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Clinicians must turn evidence into practice

November 16, 2015
by Jill Sederstrom
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As the healthcare industry moves toward more quality initiatives, a greater emphasis has been placed on the role of evidence-based practices. It's a trend gaining momentum in both the medical and behavioral healthcare fields, and experts say treatment centers must be prepared.

"If they are not providing evidence-based or evidence-informed care, my suspicion is that in the next few years that will become very problematic for them," says Kelly Clark, MD, president-elect of the American Society of Addiction Medicine (ASAM).

Clark says as payers and regulators try to ensure that the care they are paying for and licensing is of high quality, they will be evaluating  whether facilities are embracing the latest evidence that has been shown to produce optimal patient outcomes. They want the most value for their healthcare dollar.

No easy task

While behavioral healthcare experts anticipate there will be a greater emphasis on evidence in the years ahead, they acknowledge that incorporating it is no easy process.  To truly develop treatment protocols and procedures based on the best clinical intelligence available, facilities will need to invest significantly in strategic training to translate what's discovered in a research setting into everyday practice.

Researchers and clinicians don't always see eye-to-eye. In fact, Melanie Smith, LMHC, program and training manager at the Renfrew Center in Coconut Creek, Fla., says there's a significant research-practice gap that exists that can often  prevent research findings from making their way into clinical practice. That lack of real-world application then can, in turn, prevent updated clinical observations from enhancing future research.

This gap exists in part because each stakeholder has a different motivation. While researchers value quantifiable, measurable data that be observed in structured research trials, clinicians often value subtle nuances of the treatment process and base decisions on what they can learn from other clinicians in real-world settings. While researchers examine statistical populations, clinicians examine individual human beings with unique needs.

But both groups can learn from one another, and experts say it will take a collaborative approach to help close the gap that exists between researchers and practicing clinicians.

"The hope is that researchers and clinicians can start a more collaborative relationship than has traditionally taken place," Smith says. "Researchers certainly have a strong viewpoint and set of opinions, and clinicians have an equally strong opposing view point and position about such things. An environment and an attitude of collaboration is going to be essential."

Anecdotal evidence

From a clinical perspective, evidence-based approaches can add value by giving clinicians a framework based on empirical data from many sources when treating patients. Smith says that while clinicians can work for years to provide the best care for their patients, they often draw much of their knowledge and experience from anecdotal evidence and what they see working with a small sample of patients in the short-term. 

"We don't really have a lot of ability to know in the long-term how our patients are doing, and we also don't have the ability to know, just based on our small experience in the world, whether or not what we're doing is the most effective and efficient way to help someone get better," she says.

She says one of the benefits of incorporating treatments and protocols based on research and literature is that it can help clinicians move toward using sound, scientific principles that can help improve overall clinician confidence.

"I always felt like I was throwing darts at a dart board and hoping that one of them stuck. I didn't necessarily have any information to give me any increased level of confidence that it was going to stick. We kind of just had to wait and see what happened," Smith says.

Over the last several years, as the Renfrew Center has taken a more evidence-based approach to care,  she's seen her confidence grow as a clinician.

"By no means does using an evidence-based treatment guarantee a patient will be cured in any sort of quick, expedient way. That's not what I am suggesting. I don't think that's what the researchers are suggesting either, but it certainly provides us more valuable information from a large sample of people over time, in all those variables, which as an individual clinician, you don't get to see day-to-day," she says.

Clark says evidence-based medicine—or what she says is more often “evidence-informed medicine”—lends itself to quality metrics that are population-based and allow clinicians and facilities to see an issue from a broader population-based perspective that provides bench marking opportunities.

Putting evidence into practice

Incorporating more evidence-based practices into treatment is often a decision made by organizational leadership. When top leadership makes a commitment to emphasize the evidence, Smith says, it helps  set the culture for the entire facility. Enlisting the help of the research community is another important step in the process.

At the Renfrew Center, Smith has spent the last few years helping to identify which research findings and evidence-based treatments the organization was going to adopt and incorporate into practice.