Implementing Evidence and Achieving Change in Allied and Complementary Health Care: A New Frontier

Recent times have witnessed dramatic changes to health care service delivery. There is now wide spread recognition for all health care to be underpinned by key quality elements namely safety, effectiveness, timeliness, patient-centeredness, efficiency and equity. Evidence Based Practice (EBP) has been widely considered to be an integral tool in ensuring quality and safe health care practices. Evidence based practice involves three key elements namely best available research evidence, clinical expertise and patient values. While there is universal recognition for, and importance of, evidence based practice, there is growing research evidence which highlights numerous issues when implementing evidence into clinical practice and in achieving practice and behaviour change. Several research initiatives by prominent researchers, such as Richard Grol, Jeremy Grimshaw, Susan Michie and Jonathon Lomas, just to name a few, highlight numerous complex behavioural, social and personal factors which influence evidence uptake, and achieve practice and behaviour change. Recognising that evidence implementation is a science in its own merit, there is now wide spread recognition for evidence based practice to be supported by evidence based implementation.

While there is a growing body of research on evidence implementation and achieving change, much of this is confined to medical professions. There is, to date, merely a handful of research on allied and complementary health professions perspectives on evidence implementation and successful behaviour and practice change. Dr. Saravana Kumar, NHMRC NICS MAC Fellow, at the Centre for Allied Health Evidence, University of South Australia, has been researching this very issue for the past year. Dr. Kumar’s research focuses on Whiplash-associated disorders (WAD), which are a collection of symptoms that can include headache, neck pain, and stiffness. In South Australia alone, more than 2,500 people suffer WAD in road crashes every year. These injuries represent approximately 45% of all Compulsory Third Party insurance claims, and costs around AUD $130 million annually. Yet despite increasing health care and social costs as a result of WAD, persons with WAD do not necessarily attain positive health outcomes. As many as 40% of persons with WAD end up developing long term health complaints. Therefore it is essential, especially in the early stages of whiplash, to provide high quality evidence based health care for persons with whiplash with the aim to attain optimal short and long term outcomes, and reduce chronic health complaints.

Dr. Kumar’s research focuses on implementing a locally developed clinical guideline, endorsed by Australia’s peak health research body, National Health and Medical Research Council, for the management of WAD. Dr. Kumar’s research targets Physiotherapists and Chiropractors during their management of acute WAD and aims to introduce evidence based recommendations, derived from the guidelines, for physiotherapists and chiropractors in their management of acute WAD. Recognising the growing and important role of consumers, this research will also engage consumers by providing them with a consumer guide to ensure that they understand WAD and treatment options offered. Preliminary findings from this research to date are summarised below:

  • While there is universal recognition on the importance of evidence based practice, there is variable understanding, and perspectives, on what constitutes evidence based practice and the notion of “evidence”
  • Evidence based practice, from a practitioner perspective, is considered as a theoretical concept, with significant difficulties operationalizing it in a clinical setting
  • Clinical guidelines are considered to be scholastic documents, which minimally influence clinical practice. Patient perspectives and routine outcomes from treatment, at least in private practice settings, seem to influence clinical practice behaviour.
  • There are few incentives and numerous barriers in implementing evidence based recommendations in clinical practice settings and achieve behaviour and practice change.
  • Dissemination strategies (such as postal delivery in isolation), which do not promote active engagement of physiotherapist and chiropractors, may have minimal impact on evidence implementation and behaviour and practice change.

Dr. Kumar is currently organizing a multi-dimensional evidence implementation strategy which will involve interactive workshops, decision-aids and tools, consumer-directed approaches and outreach visits to support participating physiotherapists and chiropractors. Furthermore, Dr. Kumar has also developed tailored resources, specifically for WAD guidelines adoption and evidence implementation more widely, for all stakeholders in the management of WAD. These resources will be available via a dedicated web resource (www.implementationcentral.com). As this research progresses and the website matures, it will include interactive elements such as pod casts and discussing forms enabling it to act as an educational resource.

For more information about Dr. Kumar’s research, he can be contacted via his email (Saravana.kumar@unisa.edu.au)>

This research is funded by National Health and Medical Research Council (NHMRC), National Institute of Clinical Studies (NICS) and the Motor Accident Commission (MAC), South Australia.