1. Does Evidence Make a Difference?

2. Elements of Evidence Based Practice EBP Needs and preferences of patients/clients Professional expertise, skills & judgment Best available evidence, knowledge

3. ‘Provider’ l Accessibility l Literacy l Attitude

4. Context l Organisational stability l Organisational culture l Practical support and resources

5. Dissemination and Implementation Strategies 10 listed in the Cochrane EPOC Taxonomy: 1. Distribution of educational materials 2. Educational meetings 3. Local consensus processes 4. Educational outreach visits 5. Local opinion leaders 6. Patient mediated interventions 7. Audit and feedback 8. Reminders 9. Marketing 10. Mass media

6. Indicators of success SI + f (E,C,F) Where SI = successful implementation f = function of E = evidence C = context F = facilitation

7. Evaluation l How well are the guidelines known and to what extent are they valued? l To what extent are the recommendations applied? l To what extent are they effective? Burgers, et al 2005

8. Implications for you As an individual practitioner, educator, manager or researcher What message(s) am I taking away today for my practice?

9. Some useful references Grimshaw, J., Eccles, M., Thomas, R., MacLennan, G., Ramsay, C., Fraser, C. & Vale, L. (2006). Toward evidence- based quality improvement: Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1996 -1998, Journal of General Internal Medicine, 21 (Feb), Suppl 2: S14-20.

10. Some useful references l Redfern, S. & Christian, S. (2003). Achieving change in health care practice, Journal of Evaluation in Clinical Practice, 9(2): 225-238. l National Institute of Clinical Studies. (2006). Do guidelines make a difference to health care outcomes? Melbourne, NICS. l Tolson, D., McAloon, M., Hotchkiss, R. & Schofield, I. (2005). Progressing evidence- based practice: An effective model? Journal of Advanced Nursing, 50(2) : 124- 133.

11. Related Systematic Reviews l Shaw B, Cheater F, Baker R, Gillies C, Hearnshaw H, Flottorp S & Robertson, N. (2005). Tailored interventions to overcome identified barriers to change: Effects on professional practice and health outcomes. Cochrane Database of Systematic Reviews, Issue 3. l Thomas L, Cullum N, McColl E, Rousseau N, Soutter J. & Steen N. (1999). Guidelines in professions allied to medicine. Cochrane Database of Systematic Reviews, Issue 1.