Our Topic Defined

We need common referents for essential terms. The term evidence-based medicine, as applied to the helping professions, appears to have been coined by medical educators at McMaster University in Hamilton, Ontario (Evidence-Based Medicine Working Group, 1992). Where adapted to social work, evidence-based practice may be defined as follows: “Placing the client’s benefits first, evidence-based practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence.” (Gibbs, 2003, p. 6)

Evidence-based practice has arisen in response to recent advances in information technology (internet speed and accessibility), search technology (e.g. methodological filters), advances in ability to pose well-built clinical questions, accessible databases and syntheses of evidence including the Cochrane Library and Campbell Collaboration, techniques for critically appraising evidence, and useful indices to guide practice decision making (e.g. number needed to treat, positive predicitve value). To harness these advances, evidence-based practitioners learn to follow a process in real time, as problems arise to guide practice judgments and decisions. This process involves the following steps (Sackett et al., 2000, pp. 3-4):

1. Converting the need for information (about prevention, prognosis, therapy, causation, etc.) into an answerable question 2. Tracking down the best evidence with which to answer the question 3. Critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), applicability (usefulness in clinical practice) 4. Using clinical expertise to integrate external research with the client’s unique values and circumstances. 5. Evaluating effectiveness and efficiency in executing steps 1 through 4 and seeking ways to improve them both for the next time.

Evidence-based practice is new; it is not a new name for what we have been doing all along; it is not a list of practice guidelines or standards imposed from above, and it is not a cookbook approach--the process is evolving along with advances in skills and technology. It draws on practice expertise, client preferences, the current best evidence, all within the constraints of what is practical. (Haynes, Devereaux and Guyatt, 2002)