Evidence-based practice: from medicine to social work

Abstract

The last 10 years have witnessed an increasing interest in evidence-based practice in the field of medicine. The product of a time characterised by the explosion of information technology, a heightened sense of risk, and the enshrining of the principles of economy, effectiveness, transparency and consumerism, evidence-based practice has rapidly expanded from medicine to other fields, including social work. The new paradigm has generated not only great enthusiasm in many areas of the social work profession but also an intense debate about the transferability of the principles of evidence-based practice from medicine to a discipline that operates amidst particularly complex and multifaceted societal factors. Similarly, the concept of evidence upon which social work practice should be based has been the object of considerable discussion, though initial emphasis on results from randomised controlled trials seems to be gradually shifting towards broader approaches to defining evidence. Although organisational constraints and job pressures are likely to favour the use, among practitioners, of ‘preappraised’ resources, this should not prevent social workers from acquiring the skills and knowledge necessary to make independent and critical appraisal of evidence.

Keywords:

• Evidence-based Practice
• Evidence-based Medicine
• Hierarchies of Evidence
• Evidence Debate
• Evidence-based Social Work

Notes

1. Systematic reviews are collections of primary research that use systematic and explicit criteria in order to:

• search, identify, select and critically evaluate research studies relevant to a focused clinical question;

• include studies in the review;

• collect, analyse and report data from the studies included in the review (Cochrane Collaboration, 2003).

2. Meta-analysis is the statistical analysis used to analyse and numerically summarise the results of the studies included in the review (Cochrane Collaboration, 2003).

3. Randomised controlled trials are experimental studies in which participants are randomly allocated into an intervention group and to one or more groups where they can receive another intervention or no intervention at all. The groups are observed during a period of time and compared according to a range of variables set at the start of the study. As the groups are similar in everything except the intervention delivered, any differential outcomes between groups are, in principle, attributable to that intervention (Greenhalgh, 1997).

4. Cohort studies are observational studies in which groups of participants are classified according to their exposure or non-exposure to a particular factor (e.g. smokers and non-smokers). The groups are observed during a period of time and analysed in order to find out whether those exposed to the factor are more or less susceptible to develop a particular condition compared with those not exposed.

5. A case-control study is an observational study that consists of identifying and recruiting an individual with a particular condition to be investigated (‘case’) and an individual (‘control’) who, except for that condition, is similar to that considered ‘case’. The researchers, then, retrospectively analyse the exposure of each of the participants to the factor or factors hypothetically contributing to the condition (Levine et al., 1994).

6. Case-series are observational and uncontrolled studies involving a group or series of patients that have suffered a particular condition within a certain period of time and who have been given the same treatment. The researchers collect detailed information about socio-demographic characteristics of the patients, diagnosis, treatment administered, and the short- and long-term patients’ response to treatment. If this kind of study is conducted with an individual patient, the study design is a case study.

7. For instance, Pawson et al. (2003) identify five different sources of social care knowledge: organisational knowledge, practitioner knowledge, user knowledge, research knowledge and policy community knowledge.