Title: Getting evidence into practice in preventive health care settings Results of a systematic review
1Getting evidence into practice in preventive
health care settingsResults of a systematic
review
PHAA/AFPHM/AHPA Conference, 21 October 2006
Making research matter Translating research
into health policy and practice
- Belinda Lunnay
- Petra Bywood
- Ann Roche
- National Centre for Education and Training on
Addiction (NCETA) - Flinders University, Adelaide, South Australia
2Overview
- Background rationale
- Aims approach
- Preliminary results
- Implications for practice
3Role of PHC providers in preventive care
Primary health care providers are well-placed to
provide preventive health services
4Research ? Practice
Research Innovations
Dissemination to research community
Dissemination to health care providers
Translation of research into practice guidelines
Adoption dissemination and implementation
strategies
Professional interventions
Skills knowledge support strategies
Organisational factors
Evidence-based Practice
Adapted from Roche et al 2002
5The research-practice gap
- Effective research innovations not translated to
practice - Finite health resources used inefficiently
- Potentially ineffective practices persist
- and preventable disease and infirmity is not
prevented!
6Dissemination Strategies
Effective Practice and Organisation of Care
(EPOC), 2002
7Dissemination Strategies
Effective Practice and Organisation of Care
(EPOC), 2002
8Project aims
- To evaluate the effectiveness of dissemination
strategies used to improve the work practices of
health care providers - To identify key factors underlying the success of
effective strategies
9Project approach
- Systematic literature review
- Search 1966-March 2005 existing SRs
updated search 1998-March 2005 new primary
studies - Study inclusion criteria controlled collected
baseline data min. 3-month study period - Study assessment 2 reviewers assessed studies
for level (NHMRC, 2000) and quality of evidence
(EPOC, 2002)
10Systematic vs narrative reviews
11Results (1)
- 4,560 citations
- (full SR all dissemination strategies)
- Stratified by health settings
- 3 existing systematic reviews 16 primary
studies tested strategies in specific preventive
health settings
12Results (2)
- Study quality findings variable - Poor
reporting - Risk of bias - Underpowered - Conclusions based on higher level evidence,
better quality evidence - Qualitative synthesis
13Results (3) Preventive health settings
The continuum of care
Primary prevention promotion of wellbeing
Secondary prevention early intervention
Tertiary prevention disease management
Adapted from Preventing chronic disease A
strategic framework, National Public Health
Partnership, 2001
14Primary prevention -
- reduces the likelihood of disease occurring
- Settings tested
- Tobacco cessation support / services
- Alcohol screening / counselling
- Drug use prevention (among young people)
- Immunisations / vaccinations
- Stroke prevention
- Falls prevention / reduction
- HIV prevention
15Which strategy to use for primary prevention?
16Secondary prevention -
- early detection of disease before it becomes
symptomatic
- Settings tested
- Screening for
- Cancer (mammogram, pap smear, faecal occult blood
test) - Diabetes (blood glucose tests)
- Cholesterol
- Tuberculosis
- Anaemia (haemoglobin tests)
- Lead (blood test)
- Vitamin B12 deficiency
- Hypertension (blood pressure measures)
17Which strategy to use for secondary prevention?
18Tertiary prevention -
- attempt to prevent or minimise the complications
associated with established disease
- Settings tested
- Type II diabetes management
19Which strategy to use for tertiary prevention?
20Implications for practice
- Strategies exist to improve preventive health
services - No single strategy is always effective
- Each strategy is effective in some situations
21Characteristics of success
- Targeted change is simple/achievable
- Strategy is tailored to context/settingof
implementation - Organisational/systems approach
22Where to from here?
- Broader systematic review - ongoing
- Cost effectiveness study
- Tool for selecting strategies
23Contact Details
Dissemination and Implementation Strategies
Project Team National Centre for Education and
Training on Addiction Flinders
University Adelaide SA http//www.nceta.flinders.
edu.au/ belinda.lunnay_at_flinders.edu.au