Teaching critical appraisal skills in health care settings (Review)
Health Care Research Unit South Academic Block, Southampton General Hospital, Tremona Road, Southampton, Hampshire, UK, SO16 6YD. Cochrane database of systematic reviews (Online)
(Impact Factor: 6.03).
02/2001; 3(3):CD001270. DOI: 10.1002/14651858.CD001270
Critical appraisal involves interpreting information in a systematic and objective manner. This review looked at whether teaching critical appraisal skills to health professionals led to changes in the process of care, patient outcomes or health professionals' knowledge/awareness. The review found that teaching critical appraisal skills to health professionals improved their knowledge of these skills. However there was a lack of good quality evidence as to whether teaching critical appraisal skills led to changes in the process of care or to changes in patient outcomes.
Available from: Helen Buchanan
- "There was unclear or weak evidence for the effects of tailored interventions that addressed barriers to change , teaching critical appraisal skills  and printed educational materials compared to other interventions . Educational outreach visits (EOVs)  and audit and feedback  resulted in small to moderate behaviour changes with those that included EOVs being slightly more effective than audit and feedback alone . "
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ABSTRACT: Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks.
A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants’ places of employment. Audit raters were blinded, but participants and the provider could not be blinded.
Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour.
The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect.
Pan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008.
Available from: Ann Dadich
- "For instance, a comprehensive review of extant literature suggests that most methods to help clinicians and practitioners to adopt evidence-based practices have the capacity to effect change – however, robust evidence of their effectiveness (and methods of action) is lacking . Although the evidence for effective methods remains inconclusive, it does not suggest that particular methods be discontinued . Rather, there are ‘no “magic bullets” for improving the quality of health care’ , p. 1423. "
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ABSTRACT: The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector.
431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed.
All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources -- both double-sided A4-placards -- had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care.
Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care.
Available from: PubMed Central
- "A Cochrane review of the research evaluating the effect of teaching critical thinking skills to healthcare professionals already caring for patients found a remarkable 25% improvement in clinical accuracy.8 However, the Cochrane review also said there were too few properly designed and conducted studies to be confident in the size of the improvement or its actual clinical significance. "
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ABSTRACT: As 21st century health care moves from a disease-based approach to a more patient-centric system that can address biochemical individuality to improve health and function, clinical decision making becomes more complex. Accentuating the problem is the lack of a clear standard for this more complex functional medicine approach. While there is relatively broad agreement in Western medicine for what constitutes competent assessment of disease and identification of related treatment approaches, the complex functional medicine model posits multiple and individualized diagnostic and therapeutic approaches, most or many of which have reasonable underlying science and principles, but which have not been rigorously tested in a research or clinical setting. This has led to non-rigorous thinking and sometimes to uncritical acceptance of both poorly documented diagnostic procedures and ineffective therapies, resulting in less than optimal clinical care.
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