EBP in the Philippines


What is evidence based practice?

Evidence based practice (EBP) is defined as the integration of best research evidence, clinical expertise and patient values (Sackett et al 2000). Health practice needs to be underpinned by the principles of EBP in order to achieve effective patient outcomes, patient health and safety, sound clinical decisions regarding patients and efficient health systems.

 Evidence-Based medicine

EBP in the local context

Recently, it has been acknowledged that to fully apply the principles of EBP in practice, the local context needs to underpin the EBP components. Local context includes the health care system, nature of local practice, available resources and any other concerns regarding the localization or contextualization of the evidence.

To be able to underpin EBP components with the local context, it is essential to have a clear understanding of the issues that challenge the application of EBP in practice. 


top

EBP issues

EBP is now an integral component of health care in most developed countries. However, the growth of EBP in developing countries has been slower. Issues such lack of knowledge regarding EBP principles, lack of skills in applying and teaching the EBP principles delay the uptake of EBP. In addition to these, local barriers, tradition and practices also influence the uptake of EBP.

  EBP issues


top

Development, implementation and evaluation of an innovative model of EBP program for physical therapists in the Philippines

To integrate EBP in the Philippines, careful planning and development of strategies that will address the needs of health professionals and local barriers were undertaken. An EBP training program was identified essential to address the primary barrier of lack of knowledge and skills in EBP as it is not currently part of undergraduate training of health professionals in the country. EBP has to be introduced and taught using effective strategies, considering local context of health practice and health professionals’ behavior in their own practice.

Evidence for EBP training programs

The Sicily Statement on EBP outlines the minimum requirements for teaching EBP (Dawes et al 2005) (http://www.biomedcentral.com/1472-6920/5/1). Educational training programs should consist of the five basic steps in EBP (Dawes et al 2005, p3). These are:

  1. Translating a clinical uncertainty into an answerable focused question
  2. Systematic retrieval of the best evidence available
  3. Critical appraisal of evidence for validity, clinical relevance, and applicability
  4. Application of results in practice
  5. Evaluation of performance

 Evidence regarding the effectiveness of EBP training programs and components of effective strategies for allied health professionals was summarized in a systematic review of the literature. Overall, there is modest evidence regarding improvement in knowledge, skills and attitudes to EBP outcomes and equivocal evidence for behavior (this depends on the behavior strategies used) (Dizon, Grimmer-Somers and Kumar 2012) (http://onlinelibrary.wiley.com/doi/10.1111/j.1744-1609.2012.00295.x/abstract). EBP training programs consist of the basic steps in EBP and co-interventions such as integrating principles of adult learning and educational strategies, social theories and models of behavior change.

  Complex interventions required for EBP training of allied health professionals

Considering the minimum requirements for EBP training programs and the evidence for components of EBP training programs, the notion of EBP training programs as complex interventions and standardizing EBP training programs have been proposed in the literature (Dizon and Grimmer-Somers 2011) (http://www.dovepress.com/complex-interventions-required-to-comprehensively-educate-allied-healt-peer-reviewed-article-AMEP-recommendation1). Complex interventions are interventions that aim to influence not only knowledge, skills and attitudes, but more importantly, behavior. It is not enough to learn the principles of EBP but it is more important to apply the principles in practice behavior to achieve the expected outcomes.

 

Methods of standardizing EBP training programs as complex interventions

Components

Forms related to the components

EBP domain addressed

Constant/Fixed/ Core

  • Concepts of EBP
  • Steps to EBP
  • Knowledge
  • Skills
 

Variable

  • Question formulation relevant to the clinical questions that matter to the health professionals’ discipline/practice
  • Analysis of practice context
  • Availability of teaching resources (what databases are accessible)
  • Provision of support
  • Attitudes
  • Behavior (evidence-seeking or practice behaviors)

 

 


top

Phases of development, implementation and evaluation using the Medical Research Council’s model of complex interventions

The Medical Research Council’s model of complex interventions (Campbell et al 2000) was used as framework for the development, implementation and evaluation of the EBP training program. This model has sequential phases and each phase iteratively informs the succeeding phases.

1.       Theoretical phase

-        Identification of theories that would underpin the programs

-        Evidence for EBP training programs and concept of complex interventions were identified in this phase

2.       Modeling phase

-        Identification of underlying mechanisms that would influence the intervention and the outcomes.  

-        Context was essential to consider. Tailoring the intervention on the context of the local setting was the main focus of this stage 

3.       Exploratory trial phase

-        Establishment of the plan to test the intervention and pilot test the intervention in terms of outcomes and acceptability to the target population 

4.       Definitive RCT phase

-        Test of the effectiveness of the EBP training program in terms of knowledge, skills, attitudes and behavior 

5.       Long term implementation phase

-        Identification and understanding of issues regarding the delivery of the EBP training and identify strategies for ongoing implementation that could influence its long-term sustainability. 

  

 Development, implementation and evaluation of the EBP training program 


top

For more information on EBP in the Philippines see:

top

Areas of study and research

+ Click to minimise