Introduction to Evidence Informed Practice October 2017 CCGI

Introduction to Evidence. Informed Practice October 2017

CCGI Introduction • Our Vision: – Enhance the health of Canadians by fostering excellence in chiropractic patient care • Our Mission: – Develop evidence-based CPGs and best practice recommendations – Facilitate their dissemination & implementation within the chiropractic profession

WHAT DO YOU THINK OF WHEN YOU HEAR: Evidence-informed practice? Evidence-based medicine? Evidence-informed healthcare?

Evidence-Informed Practice (EIP) CLINICAL DECISION Clinical expertise Best research evidence Clinical context Patient values & preferences The clinical decision involves all three aspects

Evidence-Informed Practice (EIP) • Definition: – The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients • TAKE HOME POINT: – Best evidence, clinical expertise and patient values and preferences: all three aspects of the model are equally important!

Evidence-Informed Practice Statement Canadian chiropractors adopt evidenceinformed practice principles to guide clinical decision making by integrating their clinical expertise, patient preference and values, and the best available scientific evidence. The EIP statement is approved by colleges and regulatory boards in 9/10 Canadian provinces, and is currently pending approval in Nova Scotia

WHY WOULD YOU USE EVIDENCEINFORMED PRACTICE?

Why use EIP? ↑ chance of positive patient outcomes ↑ patient satisfaction ↓ risk of harm to the patient Facilitate effective and honest communication with patients • Improve cultural authority of chiropractic • Enhance integration and communication in multidisciplinary environments • • – Evidence is a common language!

EIP Misconceptions EIP/research = allopathic medicine EIP is a rulebook/cookbook There is no ‘chiropractic’ research Researchers don’t understand practice realities and want to tell us what we can’t do vs. what we can/should do • Volume of new research is too large, making it impossible to stay current • •

WHAT ARE SOME BARRIERS TO IMPLEMENTING EIP IN YOUR PRACTICE? WHAT ARE POTENTIAL SOLUTIONS?

Clinician Challenges • Lack of time and/or motivation • Personal beliefs regarding research: – Doesn’t reflect my practice/patients – Statistics too complex – Too much information! – Don’t know where to look

Clinical Practice Guidelines

What is a Clinical Practice Guideline? • CPGs are a comprehensive collection of: – Current best evidence regarding etiology, diagnosis & treatment of a condition – Expert opinion & consensus – Practice-based recommendations • Who puts these together? – Researchers, clinicians and patient reps – people we should listen to! • It’s a massive undertaking!

Clear Question Update & Revise Dissemination Literature Search Study Selection CPG Development Recommendations Analysis Critical Appraisal Data Extraction

Hierarchy of Evidence

CPGs – Key Points for Clinicians • CPGs are ‘Living EIP documents’ = they are updated regularly • CPGs are a tool to support clinical reasoning – NOT standards of care/practice – NOT a substitute for a practitioner’s experience • CPGs contain practice recommendations linked to best evidence

Remember… ü EIP is the rational integration of best available research, your clinical experience/expertise and what the patient wants ü CPGs help guide decision-making regarding diagnosis, treatment and patient management ü Patients should always be treated as individuals who can have multiple health problems and risk factors – humans are complex!

Useful resources for clinicians

The Canadian Chiropractic Guideline Initiative website is your essential guide to the latest news on guidelines and best practice www. chiroguidelines. org Visit us today!

New low back pain guideline Fall (2017)

With accompanying resources for clinicians……. • Practitioner guide • Algorithm • Summary of recommendations

…. and patients • A new series of exercise & yoga videos for LBP • New patient handouts • CCGI business cards

CCGI knowledge brokers Dr. Kent Stuber (AB) and Dr. Gaelan Connell (BC) Check out their new series of

Practice-Based Research Networks Dr. Katherine Harman & Dr. Peter Stilwell, NS Communication styles used by chiropractors consulting with patients with LBP Dre. Andrée-Anne Marchand & Dr. André Bussières Qc Promoting self-management strategies for spine pain

Opinion leaders and best practice collaborators program NS ON MB BC

You can also take CCGI educational learning modules CCGI resources include the webinar series and learning modules delivered in collaboration with CMCC Continuing Education offered at no cost to Canadian chiropractors

Find out more about what CCGI is doing and how you can participate Follow CCGI on social media!

At the Canadian Chiropractic Guideline Initiative we believe in teamwork and collaboration. Visit our website and find out how we can work together to bring best practices to chiropractors in Canada and across the world. www. chiroguidelines. org