Clinical effectiveness

A number of themes have run through A number of themes have run through health policy initiatives of the two Labour health policy initiatives of the two Labour Governments of the past 5 years: moder-Governments of the past 5 years: modernisation; stigma; inequalities and social nisation; stigma; inequalities and social exclusion; partnerships; involvement of exclusion; partnerships; involvement of users and carers.But perhaps the most users and carers.But perhaps the most important from the point of view of mental important from the point of view of mental health professionals is the initiative to alter health professionals is the initiative to alter the culture within which health care is the culture within which health care is offered from one based on expert knowl-offered from one based on expert knowledge and authority to one founded on the edge and authority to one founded on the principle of evidence-based practice.principle of evidence-based practice.Clinical effectiveness is one of those Clinical effectiveness is one of those self-evidently 'good' things.No one would self-evidently 'good' things.No one would want openly to advocate clinically ineffec-want openly to advocate clinically ineffective treatment approaches (despite the fact tive treatment approaches (despite the fact that in psychiatry relevant data are sparse) that in psychiatry relevant data are sparse) any more than they would wish to argue any more than they would wish to argue against the appropriateness of maternity against the appropriateness of maternity (and paternity) leave.Yet our clinical (and paternity) leave.Yet our clinical decisions are often based more on habit decisions are often based more on habit than on knowledge of what actually works.than on knowledge of what actually works.Clinical governance in the National Clinical governance in the National Health Service (NHS) has charged all Health Service (NHS) has charged all organisations with a statutory duty to seek organisations with a statutory duty to seek quality improvements in the health care quality improvements in the health care that they deliver (Department of Health, that they deliver (Department of Health, 1998 1998b b). There is high-quality research).There is high-quality research evidence to support such an initiative in evidence to support such an initiative in many areas of mental health care.There are many areas of mental health care.There are excellent collections of reviews, guidelines excellent collections of reviews, guidelines and critical appraisals of this evidence, but and critical appraisals of this evidence, but no single comprehensive index covers all no single comprehensive index covers all the relevant information.A relatively recent the relevant information.A relatively recent compilation produced by the School of compilation produced by the School of Health and Related Research (ScHARR) Health and Related Research (ScHARR) (http://www.nettingtheevidence.org.uk)in-(http://www.nettingtheevidence.org.uk)includes a library of relevant articles and a cludes a library of relevant articles and a listing of databases and organisations listing of databases and organisations concerned with evidence-based practice.concerned with evidence-based practice.Turning Research into Practice (TRIP) is a Turning Research into Practice (TRIP) is a resource hosted by the Centre for Research resource hosted by the Centre for Research Support in Wales and it covers a wide range Support in Wales and it covers a wide range of UK and US clinical effectiveness re-of UK and US clinical effectiveness resources and evidence-based guidelines sources and evidence-based guidelines (http://www.tripdatabase.com).It boasts (http://www.tripdatabase.com).It boasts of over 8000 links to resources in 28 differ-of over 8000 links to resources in 28 different centres.A particularly useful source is ent centres.A particularly useful source is Evidence-Based Medicine Reviews Evidence-Based Medicine Reviews (EBMR), which is available via Ovid online (EBMR), which is available via Ovid online (http://www.ovid.com).This is a single, (http://www.ovid.com).This is a single, fully searchable database that integrates fully searchable database that integrates the Cochrane database of systematic re-the Cochrane database of systematic reviews (see below) with Best Evidence views (see below) with Best Evidence (which provides summaries of articles from (which provides summaries of articles from major medical journals along with expert major medical journals along with expert commentaries) and DARE (Database of commentaries) and DARE (Database of Abstracts of Reviews of Effectiveness, a Abstracts of Reviews of Effectiveness, a database of high-quality systematic re-database of high-quality systematic research reviews produced by the NHS search reviews produced by the NHS Centre at the University of York; see Centre at the University of York; see below).Clinical guidelines are summarised below).Clinical guidelines are summarised on another database, at the Centre for on another database, at the Centre for Evidence Based Mental Health (http:// Evidence Based Mental Health (http:// www.cebmh.com).The very richness of www.cebmh.com).The very richness of these sources might discourage some from these sources might discourage some from extended searches.This paper aims to extended searches.This paper aims to provide an impressionistic review of some provide an impressionistic review of some of what there is to read about evidence. of what there is to read about evidence.