A reminder that my resource guide to all studies looking at % of
evidence based health care is available at:
http://www.shef.ac.uk/~scharr/ir/percent.html
Extract below:
Psychiatry
Geddes_JR, Game_D, Jenkins_NE, Peterson_LA, Pottinger_GR, Sackett_DL.
What proportion of primary psychiatric interventions are based on
evidence from randomised controlled trials? Quality In Health Care,
1996, Vol.5, No.4, pp.215-217
Univ Oxford,Warneford Hosp,Dept Psychiat,Oxford Ox3 7jx,England Oxford
Radcliffe Nhs Trust,Nuffield Dept Med,Res & Dev Programme Ctr Evidence
Based Med,Oxford,England.
AB: Objectives-To estimate the proportion of psychiatric inpatients
receiving primary interventions based on randomised controlled trials
or systematic reviews of randomised controlled trials.
Design-Retrospective survey. Setting-Acute adult general psychiatric
ward. Subjects-All patients admitted to the ward during a 28 day
period. Main outcome measures-Primary interventions were classified
according to whether or not they were supported by evidence from
randomised controlled trials or systematic reviews. Results-The
primary interventions received by 26/40 (65%; 95% confidence interval
(95% CI) 51% to 79%) of patients admitted during the period were based
on randomised trials or systematic reviews.
Conclusions-When patients were used as the denominator, most primary
interventions given in acute general psychiatry were based on
experimental evidence. The evidence was difficult to locate; there is
an urgent need for systematic reviews of randomised controlled trials
in this area.
In E-B Psychiatric Services, both in-patient (67% of admissions
treated on the basis of SRs and RCTs at the oxford centre for e-b
psychiatry) [Qual Health Care 1996;5:215-7] and out-patient psychiatry
[poster and abstract at a psych meeting] documented results as good or
better as those in medicine. [Sackett, 1998]
Summers, A.; Kehoe, R. F. Is psychiatric treatment evidence-based?
[Letter to the Editor]. Lancet 1996: 347 (8998): 409-410
Airedale General Hospital, Keighley, West Yorkshire BD20 6TD, UK.
Sir--We know of no published study of the extent to which psychiatric
interventions are evidence based. We investigated this in 158
individuals over 6 weeks during 1995, and identified decisions to
initiate new treatments (pharmacological, psychological, or social)
from case notes. We excluded decisions to provide patient education,
assessment, or monitoring; continue or adjust treatments; change
location or provider of treatment; and treat unrelated physical
problems. 160 decisions were identified, 75 in outpatients, 11 in
community mental-health centre clients, 18 in day patients, and 56 in
inpatients. Randomised controlled trials of treatments were identified
from published reviews (1,2) and from those already known to us.
Evidence was identified to support 85 (53 percent) interventions. The
most frequent were specific drug treatments for depression (n=35) and
psychotic symptoms (n=10).
A further 16 (10 percent) interventions were not considered because
trials would have been unethical. The most frequent interventions in
this group were close observation in hospital for individuals at high
immediate risk of suicide (n=6) and treatments for related physical
illness in depressed patients (n=5).
The remaining 59 (37 percent) interventions did not fall into either
category. The most frequent were supportive practical measures (n=12)
and non-specific supportive psychotherapy (n=8). We relied on
authoritative reviews and well known evidence for our evidence of
treatment effectiveness. If there is other evidence our figures would
underestimate the proportion that are evidence based. It is likely
that we overestimated the extent to which evidence underpins clinical
management for the following reasons: consideration of only a limited
range of decisions; assumption that diagnoses were accurate and
assessments of severity were appropriate; and differences between our
patients or treatments and those in the trials on which the evidence
is based. These issues have been discussed elsewhere. (3)
We note that there may be treatments that could have been initiated
but were not considered. In using higher proportions of evidence-based
treatments we may be introducing bias towards treatments that are
easier to test but not necessarily more effective. We did not
establish that our evidence-based decisions represented the most
effective, or the most acceptable or cost effective treatment for each
individual.
References and notes
1. Wing JK. Mental illness health care needs assessment no 15. Wessex
Institute of Public Health Medicine. Oxford: Radcliffe Medical Press,
1994.
2. School of Public Health University of Leeds, Centre for Health
Economics University of York, Research Unit Royal College of
Physicians. Effective Health Care. The treatment of depression in
primary care. Bulletin of the effectiveness of health service
interventions for decision-makers, no 5. University of Leeds, 1993.
3. Grimley Evans J. Evidence based and evidence biased medicine. Age
Ageing 1995; 24: 461-63.
> Date: Fri, 26 Feb 1999 11:00:21 -0000
> Subject: ref? - propn of psychiat. treatments evidence based?
> From: Mark Winston <[log in to unmask]>
> To: "'EBH mailbase'" <[log in to unmask]>
> Reply-to: Mark Winston <[log in to unmask]>
> I seem to recall reading somewhere about a study which examined the
> proprtion of psychiatric treatments, in [I think] an inpatient unit, which
> could be said to be evidence-based. I also seem to recall that about 60% of
> treatments were deemed to be EBed.
>
> What I can't recall is the reference, and a simple trawl through Bandolier
> and Medline has not helped.
>
> Can anyone help me with either the reference or the paper?
>
> Thanks.
>
>
> Mark Winston
> Associate Director
> Royal College of Psychiatrists Research Unit (Wales)
> St Tydfil's Hospital, Merthyr Tydfil CF47 0SJ
> Tel 01685 723244 Fax 01685 359085
>
Andrew Booth BA MSc Dip Lib ALA
Director of Information Resources
School of Health & Related Research (ScHARR)
Regent Court
30 Regent Street
SHEFFIELD
S1 4DA
Tel: 0114 222 5420 or 5214 Fax: 0114 272 4095
The author of Netting the Evidence:
http://www.shef.ac.uk/~scharr/ir/netting.html
and Trawling the Net:
http://www.shef.ac.uk/~scharr/ir/trawling.html
E-mail: [log in to unmask]
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