex decisions by conflicting groups such as academic clinicians, primary care physicians, and other experts. These kinds of frameworks also enable professional bodies to develop more transparent working processes and establish guide lines and standards that bring about efficiency in how such bodies go about in accomplishing their responsibilities. Patients benefit through receiving communication and explanations about the rationale behind particular medical interventions, this helps them in making decisions whether to accept one particular intervention or not. Evidence based approaches also promote the proper use of resources and this is beneficial to patients as it ensures that services are available whenever needed and that they are also reliable.
Since evidence based practice demands that physician continuously monitor and evaluate their own practice and the intervention they offer to their patients, patients can benefit through this because the physician is able to promptly change or adjust a treatment strategy that is not working for the patient. Evidence based practice is here to stay and since it involves everyone involved in the provision of health and social services , positive developments should be anticipated in the standards of care provision.
Reference List
Grove, S.K.2005.The practice of nursing research: conduct, critique, and utilization.5th Ed. Missouri: Elsevier Health Sciences.
Lewis, J.2002.The contributions of research findings to practice Change. In: Reynolds, J. Ed 2002. The managing care reader. London: Routledge.Ch.20.
Pope, C&Mays, N.2006. Qualitative research in health care.3rd ed. Massachusetts Wiley-Blackwell.
Shemmings, D& Shemmings, Y. 2003.Supporting evidence based practice and research-mindedness. In: Seden, J&Reynolds, J, Ed.2003. Managing care in practice.London:Routledge.Ch.5.
Taylor, M.C.2000. Evidence-based practice for occupational therapists. Massachusetts: Wiley-Blackwell
Upshur, R.E.G, VanDenkerkhof, E.G &Goel, V.2001. Meaning and measurement: an inclusive model of evidence in health care. Journal of Evaluation in Clinical Practice. [E-Journal]. Volume 7, Number 2, pp. 91-96(6), Abstract only. Web.
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