Trying to Bring Evidence-Based Practice to Behavioral Medicine
How do behavioral scientists and practitioners incorporate the latest evidence-based interventions in their field into clinical practice and share them with other disciplines? Not easily, according to Bonnie J. Spring, PhD, professor of preventive medicine. Unlike the infrastructure that has evolved in evidence-based medicine to promote the use of current best evidence in clinical decision-making to improve patient care and develop health care policy, such a vehicle for the behavioral sciences does not exist.
“We don’t have a good understanding of or method for how people find information or how the information finds them,” says Dr. Spring (in photo with project coordinator Kristin Hitchcock, right). “How do people in the trenches know what current evidenced-based health interventions are available? They can’t realistically see a patient and then disappear into the library for three days.”
Evidence-based practice aims to close the gap between research findings and actual clinical practice through, in part, applying information gleaned from the systematic review of empirical research, according to this director of behavioral medicine at the Feinberg School of Medicine. Databases of regularly updated research syntheses and outcomes assessments are proliferating in medicine but not yet so in the behavioral sciences.
“Those of us in behavioral medicine believe in the benefits of this practice model,” says Dr. Spring, chair of the Evidence-Based Behavioral Medicine committee of the national Society of Behavioral Medicine. “However, we’ve been talking the lingo without any real idea of the infrastructure required to disseminate information and fully participate in evidence-based practice both across the behavioral sciences and with other health disciplines.”
Hoping to bring her field up to speed in the area of evidence-based practice, Dr. Spring approached the Office of Behavioral and Social Sciences Research (OBSSR) of the National Institutes of Health. She informed the agency that it needed to upgrade its education models. Recalls Dr. Spring. “Not only did I tell the OBSSR that a need existed, but I also told them how to fix it.” The agency bought into Dr. Spring’s vision to create an infrastructure to provide educators with appropriate tools for teaching the ins and outs of finding, generating, and applying research evidence; equip practitioners with the skills to perform evidence-based behavioral intervention; and promote practice-based research.
Last September Dr. Spring received $425,877for the first year of a five-year training grant—Resources for Training in Evidence-Based Behavioral Practice—administered by the National Library of Medicine for OBSSR to create Web-based training modules to teach health professionals about evidence-based behavioral practice. Says Dr. Spring, “This was an unusual award in that it was for a totally unsolicited contract that I wrote and submitted.”
The project will involve developing teaching resources and partnering with academic and continuing education programs that train budding behavioral scientists as well as professionals in the field. A medical librarian by training, Kristin D. Hitchcock came on board in January to coordinate the project. First year efforts will focus on establishing a multidisciplinary working council as well as a scientific advisory board with members representing such health specialties as nursing, social work, medicine, public health, and psychology. The groups’ first objective will be to publish a white paper to define and describe what is needed to achieve evidence-based behavioral practice, according to Dr. Spring.
“This is a different educational model that we are creating,” explains Dr. Spring. “We are simultaneously teaching research to practice, practice to research and across disciplines so that we can eventually speak a common language and understand each other’s histories and traditions.”