Evidence-based practice and health policy development: the link between knowledge and action

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/ attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.

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Opportunistic evidence: evidence-based policy in the setting of the Australian Government's chlamydia screening pilot

Australian Health Review ◽

10.1071/ah10942 ◽

2012 ◽

Vol 36 (1) ◽

pp. 57

Author(s):

Simon R. Crouch

Keyword(s):

Systematic Review ◽

Health Policy ◽

Systematic Reviews ◽

Policy Development ◽

Good Health ◽

Chlamydia Screening ◽

Evidence Based ◽

Policy Decisions ◽

Evidence Based Policy

Objective. Chlamydia prevention and control form a significant part of the Australian Government’s sexual health policy. This paper examines the evidence for policy development and in particular the role of systematic reviews in evidence-based policy. Methods. The author undertook a review of the literature on evidence-based policy. The major theories for evidence-based policy were then linked to the Australian Government’s main chlamydia policy. Results. A systematic review on chlamydia screening has been influential in policy development, but like all systematic reviews its validity must be assessed. It has been suggested that methodological appropriateness and the question being asked are perhaps more important than study design per se. Partnerships between researchers and policymakers are important but it should be noted that experts have their own particular biases. Policymaking can also be determined by political ideologies. Conclusions and implications. The publication of a systematic review has provided a good summative evaluation of chlamydia screening that has been built upon through partnerships with researchers. The resulting chlamydia screening pilot will provide further evidence for future policy; however, a variety of sources are required to develop robust policy directions. What is known about the topic? Systematic reviews are often considered to be the best evidence on which to base policy decisions. In practice it is not always the case that best evidence is used to form policy. As well as systematic reviews, which are not always infallible, there are many other factors that affect the development of national health policy. What does the paper add? This paper provides a consideration of the role of systematic reviews in policy-making, as well as some of the pitfalls to this approach. As an example, it provides the Australian Government’s policy on chlamydia control and looks at other factors that may have contributed to the development of this policy. What are the implications for practitioners? All practitioners involved in policy decisions should consider the evidence-base from which their policies are derived. They should understand the sound basis of the systematic review while accepting that other pressures may affect the processes leading up to the formation of good health policy.

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