Letters

Evidence should be accessible as well as relevant

EDITORNational policy on research and development encourages the delivery of health care that is of proved efficacy and based on research.¹ Barker and Gilbert say that evidence of clinical effectiveness has to be relevant to health professionals for it to be incorporated into clinical practice.² We conducted a survey of community nurses and community based professionals allied to medicine (PAMs) employed by one east London community trust to identify the areas of their work where they see evidence as important.

We adapted a postal questionnaire survey that we used in 1997 among general practitioners and practice staff in teaching practices.³ In all, 124 completed questionnaires were returned (51%). Respondents were asked for their views on the role of evidence and the sources of evidence that they accessed and were also asked to list up to three areas where research evidence would be relevant to their work.

Eighty one per cent of the respondents showed a positive attitude to the use of research evidence in the daily management of patients and clients and in the planning of services. This compares with 90% of general practitioners in the 1997 survey. There were differences between these two groups in the sources of evidence that were accessed (table).

Colleagues were used as a source of evidence by a similar proportion in each group, but community nurses and PAMs were less likely to consult experts or journals. Nor did these professionals access the internet for evidence: 64% (77/121) reported never having used the internet for any purpose. Computer projects such as PRODIGY are bringing evidence based decision making into clinical settings.⁴ However, half of our respondents (58/117) reported having no access to a clinical computer system.

Community nurses and PAMs are interested in having access to evidence that is relevant to their work, especially in areas such as community mental health interventions, appropriate timing of developmental checks in children, prevention of falls among elderly people, pain management, intervention of health visitors in postnatal depression, foot and leg ulcer care, and music and art therapy. Training courses in evidence based health care need to consider the effectiveness of interventions in these areas. We agree with Barker and Gilbert that the impact of evidence based health care depends on its relevance to the work of practitioners in the field, but practitioners also need access to such evidence.

M Falshaw, research coordinator. 
m.falshaw{at}qmw.ac.uk

Y H Carter, professor. 
R W Gray, research assistant. 
Department of General Practice and Primary Care, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS