Evidence-Based Public Health: Finding and Appraising Relevant Resources

1. Evidence-Based Public Health: Finding and Appraising Relevant Resources Medical Library Association Continuing Education Course April 27, 2006

2. Objectives • Understand the characteristics of evidence-based public health • Be informed about the variety of resources available • Know how to respond to typical questions posed by public health workers and what resources are available to provide info • Identify types of evidence and methods for appraising the public health literature

3. Overview • What is Evidence-Based Public Health (EBPH)? • Why is EBPH important? • What is the difference between public health practice & medical practice? • What can be used as evidence for making informed public health decisions?

4. Example: Injury Prevention

5. Definition ofEvidence-Based Public Health “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement.” Source: Jenicek M. Epidemiology, evidenced-based medicine, and evidence-based public health. J Epidemiol. Dec 1997;7(4):187-197.

6. Evidence-Based Practice • Requires integrating practitioner expertise with the best evidence from systematic research. [someone must be doing research] • Involves finding and selecting resources that are credible, relevant, and applicable to practice. [how unique is your community?]

7. Process of Evidence-Based Practice • Define the problem: convert information needs into focused questions. • Find the best evidence from the literature. • Critically appraise the evidence for validity and relevance. • Apply the evidence to practice. • Evaluate the results. • Adopted from: • Sackett DL, Rosenberg WM. The need for evidence-based medicine. J R Soc Med. Nov 1995;88(11):620-624. • Sibbald WJ. Some opinions on the future of evidence-based medicine. Crit Care Clin. 1998;14(3):549-558.

8. Why Evidence-Based Practice? • So much information, too little time • Need high quality, filtered information to make informed decisions • Value of scientific knowledge for decision making • Decisions should not be based only on intuition, opinion or anecdotal information

9. Evidence for Public Health Practice and Policy Decisions • “I make a lot of decisions about how money is going to be spent, and I would like to always be able to back it up and say that this is proven, or evidence-based.” • Politicians need evidence to make decisions about public health programs.

10. From Public Health Professionals: “Some things have simply always been done a certain way – are common practice, but there is really no research to back it up.” “Politics always overlays decision-making on everything that is not evidence-based in the public health world. Everything we do is imbued with political priorities and funding decisions.” Quotes on this and previous page from MA DOH, Bureau of Communicable Dis Control

11. The Evidence-Based Movement EBM → EBPH How does public health relate to medicine?

12. Public Health: Health of Populations Medicine: Health of Individuals

13. Focus on populations Prevention & health promotion Environment & human behavior interventions Diverse workforce, variable education & certifications Social sciences integral; clinical sciences peripheral to education Observational studies: case control & cohort studies Focus on individuals Diagnosis & treatment Clinical interventions Well-established profession, standardized education & certification Clinical sciences integral; social sciences less emphasized Experimental studies with control groups: RCTs. Public Health Medicine

14. Public Health Medicine Interaction of Public Health & Medicine: • Medicine/Public Health Initiative • AAMC-CDC Cooperative Agreement (pop health) • Collaboration on emerging health threats • Bioterrorism (anthrax, 2001) • Emerging infections (SARS,2003) • Surveillance Technology: ability to quickly exchange information electronically • Managed care: What can we afford?

15. 10 Essential Services of Public Health Public Health Functions Project, U.S. Dept. of Health and Human Services

16. Evidence-Based Public Health Best Evidence from Research Social values, Politics, Economics $ Expertise, Knowledge • Decisions for Public Health Practice • Interventions • Programs • Policies

17. Journal literature Books Conference proceedings & abstracts Dissertations & theses Unpublished scientific papers Government reports Policy statements, laws & regulations Surveillance data Newsletters Teleconferences & webcasts Alert systems Email discussion lists Internet sources Expert knowledge & opinion Sources of Public Health Evidence

18. Evidence Pyramid Applicable to toxicology, environmental health, food safety, vaccine development, etc… From: The Medical Research Library of Brooklyn, http://servers.medlib.hscbklyn.edu/ebm/2100.htm

19. Evidence Pyramid Systematic Reviews & Meta-analyses [Perhaps also Meta-syntheses of qualitative studies?] Adapted from: The Medical Research Library of Brooklyn, http://servers.medlib.hscbklyn.edu/ebm/2100.htm

20. Evidence Matrix Petticrew M, Roberts H. Journal of Epidemiology and Community Health, 2003

21. The Project’s Website http://library.umassmed.edu/ebpph

22. CDC/ATPM Qualitative StudyInvestigation of Information Needs of Public Health Professionals Nancy La Pelle, PhD Roger L. Luckmann, MD, MPH E. Hatheway Simpson, MPH Elaine R. Martin, DA Identifying Strategies to Improve Access to Credible and Relevant Information for Public Health Professionals: A Qualitative Study 2006 Evidence-Based Practice for Public Health Project University of Massachusetts Medical School

23. Findings from Study of Public Health Workforce Information Needs • There are many relevant websites to search: need for one portal access. • Bombarded with unfiltered, irrelevant information: need filtered searches. • Too little information on legislation and policy change and newly identified health threats. Evidence-Based Practice for Public Health Project University of Massachusetts Medical School

24. Findings Continued • Need information from areas beyond biomedical domains. • Need access to systematic reviews and summary information. • Need access to full-text journal articles, government reports (grey literature), and conference proceedings. • Need for training in accessing evidence-based resources. Evidence-Based Practice for Public Health Project University of Massachusetts Medical School

25. Models of Information:Sources of evidence-based knowledge • Reports of Original Research • Summaries, Critiques and Commentaries • Systematic Reviews, Meta-Analyses, and Evidence-Based Guidelines • Knowledge Bases

26. 1. Reports of Original Research • Journal articles • Book chapters • Reports (government & other sources) • Newsletter articles • Conference proceedings and abstracts • Dissertations from Schools of Public Health • Bibliographic databases that cite the above • Filtered searches of bibliographic databases

27. Original Research Article: Am J Public Health

28. 2. Summaries, Critiques and Commentaries • Summaries of original studies • Critiques of original studies • Expert commentary and recommendations based on original studies • Structured abstracts of individual research articles

29. http://www.medscape.com/publichealth

30. 3. Systematic Reviews, Meta-Analyses, and Evidence-Based Guidelines • Systematic reviews with explicit criteria • Meta-analyses of data from original studies • Evidence-based guidelines based on original studies, systematic reviews, and meta-analyses • NB: Not all guidelines are EB; some are expert opinion/consensus

33. Link from Guide to Community Preventive Services: American Journal of Preventive Medicine

34. 4. Knowledge Bases • Searchable online textbooks with up-to-date information • Collections of multiple online resources • Journal articles • E-textbook chapters • Guidelines • Recommendations • Patient handouts • Images • Data (prevalence, incidence, costs, charges, etc..) • Multiple databases with integrated searching

36. What are the Knowledge Domains of Public Health? • The field of public health is very broad and diverse • There are multiple disciplines (knowledge domains) within the field of public health

37. Epidemiologists Statisticians Environmental Engineers Animal Control Officers Sanitarians Food Scientists Industrial Hygienists Health Care Administrators Health Economists Politicians Social Workers Mental Health Workers Substance Abuse Counselors Doctors Nurses Teachers Disaster Relief Workers Nutritionists Lab Technicians Librarians Communication Security & Enforcement / Health Police Public Health is Multidisciplinary

38. Defining Public Health • Public health accreditation criteria • Public health associations • Government health agencies • National health objectives • Public health occupational categories • Public health literature • Public health subject headings from the National Library of Medicine

39. General Public Health Epidemiology Biostatistics Vital Statistics & Surveillance Environmental Health Occupational Health Health Services Administration Social & Behavioral Sciences Health Promotion & Education Community Health Maternal & Child Health Public Health Nursing Disaster Control & Emergency Services Communicable Diseases HIV/AIDS Nutrition Chronic Diseases Public Health Laboratory Sciences Public Health Informatics Global Health Identified Knowledge Domains Public Health

40. Define the public health problem Convert the information needs into focused questions

41. Forming a Searchable Public Health QuestionPICO P - Population I - Intervention C - Comparison O - Outcome

42. Search and find the best evidence Critically appraise the evidence for validity and relevance

43. Sample Search Pathway • Evidence-Based Guidelines • Systematic Reviews • Pre-formulated Searches • Best and Model Practices • Bibliographic Databases • Public Health Journals • Health Data and Statistics • Legislation and Policy • Government Reports

44. EBPPH Project Web Site: http://library.umassmed.edu/ebpph

45. Evidence-Based Resources for Public Health Practice • Evidence-Based Guidelines • Systematic Reviews • Pre-formulated Searches • Best & Model Practices • Public Health Bibliographic Databases • Public Health Journals

46. Public Health Bibliographic Databases • CDC Information Center • Public health librarians • Abstracting and indexing services for key public health journals • Journals and newsletters • E-mail discussion lists • Public health websites • Public health subject experts

47. Public Health Bibliographic Databases Access free or by subscription only? Who produced the database? What topics are covered? What kinds of materials are indexed?

48. CDC Information Center Healthy People 2010 Information Access Project Core Public Health Journal Project ISI’s Journal Citation Reports Public health subject experts Sources Used to Identify Public Health Journals

49. Continuing the Pathway:Evidence-Based Resources for Public Health Practice • Health Data and Statistics • Legislation and Policy • Government Reports PublicHeath Web Portal:http://PHPartners.org

50. Public Health Web Portal: http://PHPartners.org