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Allied Health Group Makes Evidence Into Practice A Reality

Saravana Kumar

Evidence based practice (EBP) – a term which is now increasingly common in health care and recognised as an important component of safe and quality health care practices. While the importance of EBP is well recognised, implementing evidence into practice continues to face several barriers.

Members are: (from left to right) Front row: Alexandra Fung, Catherine Chan, Aileen Chu (Convener), Alex Chan and Leung Kwan Lok. Back row: So Chi Tao, Lewina Chan, Sammy Cheung, Stanley Chau and Frank Leung (Missing from photo are Ms. Ashley Ng and Ms. Janice Lui).

These include organisational barriers (such as support and commitment from management), availability of resources (time, access to evidence), clinicians’ perspectives (recognising the need to implement evidence and achieve change), team members’ perspectives (support from other professions who are part of the team), just to name a few. Therefore, often while the intention is there, behaviour is absent. This was not the case in the instance of a group of occupational therapists (OT) from Hong Kong.

These OTs, based in different public hospitals administered by the Hong Kong Hospital Authority (HKHA), undertook an innovative project to develop and implement a clinical practice guideline for home oxygen therapy for adult patients. The background to this project was that many chest patients were sent home from hospitals with prescriptions for home oxygen therapy. As it carries potential risks and considerable cost, a more stringent approach in assessment, prescription, and monitoring of the therapy was warranted. According to local findings, it was identified that there were over 1000 home oxygen therapy arrangements done by OTs in public clinical settings each year.

The Chronic Obstructive Pulmonary Disease (COPD) working group (WG) of the OT Co-ordinating Committee (COC) had recognised the need for a clinical practice guideline to streamline services to ensure the right patient received the right amount of oxygen for the right length of time. Thus the development of a clinical practice guideline commenced. The WG members, in consultation with researchers and guideline developers at the International Centre for Allied Health Evidence and the Institute of Advanced Allied Health Studies, commenced a step-by-step approach for this initiative. A summary of the guideline development process is outlined below:

  • 2007 : clinical practice guideline drafting led by the guideline development team and advised by a stakeholder reference group which involved experts from occupational therapy, medicine, nursing and academia.
  • January – June 2008 : evaluation of clinical practice guideline applicability across different hospitals within HKHA (pilot).
  • August 2008 : briefing workshop and preliminary draft reviewed by stakeholders using AGREE tool (to appraise the quality of the clinical practice guideline). Modifications made based on feedback attained from this process.
  • February 2009 : Formal launching of the clinical practice guideline for home oxygen therapy (HOT). This launch was attended by more than 104 OTs during which implementation and dissemination strategies were formulated.
  • August - September 2009 : survey on overview of HOT services in HKHA settings.
  • September 2009 : an article was published on this initiative.
  • October 2009 – March 2010 : regular audits conducted (e.g. an e-survey) to evaluate the impact of the CPG-HOT.
  • Ongoing – development of resources to aid in ongoing implementation and sustainability of the initiative. Roll out of CPG-HOT to external organizations.

This evidence implementation project has achieved several positive outcomes for OT in the HKHA. These include improved awareness of evidence based practice among OTs, improved process and outcomes in OT practices, collaborative engagement with other health professions, achieving tangible outcomes which are relevant to clinicians, funders and administrators, creating an environment where practice and behaviour change can happen. Ultimately though, what this initiative demonstrates is the ability of clinicians’ to engage with, and implement, evidence in clinical practice, provided they are supported in that journey. This enthusiastic and committed group of allied health professionals are shining examples of how evidence based practice can become a reality.

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