Samrehab, Värnamo Hospital, Värnamo, Sweden.
Int J Evid Based Healthc. 2012 Jun;10(2):117-25. doi: 10.1111/j.1744-1609.2012.00263.x.
Healthcare today is a complex system with increasing needs of specific knowledge of evaluation of research and implementation into clinical practice. A critical issue is that we all apply evidence-based practice (EBP) with standardised methods and continuing and systematic improvements. EBP includes both scientific and critical assessed experience-based knowledge. For the individual, this means applying evidence-based knowledge to a specific situation, and for the organisation, it means catering for a systematic critical review and evaluation and compiling research into guidelines and programmes. In 2009, the County Council of Jönköping had approximately 335,000 inhabitants and the healthcare organisation had more than 10,000 employees. As the County Council actively promotes clinical improvement, it is interesting to explore how healthcare employees think about and act upon EBP. The aim of this survey was therefore to describe factors that facilitate or hinder the application of EBP in the clinical context.
A quantitative study was performed with a questionnaire to healthcare staff employed in the County Council of Jönköping in 2009. The questionnaire consisted of questions concerning which factors are experienced to affect the development of evidence-based healthcare. There were 59 open and closed questions, divided into the following areas: • Sources of knowledge used in practice • Barriers to finding and evaluating research reports and guidelines • Barriers to changing practice on the basis of best evidence • Facilitating factors for changing practice on the basis of best evidence • Experience in finding, evaluating and using different sources of evidence. The participants were selected using the county council's staff database and included medical, caring and rehabilitative staff within hospitals, primary care, dentistry and laboratory medicine. The inclusion criteria were permanent employment and clinical work. Invitations were sent to 5787 persons to participate in the study and 1445 persons answered the questionnaire.
Knowledge used in daily clinical practice was mainly based on information about the patient, personal experience and local guidelines. Twenty per cent answered that they worked 'in the way they always had', and 11% responded that they used evidence from research as a basis for change. The participants experienced that EBP was not used enough in clinical healthcare and explained this with practical and structural barriers, which they thought should be better monitored by the organisation and directors.
Overall, the results indicate that the scientific evidence for healthcare is not used sufficiently as a base for decisions in daily practice as well as for changing practice. This is more prominent among assistant staff. As a consequence, this might affect the care of the patients in a negative way. Increased awareness of EBP and a stronger evidence-based approach are keys in the ongoing improvement work in the county. Local guidelines seem to be a way to implement knowledge. But, as the arena of activities is complex and the employees have diverse education levels, different strategies to facilitate and promote EBP are necessary.
如今的医疗保健是一个复杂的系统，对评估研究和将其实施到临床实践中的特定知识的需求不断增加。一个关键问题是，我们都在应用循证实践（EBP），采用标准化方法并持续进行系统改进。EBP 包括科学的和经过批判性评估的经验知识。对于个人而言，这意味着将循证知识应用于特定情况，而对于组织而言，这意味着需要对循证知识进行系统的批判性审查和评估，并将研究纳入指南和计划中。2009 年，约有 335000 名居民居住在延雪平省议会辖区内，医疗保健组织拥有超过 10000 名员工。由于该省议会积极推动临床改进，因此了解医疗保健员工如何看待和实施循证实践是很有趣的。因此，本调查旨在描述促进或阻碍临床环境中循证实践应用的因素。
这是一项在 2009 年对延雪平省议会员工进行的定量研究，使用问卷调查的方式进行。该问卷包含有关哪些因素会影响循证医疗保健发展的问题。问卷共包含 59 个开放和封闭问题，分为以下几个领域：•在实践中使用的知识来源•查找和评估研究报告和指南的障碍•根据最佳证据改变实践的障碍•根据最佳证据改变实践的促进因素•查找、评估和使用不同证据来源的经验。参与者是通过省议会的员工数据库选择的，包括医院、初级保健、牙科和实验室医学中的医疗、护理和康复人员。纳入标准为长期雇佣和临床工作。向 5787 人发出参加研究的邀请，有 1445 人回答了问卷。
日常临床实践中使用的知识主要基于患者信息、个人经验和当地指南。20%的人回答说他们“一直按照自己的方式工作”，11%的人回答说他们使用研究证据作为改变的基础。参与者认为循证实践在临床医疗保健中没有得到充分应用，并解释说这是由于实际和结构障碍造成的，他们认为这些障碍应该由组织和主管更好地监测。
总体而言，结果表明，医疗保健的科学证据没有被充分用作日常实践决策以及改变实践的基础。这在助理人员中更为明显。因此，这可能会对患者的护理产生负面影响。提高对循证实践的认识和采用更强有力的循证方法是该省持续改进工作的关键。当地的指南似乎是实施知识的一种途径。但是，由于活动领域复杂，员工教育水平参差不齐，因此需要采取不同的策略来促进和推广循证实践。
