EvidenceInformed Practice Introduction amp implications for clinicians patients amp the chiropractic profession CCGI Introduction Our Vision Enhance the health of Canadians by fostering excellence in chiropractic patient care ID: 1034246
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1. Canadian Chiropractic Guideline Initiative (CCGI)Evidence-Informed Practice: Introduction & implications for clinicians, patients & the chiropractic profession
2. CCGI IntroductionOur Vision:Enhance the health of Canadians by fostering excellence in chiropractic patient careOur Mission:Develop evidence-based CPGs and best practice recommendationsFacilitate dissemination & implementation within the chiropractic profession
3. Top 10 (+1) Causes of Disability (Global Burden of Disease – Vos et al. 2012)Low back painMajor depressive disorderIron-deficiency anaemiaNeck painChronic obstructive pulmonary disease“Other” MSK disordersAnxiety disordersMigraineDiabetesFallsOsteoarthritis Musculoskeletal Disorders (MSDs) result in enormous social, psychological & economic burdens (IOM 2011)
4. Reasons for consulting chiropractors in North America(Coulter 2005)
5. Location of patient treatment areas(Waalen & Mior 2005)
6. What do you think of when you hear:Evidence-informed practice?Evidence-based medicine?Evidence-informed healthcare?
7. Evidence-Informed Practice (EIP)Clinical contextCLINICAL DECISIONThe clinical decision involves all three aspects
8. Evidence-Informed Practice (EIP)Definition:The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patientsTAKE HOME POINT: Best evidence, clinical expertise and patient values and preferences: all three aspects of the model are equally important!
9. Evidence-Informed Practice StatementCanadian chiropractors adopt evidence-informed 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
10. Why would you use evidence-informed practice?
11. Why use EIP?↑ chance of positive patient outcomes↑ patient satisfaction↓ risk of harm to the patientFacilitate effective and honest communication with patientsImprove cultural authority of chiropracticEnhance integration and communication in multidisciplinary environments Evidence is a common language!
12. EIP Misconceptions EIP/research = allopathic medicineEIP is a rulebook/cookbookThere 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 doVolume of new research is too large, making it impossible to stay current
13. What are some barriers to implementing eip in your Practice?What are potential solutions?
14. Clinician ChallengesLack of time and/or motivationPersonal beliefs regarding research:Doesn’t reflect my practice/patientsStatistics too complexToo much information!Don’t know where to look
15. Clinical Practice Guidelines
16. What is a Clinical Practice Guideline?CPGs are a comprehensive collection of:Current best evidence regarding etiology, diagnosis & treatment of a conditionExpert opinion & consensusPractice-based recommendationsWho puts these together?Researchers, clinicians and patient reps – people we should listen to!It’s a massive undertaking!
17. CPG Development
18. Hierarchy of Evidence
19. Evidence-Informed Practice (EIP)Clinical contextCLINICAL DECISIONBest research evidence is one part of EIP
20. CPGs – Key Points for CliniciansCPGs are ‘Living EIP documents’ = updated regularlyCPGs are a tool to support clinical reasoningNOT standards of care/practiceNOT a substitute for a practitioner’s experience CPGs contain practice recommendations linked to best evidence
21. Summary & Take Home MessagesEIP = rational integration of best available research, your clinical experience/expertise and what the patient wants
22. Summary & Take Home MessagesCPGs help guide decision-making regarding diagnosis, treatment and patient management Patients should always be treated as individuals who can have multiple health problems and risk factors – humans are complex!
23. Useful resources on EIP for clinicians
24. Visit us today!The Canadian Chiropractic Guideline Initiative Website is your essential guide to the latest news on guidelines and best practicewww.chiroguidelines.org
25. EIP interactive learning moduleCCGI resources include the webinar series and learning modules delivered in collaboration with CMCC Continuing Education offered at no cost to Canadian chiropractors. Look for the module on :Evidence-Informed Practice (EIP)
26. Connect with your local opinion leaders and best practice collaborators22 Opinion Leaders are now in place across Canada Over 100 Best Practice Collaborators are joining the program in Spring 2016Ask them about the evidence-informed practice and best practices
27. Contact usFor any questions please contact us at: ccgisupport@chiropractic.cawww.chiroguidelines.org
28. Additional resourceswww.chiroguidelines.orgEvidence Informed Practice Program - EIP modulesCentre for Evidence-Based Medicine Evidence UP DATES: Free Tools for Evidence-Based Clinical PracticeJAMA Evidence Evidence-Based Medicine Tool KitGrey Matters: A practical search tool for evidence-based medicine Centre for Evidence-Based Medicine (Toronto)
29. Helping practitioners and patients make the right choice for optimal careGIG Group MembersProject lead: André Bussières Clinician Kent Stuber (lead) Jeff Quon (lead) Fadi Al Zoubi Sandy Sajko Simon French (KT Expert) Alex Pessoa (collaborator)Decision Makers Diane Grondin (lead) Simon Brockhusen (collaborator) André Bussières (KT Expert) Michele Maiers (collaborateur) John Triano Chiropractic programs Tony Tibbles (lead) Danica Brousseau (lead) Tue Jensen Aliki Thomas (KT Expert) Craig Jacobs (CMCC collaborator) Joe Lemire (UQTR collaborator) Caroline Poulin (UQTR collaborator) I sabelle Pouliot (UQTR student) Patients Sara Ahmed (lead) Shawn Davies Monika Kastner (KT Expert) Nadia Richer (UQTR collaborator) Physical activity: Bob Grisdale (lead)Website- Vic Weatherall (lead)Reviewer: Bryan BudgellAny questions?
30. ReferencesCoulter ID & Shekelle PG. Chiropractic in North America: Descriptive analysis. J Manipulative Physiol Ther 2005; 28(2): 83-89. Fineout-Overholt E, Mazurek Melnyk B, Schultz A. Transforming Health Care from the Inside Out: Advancing Evidence-Based Practice in the 21st Century. J Professional Nursing. 2005;21(6):335-44.Kawchuk G, Newton G, Srbely J, Passmore S, Bussières A, Busse JW, Bruno P. Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap. J Can Chiropr Assoc 2014; 58(3):206-14 (In Press).Lizarondo L, Grimmer-Somers K, Kumar S. A systematic review of the individual determinants of research evidence use in allied health. J Multidisciplinary Healthcare. 2011;4:261-72.Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996; 312(7023):71–72.Vos T, Flaxman AD, Naghavi M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163–96.Waalen JK, Mior SA. Practice patterns of 692 Ontario chiropractors (2000-2001). J Can Chiro Assoc 2005; 49(1): 21-31.