What are the barriers to the use of research evidence in health care practice or policy?

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Table of Contents Show

Why is it important?
How can you implement evidence-based initiatives to improve outcomes for older people?
Identify a practice that could be improved
Barriers, enablers and issues
The intervention
What did and didn’t work
Maintaining the intervention

Got it, thanks!

Evidence-based practice (EBP) is an approach to care that integrates the best available research evidence with clinical expertise and patient values.1

It involves translating evidence into practice, also known as knowledge translation, and ensuring that ‘stakeholders (health practitioners, patients, family and carers) are aware of and use research evidence to inform their health and healthcare decision-making’.2

Why is it important?

Implementing clinical knowledge, and introducing new interventions and therapies, is an important way to minimise functional decline in older people.

Four in 10 adult patients receive care that is not based on current evidence or guidelines, including ineffective, unnecessary or potentially harmful treatments.2
Despite the availability of evidence-based guidelines, there are significant gaps in implementing evidence into routine clinical practice.3
Translating evidence into practice can not only improve outcomes and quality of life for older people, it can also improve productivity and reduce healthcare costs.1

How can you implement evidence-based initiatives to improve outcomes for older people?

Implementing evidence-based practice is a key part of improving outcomes for older people in hospital. When considering current best practice in the areas of nutrition, cognition, continence, medication, skin integrity, and mobility and self-care, a good first reference is the Older people in hospital website.

The National Safety and Quality Health Service Standards outlines the standards for providing best evidence care for older people in hospital.

The ‘how to’ guide: turning knowledge into practice in the care of older people identifies a five-stage process to implementing change, which can be applied to translate evidence into practice.

Identify a practice that could be improved

Select an area of interest in your clinical practice that could be improved – for example falls, medication errors or malnutrition.
Identify current best practice guidelines and evidence-based interventions associated with improved outcomes.
With your team, select an appropriate intervention and outcome measures that will influence your practice.
Collaborate with quality teams and researchers with expertise in the area you are focussing on.

Barriers, enablers and issues

Identify the barriers to implementing change. This includes anything that might obstruct or slow down the adoption of a new clinical intervention, such as feasibility, existing care processes or existing team culture.
Explore the enablers to implementing change. This includes anything that might assist or encourage take up of a new evidence-based practice, such as positive staff attitudes, funding or alignment with accreditation standards.
Consider issues for any data collection for measuring the effectiveness of your intervention.
Plan for sustainability to ensure the change can be maintained.

The intervention

Tailor the intervention to fit within the appropriate policies, standards and guidelines.
Engage and communicate with relevant stakeholders including staff, patients, family and carers to promote and facilitate adoption of the new intervention.
Consider implementing a plan-do-study-act cycle from the ‘how to’ guide in which interventions are introduced and tested in the real work setting, in a sequence of repeating, smaller quality cycles.

What did and didn’t work

Monitor patient outcomes following the adoption of a new intervention.
Measure the impacts of translating evidence in your current practice.
Outline an evaluation to measure outcomes and demonstrate any improvement.

Maintaining the intervention

Adapt and integrate the new intervention within the current systems taking into account funding and resources.
Ensure all new staff receive ongoing training.
Maintain ongoing communication, engagement and partnerships with relevant stakeholders and the broader network.

1. Sackett D et al. 2000, ‘Evidence-Based Medicine: How to Practice and Teach’ EBM, 2nd edition. Churchill Livingstone, Edinburgh, p1.

2. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ & Squires JE 2012, ‘Knowledge translation of research findings’, Implement Sci, 7(50):50.

3. Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, Day RO, Hindmarsh DM, McGlynn EA & Braithwaite J 2012, ‘CareTrack: assessing the appropriateness of health care delivery in Australia’, Med J Aust, 197(2):100-5.

Reviewed 26 October 2021

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Review	Countries where the primary studies were conducted	Health theme	Type of review	Quality JBI
Slade et al. (2015) [21]	Canada, United States, Netherlands, Israel, New Zealand, Germany, United Kingdom and Norway	Low back pain	SR	Qualitative	8/10
Baatiema et al. (2017) [18]	Australia, Usa, Switzerland, Denmark, Netherlands, Norway	Cerebrovascular disease	SR	Mixed	9/11
Chan et al. (2017) [22]	United States	Dyslipidaemia, high blood pressure and overweight/obesity	RR	Qualitative	8/10
Craig et al. (2016) [23]	United States, France, Australia, Sweden, The Netherlands	Cerebrovascular disease	SR	Mixed	9/11
Egerton et al. (2017) [24]	Australia, France, United Kingdom, Germany and Mexico	Osteoarthritis	SR	Qualitative	8/10
Eisner et al. (2011) [25]	Switzerland	Infectious diseases and prevention activities	SR	Mixed	9/11
Gaston et al. (2011) [26]	United States, Australia, Saudi Arabia, United Kingdom, Iran, Ireland, Canada	Venous thromboembolism	SR	Mixed	10/11
Ince et al. (2016) [27]	United Kingdom	Schizophrenia, cognitive behavioural therapy and family intervention	SR	Mixed	9/11
Jun et al. (2016) [19]	United States, Australia, Canada, Finland, Singapore, Sweden and the Netherlands	Nursing Clinical Practice Guidelines	SR	Mixed	8/11
Stokes et al. (2016) [12]	Sub-Saharan Africa, Somalia, Tanzania, Burkina Faso, Benin, Senegal, South Africa	Obstetric care	SR	Qualitative	9/10
Rushforth et al. (2016) [28]	United States, United Kingdom, Asia, Africa, Europe (not United Kingdom)	Diabetes mellitus 2	SR	Qualitative	8/10
Rubio-Valera et al. (2014) [14]	United Kingdom, Denmark, United States, Sweden, Switzerland, Spain, Germany, Israel, Ireland, Netherlands, Canada, Australia, New Zealand	Chronic diseases; promotion and prevention of health in primary care	SR	Qualitative	9/10
Khatib et al. (2014) [29]	United States, Canada, United Kingdom, Israel, Brazil, Korea, Australia, Netherlands, India, Egypt, Switzerland, Ireland, Trinidad, Croatia, China, Russia, Nigeria, Malaysia, South Africa, Kuwait, Singapore	Arterial hypertension	SR	Mixed	10/11
De Vleminck et al. (2013) [30]	United States, Canada, United Kingdom, Netherlands, Australia, Singapore, Belgium, Israel	Advance care planning	SR	Mixed	9/11
Siabani et al. (2013) [31]	Sweden, United States, United Kingdom, New Zealand, Canada, Australia, Malaysia	Chronic heart failure	SR	Qualitative	7/10
Sadeghi-Bazargani et al. (2014) [17]	United Kingdom, United States, Netherlands, India, Canada, Australia, Poland, Finland, Jordan, Belgium, Africa, Chile, Argentina, China, Japan, Ireland, Malaysia, Saudi Arabia, Iran, Switzerland, South Korea, Germany	EBM in primary healthcare, secondary and specialised care	RR	Mixed	10/11
Wood et al. (2017) [15]	United States, United Kingdom, Germany, Canada	Depression (collaborative attention)	SR	Qualitative	10/10
Gravel et al. (2006) [32]	Canada, United Kingdom, United States, Netherlands, Australia, France, Mexico, Norway, Germany, China	Shared decision-making	SR	Mixed	9/11
Busetto et al. (2015) [20]	United States, Belgium, Austria, Israel, Canada, United Kingdom, Germany	Diabetes	SR	Mixed	10/11
Lau et al. (2015) [16]	United States of America, Canada, the United Kingdom, Australia and Europe	EBM	RR	Mixed	8/11
Cochrane et al. (2007) [33]	No data	EBM	SR	Mixed	7/11
Samnani et al. (2017) et al. [13]	Bangladesh, Afghanistan, Ethiopia, Ghana, Kenya, Uganda, Northern Nigeria, Tanzania, India, Pakistan, Kosovo, Malawi, Myanmar, sub-Saharan African countries (Democratic Republic of the Congo, Maban and Burkina Faso)	Obstetric haemorrhage	SR	Mixed	7/11
Christl et al. (2011) [34]	Australia	Prevention of cardiovascular diseases	SR	Mixed	4/11
De Clercq et al. (2017) [35]	United States, United Kingdom, Canada, Australia, Italy, Germany, Switzerland, Israel and Poland	Paediatric palliative care	SR	Mixed	5/11
Flottorp et al. (2013) [6]	No data	Healthcare setting and public health services and clinical services	SR	Mixed	8/11