one of the issues we face is that in theory to be an eb person one is always asking questions, finding answers and probably changing practice. This actually may be harmful as coninuity of practice is a major positive element for patient care. Why are you changing me from a beta blocker to the diuretic after 10 years? The bedside may not be the best place to change practice but it is probably the correct setting to ensure practice is safe and effective????
Evidence based change mangement - this could range from readiness to change theories to audit. One of the major issues in assessing and E-B approach is that theoretically we should be changing all the time and this plays havoc with the continuity of management pillar of general/family practice. THe dilemma of having the patent content taking a NSAID for their arthritis while their blood pressure rises. In policy terms this is not so easy to handle. More to follow...... Martin Dawes - really just introducing the blog to some change!
So if a practice is really e-b then they should be changing all the time as new evidence occurs. Patients who have been given treatment (nsaid for arthritis) will have treatment changed and this may lead to discontinuity of mangement of care. The impact of this process is difficult and has not been assessed. Potenially one could look at 3 chronic disease and identify the number of changes to tereatment recommended in the last 5 years to estimate change. What we really lack are trials thhat reflect this reality. What happens to people who I stop the NSAID, or change from brufen to naprosyn? These are the precise management questions we need to address as a consequence of the effectiveness studies. In summary the duet of efficacy followed by effectiveness now needs to be joined by "reality". Thus we might ask what is the reality of replacing all brufen prescriptions with naprosyn for example.
ABNA williamson 1978 JAMA looks like an interesting concept that seems to have been forgotten - achievable but not achieved - maybe worth dicussion at our first meeting
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one of the issues we face is that in theory to be an eb person one is always asking questions, finding answers and probably changing practice. This actually may be harmful as coninuity of practice is a major positive element for patient care. Why are you changing me from a beta blocker to the diuretic after 10 years?
The bedside may not be the best place to change practice but it is probably the correct setting to ensure practice is safe and effective????
Evidence based change mangement - this could range from readiness to change theories to audit. One of the major issues in assessing and E-B approach is that theoretically we should be changing all the time and this plays havoc with the continuity of management pillar of general/family practice. THe dilemma of having the patent content taking a NSAID for their arthritis while their blood pressure rises.
In policy terms this is not so easy to handle. More to follow......
Martin Dawes - really just introducing the blog to some change!
So if a practice is really e-b then they should be changing all the time as new evidence occurs. Patients who have been given treatment (nsaid for arthritis) will have treatment changed and this may lead to discontinuity of mangement of care. The impact of this process is difficult and has not been assessed. Potenially one could look at 3 chronic disease and identify the number of changes to tereatment recommended in the last 5 years to estimate change. What we really lack are trials thhat reflect this reality. What happens to people who I stop the NSAID, or change from brufen to naprosyn? These are the precise management questions we need to address as a consequence of the effectiveness studies. In summary the duet of efficacy followed by effectiveness now needs to be joined by "reality". Thus we might ask what is the reality of replacing all brufen prescriptions with naprosyn for example.
ABNA williamson 1978 JAMA looks like an interesting concept that seems to have been forgotten - achievable but not achieved -
maybe worth dicussion at our first meeting
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