{"id":1412,"date":"2017-09-26T14:52:24","date_gmt":"2017-09-26T14:52:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1412"},"modified":"2017-11-01T15:50:15","modified_gmt":"2017-11-01T15:50:15","slug":"what-can-we-learn-from-the-better-evidence-for-better-healthcare-manifesto","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2017\/09\/26\/what-can-we-learn-from-the-better-evidence-for-better-healthcare-manifesto\/","title":{"rendered":"What can we learn from the EBM Manifesto?"},"content":{"rendered":"

 <\/p>\n

The\u00a0Better Evidence for Better Healthcare Manifesto (EBM manifesto)<\/a>\u00a0has been launched in order to improve the implementation of evidence-based interventions by pulling together a clear set of achievable goals and a strong overview of the strategies that work best, to help deliver change better and faster.<\/p>\n

In some areas, such as the treatment of illicit drug-related problems, evidence-based medicine struggles to be firm. Ideologies, political views, and advocacy agendas complicate the picture. In\u00a0this area, some suggestions from\u00a0the manifesto also help to address other difficult areas like mental health, obesity, and behavioural-related health problems.<\/span><\/p>\n

In the treatment of illicit drug-related problems, the EBM approach is taking time to be accepted and implemented. Some of the lessons learned can contribute to the manifesto.<\/p>\n

The evidence base\u00a0has been formalised through the creation of the Cochrane Drugs and Alcohol Group in 1998 (Davoli 2000). Today, using the evidence base has become a requirement in many drugs policy documents at both European and national levels (Ferri and Bo, 2012). This is particularly important in a field where most of the patients in need of publicly financed treatment have a low socioeconomic status and may not be able to demand effective treatments and quality interventions (Galea and Vlahov, 2002).<\/p>\n

However, the extensive use of the term: \u201cevidence base\u201d creates potential \u201cside effects,\u201d which are of interest for the manifesto.<\/p>\n

Many people from a variety of backgrounds use \u201cevidence base\u201d to mean different things. Evidence is used to justify decisions. Rather than identifying a question, searching for the evidence, and then making decisions, the process is inverted. The decision comes first, followed by the opportunistic choice of supporting evidence (\u201ccherry picking\u201d).<\/p>\n

More commonly there is a\u00a0misunderstanding of what a systematic review actually is. For example, rather than being based on systematic reviews of studies\u2014in agreement with standards set by the Cochrane and Campbell collaborations\u2014recommendations are based on a much simpler narrative synthesis of published reviews. These \u201creviews of reviews\u201d combine the conclusions of several primary reviews, often irrespective of their quality. In addition, the primary reviews may be based on the same sets of individual studies, resulting in artificially inflated conclusions.<\/p>\n

The common confusion between lack of evidence and evidence of non-effectiveness exacerbates defensive rejections of EBM, rather than encouraging advocacy for more investment in research.<\/p>\n

Professionals and decision makers are uncertain on how to implement and monitor evidence-based interventions and can be tempted by simplistic approaches.<\/p>\n

What change do we want to achieve?<\/u><\/h5>\n

We need a shared understanding of what evidence-based medicine is and how to apply it in one\u2019s daily life.\u00a0We must encourage greater participation: front-line carers, patients, and their families should become EBM knowledge brokers for their peers. This is particularly vital for marginalised patients and for conditions with low research investment. I recommend that projects\u00a0like the\u00a0James Lind Alliance<\/a>\u00a0should be piloted in more European countries; projects\u00a0like\u00a0Sense about Science<\/a>\u00a0should be implemented in all schools in order to increase the numbers of those able to advocate for evidence-based interventions.<\/p>\n

What actions are currently underway to achieve this change?<\/u><\/h5>\n

Avoiding research waste<\/a>\u00a0by enhancing the availability of timely systematic reviews and targeting research priorities is crucial. We should make these activities and results available across all health conditions and geographical settings. Examples of gap analysis using systematic reviews to engage carers, patients, and families should be replicated (Ferri, 2013).<\/p>\n

What new actions do you think would achieve this outcome better?<\/u><\/h5>\n

We need investment in promoting partnerships among decision-makers, health professionals, patients, and families in order to identify both knowledge needs and strategies for the dissemination and implementation of evidence.<\/p>\n

In the illicit drugs-related problems area we should implement a three-step participatory exercise:<\/p>\n