How can evidence-based practice and care help practitioners and the veteran community – and what exactly is it?
Dr Mark Hinton describes evidence-based practice in terms of a three-legged stool. The Director of the Treatment Research Collaboration at the Centenary of Anzac Centre says three elements work together to help practitioners understand how they can do the best for their patients.
The three ‘legs’ of evidence-based practice are: patient preference, clinical expertise, and the best scientific evidence.
“I think we have lost our way a bit in terms of patient involvement in treatment. I wonder how many practitioners regularly ask a patient what they want. Do they ask about their key concerns and priorities for treatment and then work to address those specific issues in treatment?” says Mark.
Mark says clinical expertise is equally vital to provide veterans with the most effective care on a case-by-case basis.
Clinical expertise involves the clinician drawing on their experience and their knowledge of the person in front of them. “As a clinician, when working with veterans or their family you need to be up-to-date with current research and be familiar with veteran culture. On top of that, you need to have an intricate, ‘nuts and bolts’ knowledge of any intervention you agree is appropriate and how to flexibly apply that to meet the very specific needs of the individual, couple or family that have sought your help – it’s more complicated than it looks, ” he says.
Finding the latest scientific evidence about veteran mental health care and treatment can be challenging for busy practitioners. The internet has created a mass of freely available information – but that is a double-edged sword, says Mark.
“We have moved into an age where we possibly have too much evidence available and so we need to be able to sift and identify what constitutes good evidence from not-so-good evidence.” He suggests, “It’s always worth considering the quality of any evidence. Is the information taken from a randomised control trial with a very robust methodology, or is it perhaps a bit speculative in nature and derived from a rough and ready, best guess evaluation?” Mark explains.
The Centenary of Anzac Centre’s Treatment Research Collaboration carries out rigorous research based on the needs of veterans. That research is then freely shared and promoted with clinicians through our Practitioner Support Service. In addition, the Treatment Research Collaboration gathers and assesses research evidence from around the world relating to mental health and mental health treatments to produce systematic reviews of current knowledge and best practice recommendations for veterans and their families.
“When we get a research question from a practitioner who calls the support service, we sift through the available evidence to give them an answer. So, a practitioner might ask, ‘What anger interventions have shown some success?’ or ‘What additional therapies can augment or super-charge the recovery process for a struggling client?’” says Mark.
“We find the best quality evidence currently available and pass that information on to the practitioner with an explanation of how to integrate the evidence into clinical decision-making. The Practitioner Support Service enables us to translate research from academia and get it into practice. We want people to be across the evidence so they can use it to give veterans the best possible opportunity for recovery. Practitioners have so many day-to-day responsibilities and decisions to make and it’s hard to be across everything,” adds Mark.
Mark says that evidence-based practice is vital to help the veteran community, many of whom miss out on effective treatment.
“Research has to do better at helping practitioners make good clinical decisions about readiness for treatment, what treatments to use when opportunity allows and veterans agree, and how and when to use complementary or a combination of treatments. Research also needs to help practitioners know when to augment treatment and what to do when treatment doesn’t work as well as expected or perhaps not at all. That is a priority for us. We need to build scientific evidence that supports quality clinical decision-making, rather than leaving it to practitioners to do their best with too little information.”
Are you currently involved with a study that could be included on our Research Map? Please contact The Centenary of Anzac Centre Treatment Research Collaboration for more information.