Research project SO/02/021 (Research action SO)
The past five years have seen an important development in medical knowledge in the area of the ´evidence´ of specific diagnostic and therapeutic procedures. The ´Cochrane Collaboration´ is not just a symbol, but rather an efficient international think tank which has developed a solidly grounded method for seeking answers to relevant clinical questions. In a growing number of countries and regions, this ´evidence´ has been translated into ´clinical guidelines and standards´ which make a major contribution to quality assurance.
One is currently confronted with three kinds of problems in this development:
A. Conceptual problems: Most of the ´evidence´ was collected through interventions with selected groups of patients (generally in hospitals). The conclusions cannot be automatically transposed to the situation of the patient as he is seen, for example, by the family doctor.
B. Technical problems: The relationship between the results of a scientific study (e.g. randomised clinical trial) on a specific disorder among a given population and the conclusions of a meta-analysis is not always congruent; there are problems with the ´cut-off point´ concerning the ´numbers needed to treat´ . In recent years these problems have been adequately resolved.
C. Implementation: In practice, one finds that there is a ´double resistance´ vis-à-vis application of the conclusions of research on ´evidence-based medicine´ (EBM). Professionals are clearly reluctant to alter their approach and policy. It also appears to be difficult to disseminate the conclusions of ´evidence-based medicine´ to the wider population: reporting to the population on the scientific evidence that antibiotics are not effective for acute bronchitis is seen as ´communicating bad news´.
Current developments indicate that the implementation of ´evidence-based medicine´ does not contribute to greater cohesion, but rather to disruption both within the professional world and amongst the population. There is therefore a need for an integrated communication strategy with a double focus: on the professionals, on the one hand, and the general population, on the other. Internationally, those participating in the ´Cochrane Collaboration´ are keenly aware of the difficulties encountered in bridging the gap between knowledge and action. In Flanders, Minerva - an inter-university co-operative project in which the four general medicine departments of the Flemish universities are involved - tries to make general practitioners aware of the concepts and the practical implications of ´evidence-based medicine´. This team can use its expertise as a starting point for a broader approach to other groups of professionals and the public. This approach requires the development of scientifically solidly based strategies. Widening the field of action requires contacts with other health-care actors.
The objectives of this project are:
1. Development of an integrated strategy and the elaboration of adequate scenarios aimed at different target groups of health care providers, with a view to bridging the gap between concepts about ´evidence-based medicine´ and application in day-to-day practice;
2. Development of a strategy for the general population, so as to be able to explore how reports on ‘evidence-based medicine´ can be translated for the public.
The following methods are used to achieve these objectives: literature research, analysis of existing projects, focus groups and ´expert panels´, ´field research´ with scenarios concerning one specific subject among several groups of health care providers, and ´field research´ of a scenario concerning one specific subject among the general population. In this way, this project will produce a general strategic plan, a number of specific scenarios, and policy advice.
The specific tasks of the PROJECT are the following:
A. Stocktaking on the basis of (inter alia) literature research of different strategies on the national and international scale concerning the application of EBM in practice. Preparing a comprehensive list of existing projects, both national and international.
A.1 Stocktaking of strategies/projects aimed at health workers.
A.2 Stocktaking of strategies/projects aimed at population/patients.
A.3 Organisation of a workshop at an international congress with a view to drawing up an inventory of international initiatives and experiences.
B. Focus groups and consultation of experts with a view to collecting the necessary information on strategy development.
B.1 Organising and conducting focus groups.
B.2 Processing and analysing the focus groups.
B.3 Consultation of experts.
B.4 Processing and analysing the opinions of experts.
C. Development of strategy with field research; aimed at health workers, on the one hand, and the population/patient groups, on the other.
C.1 Developing and setting up field research: development of knowledge, attitude and process indicators, selection of intervention and control groups, establishment of before and after measurements.
C.2 Performance of the field research among groups of health workers and among population/patient groups.
C.3 Analysis of the data.
Op wetenschappelijke evidentie gebaseerde zorg : van theorie naar praktijk : een tweevoudige strategie : eindrapport
Van Driel, Mieke - Provoost, Siegfried - Van Paepegem, Tom ... et al Gent : Academia Press, 2003 (PB6006)
"Soins basés sur des faits scientifiques": de la théorie à la pratique: une stratégie double : résumé
Bruxelles : Politique scientifique fédérale, 2003 (SP1190)
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"Op wetenschappelijke evidentie gebaseerde zorg": van theorie naar praktijk: een tweevoudige strategie : samenvatting
Brussel : Federaal Wetenschapsbeleid, 2003 (SP1191)
[To download]
Evidence Based Care": from theory to practice: a dual approach : summary
Brussels : Federal Science Policy Office, 2003 (SP1192)
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