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Evidence Based Chronic Disease Prevention Module One Introduction

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Evidence Based Medicine Working Group, Cochrane Collaboration. Module One. Evidence Based Chronic Disease Prevention. 3. Definitions and Background ... – PowerPoint PPT presentation

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Title: Evidence Based Chronic Disease Prevention Module One Introduction


1
Evidence Based Chronic Disease Prevention Module
One - Introduction
  • Presented by Bill Baldyga, DrPH

2
Introduction to Evidence Based Curriculum
  • St. Louis University Course - Ross Brownson and
    colleagues, Missouri State Health Department
  • Evidence Based Medicine Working Group, Cochrane
    Collaboration

3
Definitions and Background
  • What is evidence-based public health (EBPH)?
  • What are contrasts with evidence-based medicine
    (EBM)?
  • What are levels of evidence?
  • What are useful tools and processes to uncover
    evidence?

4
Levels of Evidence
5
What is Evidence?
  • What is evidence?
  • Facts and/or data on which a conclusion can be
    based
  • Based on probability
  • It is cumulative and time sensitive

6
What is an Evidence-Based Method?
  • A strategy for explicitly linking public health
    or clinical practice recommendations to the
    underlying scientific evidence that demonstrates
    effectiveness in real world situations.

7
What is a Decision?
  • A final choice or judgment
  • Include political concerns
  • May involve compromised positions
  • How are decisions made within your
    agency/organization?

8
How are Decisions Made?
  • Anecdote or gut feeling
  • Press reports
  • Pressure from policy makers, advocacy
    organizations or administrators
  • History
  • Expert opinions
  • Cost minimization
  • Or
  • Combined methods, based on sound science

9
Hierarchy of Evidence
  • Consensus conferences NIH based upon expert
    opinion
  • Systematic reviews inform expert panels
  • Best practice case studies
  • Guideline development what to do, not how to do
    it
  • Meta-analysis more epidemiological, no standard
    methodology, based on quantitative evidence on
    the road to EBPH
  • EBPH current state of the art

10
What is EBM?
  • EBM is the application of best, current
    scientific information to clinical practice.
  • There are five components
  • Framing an answerable question.
  • Finding evidence.
  • Appraising evidence.
  • Applying the evidence.
  • Evaluating the results.

11
What is EBM?
  • In large part, learning to use evidence for
    diagnostic and therapeutic decisions. Now part of
    medical training from the first semester onward
  • Reduces MD reliance on their training and
    experience
  • Based largely on RCTs
  • Includes cost-effectiveness information
  • Provides a basis to construct diagnostic and
    treatment algorithms

12
History of EBM
  • Studies of physician behavior how are questions
    about diagnosis and treatment resolved?
  • Cochrane Collaboration the father of evidence
    based approaches
  • McMaster University Evidence-Based Medicine
    Working Group used EBM to refocus medical
    education

13
EBMs Impact
  • Reorientation of clinical practice
  • Filtering its way down
  • Changing the behavior of practicing MDs
  • Its greatest impact has been to redirect
    physician education
  • Earlier patient contact
  • Use of PBL modules
  • Focus on improved outcomes

14
What is EBPH?
  • ...The development, implementation, and
    evaluation of effective programs and policies in
    public health through application of principles
    of scientific reasoning, including systematic
    uses of data and information systems, and
    appropriate use of program planning models.
  • Brownson et al., J Public Health Management
    Practice 1999, 586-97

15
What is EBPH?
Relies on multiple disciplines
  • Behavioral sciences
  • Biostatistics
  • Epidemiology
  • Community health
  • Social Psychology
  • Nursing
  • Health economics
  • Sociology
  • Health care management
  • Anthropology
  • Medicine
  • Psychology

And Others!!!
16
What is EBPH?
  • Provides information to make choices among
    rational alternatives, based upon level 2
    evidence.
  • The public…demands certainties…but there are no
    certainties.
  • Must be time efficient.

17
Differences Between EBM and EBPH?
18
Some Characteristics of EBPH
  • Problem is quantified and assessed based on
    descriptive epidemiological data.
  • Established planning models/behavioral science
    theories are utilized to address the problem.
  • Intervention approaches developed based on
    evidence in the peer-reviewed literature.
  • The program or policy is systematically evaluated
    following implementation.

19
Examples Based on Varying Degrees of Evidence
  • Youth Access to Tobacco
  • Adolescents have little difficulty purchasing
    tobacco products (83)
  • What is the effect of fines and penalties for
    retailers who sell to minors?
  • 1989, tobacco vendor license law in Woodbridge,
    IL
  • Compliance monitoring through sting operations
  • Illegal sales reduced to 0.
  • EFFECTIVE POLICY INTERVENTION TO REDUCE ACCESS

20
Examples Based on Varying Degrees of Evidence
  • IMPROVING COMPLIANCE WITH CARE
  • Many diabetics are at high risk for complications
  • Can community health workers improve compliance?
  • Received at least 20 education sessions/year
    from CHWs
  • Blood glucose control (N52) 40 improved 40
    stayed the same 20 got worse
  • ARE CHWs EFFECTIVE IN DIABETES ED?

21
Summary
  • EBPH is growing more interest, more use
  • When is evidence sufficient for action?
  • Public health largely remains a zero-sum game
  • Put data/information at your fingertips and break
    down data silos
  • Numerous challenges and barriers
  • Course will highlight current EBPH strategies
  • Course is only a beginning remember to continue
    to refer to the resources identified in this
    course
  • Remember sound chronic disease prevention is a
    blend of art and science i.e. you will have to
    adapt recommendations to the community in which
    you practice.
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