1 evidence-based public health prof.dr.surasak taneepanichskul md. m. med(ph) ll.b frtcog frtcpm

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Evidence-Based Public Health

Prof.Dr.Surasak Taneepanichskul

MD. M. Med(PH) LL.B FRTCOG FRTCPM

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Rise of Evidence-Based Medicine and Public Health

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Objectives and Competencies

Describe evidence-base in public health.

Searching EBPH

Analytic assessment: Identifies relevant and appropriate data and information

sources.

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Definitions

Evidence-based Public Health

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Definition: Evidence-based Public Health

“the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models”

Source: Brownson, R.C. et al, Evidence-based public health, Oxford University Press, 2003.

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Why EBPH?

Need credible filtered information to make informed decisions.

Research evidence is valued. So much information,

too little time!

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Why is EBPH important?

provides assurance that decision making is based on scientific evidence and effective practices;

helps ensure the retrieval of up-to-date and reliable information about what works and doesn’t work for a particular public health question;

provides assurance that one’s time is being used most efficiently and productively in reviewing the “best of the best” information available on the particular public health question.

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When is EBPH used?

when it’s important to have scientific evidence to support decision making;

when evaluating the effectiveness and cost benefits of health programs;

when establishing new health programs; when policies are being implemented; and when conducting literature reviews for grant

projects.

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The EBPH Model

Based on Brownson et al., 2002Evidence-Based Public Health

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Evidence-Based Public Health

Decisions for Public Health Practice• Interventions

• Programs• Policies

Social values,Politics,

Economics

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Expertise,Knowledge

Best Evidencefrom

Research

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Source: Guide to Research Methods: The Evidence Pyramid: <http://servers.medlib.hscbklyn.edu/ebm/2100.htm>.

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Hierarchy of Research Designs Category I: Evidence from at least one properly

randomized controlled trial. Category II-1: Evidence from well-designed controlled trials

without randomization. Category II-2: Evidence from well-designed cohort or case-

control analytic studies, preferably from more than one center or research group.

Category II-3: Evidence from multiple times series with or without intervention or dramatic results in uncontrolled experiments such as the results of the introduction of penicillin treatment in the 1940s.

Category III: Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

Source: Harris, R.P. et al. (2001). Current methods of the U.S. Preventive Services Task Force: a review of the process. American Journal of Preventive Medicine. April 20 (3 Supplement): 21-35.

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Types of Evidence

Systematic Review: critical assessment and evaluation of research that attempts to address a focused question using methods designed to reduce the likelihood of bias.

Meta-Analysis: overview that incorporates a quantitative strategy for combining the results of several studies into a single pooled or summary estimate.

Source: R.C. Brownson et al, Evidence-Based Public Health, Oxford: Oxford University, 2003.

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Types of Evidence

Risk Assessment: systematic approach to characterizing the risks posed to individuals and populations by environmental pollutants and other potentially adverse exposures.


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Types of Evidence

Decision Analysis: systematic approach to decision making under conditions of uncertainty; involves identifying all available alternatives and estimating the probabilities of potential outcomes associated with each alternative, valuing each outcome, and, on the basis of the probabilities and values, arriving at a quantitative estimate of the relative merit of the alternatives.


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Types of Evidence

Economic Evaluation: comparative analysis of alternative courses of action in terms of both their costs and consequences.

Expert Panels: examination of research studies and their relevance to health conditions, diagnostic and therapeutic procedures, planning and health policy, and community interventions.


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Types of Evidence

Practice Guidelines: systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances; may be developed by government agencies, institutions, or by the convening of expert panels.


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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.

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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.

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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.

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Identifying Evidence-Based Identifying Evidence-Based Resources in Public HealthResources in Public Health

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Public Health: Health of Populations

Clinical Medicine: Health of Individuals

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The Public Health Workforce• 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

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• 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 DomainsPublic Health

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Sources of Public Health Evidence

• Journal literature• Books• Conference

proceedings & abstracts

• Dissertations & theses• Unpublished scientific

papers• Government reports• Policy statements, laws

& regulations

• Surveillance data• Newsletters• Teleconferences &

webcasts• Alert systems • Listservs• Internet sources• Expert knowledge &

opinion

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1. Define the public health problem.

2. Search and find the best evidence.

3. Critically appraise the evidence for validity and relevance.

4. Apply the evidence to practice.

5. Evaluate the results.

Evidence-Based Public Health Process

Adopted from:Source: 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.

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Define the public health problem

Convert the information needs into focused questions

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Forming a Searchable Public Health Question

PICO

P - Population

I - Intervention

C - Comparison

O - Outcome

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Sample Question

You will be working with health teachers in a rural Southern high school. They have heard girls talking about what sounds like STD symptoms and you the teachers want to start teaching safer sex education. The principal espouses abstinence-only education. You want to compile some evidence about the effectiveness of sex education curricula to bring to a discussion with the superintendent and the principal.

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Search and find the best evidence

Critically appraise the evidence for validity and relevance

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Search Pathway1. Evidence-Based Guidelines

2. Systematic Reviews

3. Pre-formulated Searches

4. Best and Model Practices

5. Bibliographic Databases

6. Public Health Journals

7. Health Data and Statistics

8. Legislation and Policy

9. Government Reports

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

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Evidence-Based Resources for Public Health Practice

1. Evidence-Based Guidelines



4. Best & Model Practices

5. Public Health Bibliographic Databases


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

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Guide to Community Preventive Serviceshttp://www.thecommunityguide.org

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Tobacco Use Prevention & Control

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Guide to Community Preventive ServicesSummary of Findings: Tobacco Use Prevention and Control

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Link to Full-Text Article from the American Journal of Preventive Medicine

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National Guideline Clearinghouse http://www.guideline.gov

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National Guideline Clearinghouse

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Cochrane Health Promotion and Public Health http://www.vichealth.vic.gov.au/cochrane/activities/reviews.htm

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Cochrane Library http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME?CRETRY=1&SRETRY=0

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Health-Evidence.ca http://health-evidence.ca

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heath-evidence.ca

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health-evidence.ca search tool

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health-evidence.ca search tool

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Healthy People 2010 Information Access Projecthttp://phpartners.org/hp

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Model Practices Database http://archive.naccho.org/modelPractices

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Model and Promising Practices

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Example of Model Practice

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Promising Practices Network on Children, Families and Communities http://www.promisingpractices.net/default.asp

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Big Brothers Big Sisters of America

Promising Practices Network on Children, Families and Communities

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Evidence-Based Practice for Public Health Project – Bibliographic Databases http://library.umassmed.edu/ebpph/dblist.cfm

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Maternal and Child Health Library http://www.mchlibrary.info

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PubMed (MEDLINE)http://pubmed.gov

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Details of PubMed Search

Mapped to Medical Subject Heading (MeSH)teen pregnancy = pregnancy in adolescence

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PubMed Limits

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History of PubMed Search Session

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Evidence-Based Practice for Public Health– Public Health Journals http://library.umassmed.edu/ebpph/journallist.cfm

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Evidence-Based Practice for Public Health– Maternal & Child Health Journals http://library.umassmed.edu/ebpph/journalsKNaction.cfm

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Evidence-Based Practice for Public Health– Free Public Health Journals http://library.umassmed.edu/ebpph/freephjo

urnals.cfm

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Evidence-Based Practice for Public Health Project Web Site:

http://library.umassmed.edu/ebpph

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

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Continuing the Pathway:Evidence-Based Resources for

Public Health Practice

7. Health Data and Statistics 8. Legislation and Policy9. Government Reports

Public Heath Web Portal: http://PHPartners.org

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

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List of Partners

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PHPartners.org Suggest a Link

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PHPartners.org: Public Health Tutorial

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Training and Resources from the National Network of Libraries of Medicine

http://nnlm.gov

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Health Data & Statistics

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PHPartners.org: Health Data Tools & Statistics

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Child Trends Data Bank http://www.childtrendsdatabank.org

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National Survey of Children’s Health Data Resource Center http://nschdata.org

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Legislation and Policy

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Maternal and Child Health Policy Research Centerhttp://www.mchpolicy.org

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Maternal and Child Health Policy Research Center

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Maternal and Child Health Policy Research Center

State Medicaid Coverage of Selected Services Important to Children in the Absence of the EPSDT Mandate, 2005

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AMCHP Legislative Center

http://www.amchp.org/legislative/index.php

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Government Reports

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PHPartners.org: Government and Other Reports

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PHPartners.org: Reports & Other Publications

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Search Pathway1. Evidence-Based Guidelines



4. Best and Model Practices

5. Bibliographic Databases


7. Health Data and Statistics

8. Legislation and Policy

9. Government Reports

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Case Presentation

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Case Presentation

Assume that you are the health director of a local health department.

A community in your jurisdiction is concerned with its high rate of childhood obesity and requests your help.

How do you proceed to develop the program?

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Develop an InitialStatement of the Issue

The prevalence of obesity among the 327 elementary school children in the community is 35%. With the support of parents, school staff, and community-based organizations, how can this obesity rate be reduced through lifestyle interventions?

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Quantify the Issue

The prevalence of obesity was determined by a special survey.

The rate of obesity was found to increase by grade level.

The rates were about equal in girls and boys.

100 minutes/wk provided at school for physical activity, but only 40 minutes is guided by a teacher.

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Search the Scientific Literature and Organize Information

Medline search Cochrane Collaboration Task Force on Community Preventive

Services

Evidence-Based Practice for Public Health ProjectUniversity of Massachusetts Medical School

Task Force on Community Preventive Services

Insufficient evidence to recommend classroom-based health education to provide information on managing health risks.

Strongly recommended curricula and policies to increase the amount of moderate or vigorous activity, increase the amount of time in PE class, or the amount of time being active in PE.

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Develop and PrioritizeProgram Options

A community-based work group develops a number of options to increase physical activity in school.

There are debates about losing time in the classroom and impact on test performance.

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Develop an Action Plan

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Develop an Action Plan

Agreement is reached on a pilot project for the next school year involving reducing the lunch hour and increasing time in physical education with an emphasis on activities that get all children to be active.

The program will be evaluated by all stakeholders (e.g., children will be surveyed)

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Summary

EBM has transformed medicine EBM has fostered development of EBPH EBPH continues to evolve increased

community engagement

1 evidence-based public health prof.dr.surasak taneepanichskul md. m. med(ph) ll.b frtcog frtcpm

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