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Overview

Definition of EBPH

Public Health Knowledge Domains

"When and Why" of Using an EBPH Approach

Steps in Searching and Evaluating the Literature

Selected EBPH Terms from PubMed

Hierarchy of Evidence

 

 

 

 

 

 

 

 

Overview

From Evidence-based Medicine to Evidence-Based Public Health 

The evidence-based movement in the health sciences is over a decade old, and its beginnings are tied to evidence-based practice in medicine. The first appearance of the term evidence-based medicine occurred in the fall of 1990 in a document describing the residency program at Canada’s McMaster University:

Residents are taught to develop an attitude of “enlightened skepticism” toward the application of diagnostic, therapeutic, and prognostic technologies in their day-to-day management of patients. This approach, which has been called “evidence-based medicine,” is based on principles outlined in the text Clinical Epidemiology. The goal is to be aware of the evidence on which one’s practice is based, the soundness of the evidence, and the strength of inference the evidence permits. The strategy employed requires a clear delineation of the relevant question(s); a thorough search of the literature relating to the questions; a critical appraisal of the evidence, and its applicability to the clinical situation; and a balanced application of the conclusions to the clinical problem. [Source: Guyatt, G. and Drummond Rennie. 2002. User’s Guides to the Medical Literature: A Manual for Evidence-Based Practice. Chicago: American Medical Association, p. xiv.]

Some of the key concepts in this description are evidence and critical appraisal. Evidence can be defined as that “which furnishes proof,” and critical appraisal can be defined as an evaluation process “which determines the significance or worth of something by careful appraisal and study.” These concepts became a fundamental principle for a new approach to patient care, using evidence-based principles and a philosophy that evidence from the medical literature should support clinical decisions. As a body of literature began to emerge, it was soon recognized that evidence-based medicine approaches could be applied to other fields, including public health. Within this field, some of the principal user groups are practitioners, policy makers, researchers, the general public, and health sciences information professionals.

There are notable differences between the two disciplines of medicine and public health; however, that are helpful to understand in the application of evidence-based approaches to decision making.

  Public Health Medicine
Primary Focus Populations Individuals
Emphasis Prevention Diagnosis
Health Promotion Treatment
Whole Community Whole Patient
Paradigm Interventions aimed at Environment, Human Behavior and Lifestyle, and Medical Care Medical Care
Organizational Lines of Specialization Analytical (Epidemiology); Organ (Cardiology);
Setting and Population (Occupational Health); Patient Group (Pediatrics);
Substantive Health Problem (Nutrition); Etiology, Pathophysiology (Oncology, Infectious Disease)
Skills in Assessment, Policy Development, and Assurance Technical Skill (Radiology)

[Adapted from: Fineberg, Harvey, MD, PhD, Dean, Harvard University School of Public Health, 1990. Traditional Distinctions Between Public Health and Medicine. Table 5-1, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Institute of Medicine, 2003.
http://www.nap.edu/books/030908542X/html/]

As shown on the chart above, public health research and practice is aimed at whole communities. Evidence-based approaches within this context require an understanding of the complexities of organizational structures, interactions, and myriad other dynamics that shape and influence decision making at the local, state, regional, and national levels within which public health operates and within which policies and programs are established.

Role of Librarians and Information Professionals in Evidence-Based Public Health

Librarians and information professionals are trained in the skills and procedures needed for applying evidence-based principles, including information retrieval and evaluation of search strategies and results. Librarians and information professionals provide training and instruction on evidence-based public health concepts, develop web-based resources and guides to evidence-based sources, consult on search strategies and techniques for identifying the evidence-based literature, and apply criteria for assessing and evaluating the reliability and validity of search results.

An Opportunity to Find Out More about Evidence-Based Public Health

The 2005 Annual Meeting of the American Public Health Association will be focused on the theme: Evidence-Based Policy and Practice. The meeting is in New Orleans, Louisiana on November 5-9, 2005.

"Evidence-based Policy and Practice" explores the processes of systematically finding, appraising and using scientific research as the basis for developing sound practices. The knowledge gleaned from this research is used to develop policies and practices that improve health outcomes and performance as well as allowing for more efficient use of resources. Policy makers are also provided with a better understanding of the science, ensuring that policy decisions are based on the best information available.

 

 

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