Evidence in Our Health System

EvidenceBackground

Wales is the home of one of the pioneers of "evidence-based" medicine. In 1960 Archie Cochrane established the Medical Research Council Epidemiology Unit at Llandough Hospital, and was appointed to the David Davies Chair of Tuberculosis and Chest Disease at the Welsh National School of Medicine.
Professor Cochrane is still remembered in the Rhondda Fach for conducting a Medical Research Council study into pneumoconiosis and other lung diseases that involved the
mining community there. From this study and other investigations Cochrane advocated the view that the NHS should only treat people in ways that were evidence-based.
 
We have more information available than ever before to help clinicians. Our challenge is using that information applying it in what we do and being explicit with patients, carers and healthcare colleagues about our reasoning for what we are doing. We are continuing to strive for better and more robust evidence to inform clinical practice.
 
 

Sources of Evidence

 
One of the main distributive networks of evidence based interventions is known as the Cochrane Library. It is an electronic library supplying high quality evidence to inform people providing and receiving care, and those responsible for research, teaching, funding and administration at all levels.

In simple terms the phrase ‘evidence-based’ means those interventions or treatments that have been shown by research evidence to have a positive outcome when tested using a process based on rigorous scientific principles. The gold-standard of these tests is the double-blind, randomised control trial (RCT) and then further analysis through systematic reviews.

Such an evidence base enables clinicians to make treatment decisions with confidence and to act to the best of their abilities to improve and protect the health for those patients in their care. Clinical evidence does not only draw on RCTs but the methodologies and processes used by the National Institute for Health and Clinical Excellence (NICE) have made a major contribution to building standards for evidence based practice. It also distils the growing wealth of knowledge available for use and application.

Applying scientific principles to people who by nature are very different is not so straight forward outside of laboratory or controlled trials. This is particularly challenging with public health interventions. In Wales DECIPHer: the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement is enhancing our ability to understand the impact of health interventions on society. It is one of five UK centres of excellence for public health research.

The acronym CHIRAL is short for the Centre for Health information, research and evaluation. CHIRAL is an integrated, multidisciplinary research centre of international standing conducting clinical trials, health services research, public health research, and population science all linked by methodological innovation in high powered computing using both quantitative and qualitative methodologies. The focus on health informatics is central to much of the cutting edge work carried out.

Cardiff Institute of Society and Health (CISHE), School of Social Sciences Cardiff University aims to lead and facilitate research of international excellence, placing emphasis on tackling health inequalities and ensuring that our research has an impact on policy and practice in Wales and beyond.

The Public Health Wales Observatory aims to provide useful public health information to improve health and health services in Wales, and reduce health inequities.

Launched in April 2009 NHS Evidence allows everyone working in health and social care to access a wide range of health information to help them deliver quality patient care.

As we see more and more complex evidence published, one of the unintended consequences of the evidence revolution is that individuals are unable to keep up with the breadth of publications generated in their field. We need to ensure that our clinicians are able to sort the ‘wheat from the chaff ’ and know how to evaluate the quality of what they read across diverse media. The Welsh NHS programme Informing Healthcare has developed a series of tools and applications, including the Welsh Clinical Portal and e-Library for Health, making knowledge available in a smarter way.

To ensure that the introduction of effective remedies is not delayed the All-Wales Medicines Strategy Group (AWMSG) ensures speedy appraisal of the cost effectiveness of new
pharmaceutical treatments which not on the immediate NICE evaluation programme.

This enables Wales to make investment decisions based on available evidence in a timely manner, enabling improved and equitable access to new treatments for Welsh patients and helping to reduce post code prescribing variation in Wales.

The Minister has recently resourced the Group to appraise even more new medicines following recommendations made in the Routledge Report: Towards Improving the Availability of Medicines for People in Wales (2009).

We are ensuring that through these and other mechanisms the best evidence is available to directly and efficiently inform frontline clinical staff. Recent development of the National Institute of Social Care and Health Research (NISCHR) and programmes of healthcare improvement such as the 1000 Lives Plus campaign support our existing research community . This provides the foundations for our primary drive to translate research evidence into practice in order to improve quality.