In 2009 the evidence base for practice has been a key topic for occupational health (OH) practitioners. In April, Dr Richard Preece’s opinion article in this journal provoked a reaction when it pointed to the dearth of evidence produced by OH nurses. The debate continues with OH adviser Graham Johnson writing that OH nurse practitioners know that what they do works, but proving that it does is an issue.
This year has produced two sets of guidelines from the National Institute of Health and Clinical Excellence (NICE) about workplace health issues. The first in March gave guidance based on the available evidence on long-term absence and incapacity, while the second, published in November, advised on promoting mental wellbeing at work. This follows other heavyweight reports on the evidence base for managing mental wellbeing at work, first the government’s Foresight report in 2008 on mental capital wellbeing, and then the NHS Plus OH Clinical Effectiveness Unit’s (OHCEU) audit of depression management launched in February this year, together with an audit of back pain.
This year also saw Dr Steve Boorman’s report on health and wellbeing in the NHS, which was triggered by Dame Carol Black’s review of the health of working-age people in 2008. Another project initiated by Black’s review is the forthcoming launch of Occupational Health Standards for Accreditation for the provision of OH services, under development by a new council led by OH doctors’ body the Faculty of Occupational Medicine.
Need for more research
The need for more research to inform the evidence base for OH was a major theme in Black’s report. Recommendation 9 of Working for a Healthier Tomorrow calls for: clear standards of practice and formal accreditation for all providers; a sound academic base; systematic gathering and analysis of data; and a universal awareness and understanding of the latest evidence and most effective interventions.
To find out how seriously the profession is taking the issue of evidence-based practice, Occupational Health carried out an online survey this autumn, hosted by Surveymonkey.com. Just under 100 (96) workplace health professionals took part, of whom about 70% were OH nurses, 18% OH physicians, and 12% health and wellbeing consultants.
Ninety-five per cent of respondents said they thought informing readers about the evidence base for practice is a top priority for the journal. But what do practitioners mean by the evidence base and which types of evidence are most useful in guiding their practice? This is an important question in relation to deciding what kind of articles readers would most like to see in the journal.
The most important evidence for guiding OH practice is standards and guidelines, according to respondents, with 97% agreeing they were important or very important, and 69% saying they were very important. The next most important guidance was evidence reviews, for example those by the British Occupational Health Research Foundation (BOHRF), NICE or the NHS Plus OHCEU. Ninety-two per cent said reviews were important or very important.
Interestingly, the next most useful guide to practice according to those surveyed was good practice case studies. This demonstrates a recognition that the evidence base for practice cannot be based solely on quantitative research, and case studies showing effective interventions in specific organisations are a useful benchmark.
Academic papers by nurses, a regular feature in this journal, were seen as very important by only 32% of respondents. In the June issue of Occupational Health, OH practitioners debated this issue, with many regretting the lack of research undertaken by nurses and others pointing out the obstacles of funding and logistics that prevent more nurses contributing to the evidence base. The survey suggests that OH nurses are realistic about the limited opportunities for nurses to undertake research, and that practitioners are satisfied with basing their practice on research carried out by others. Elsewhere in the survey, however, respondents were enthusiastic about nurse-written articles in this journal.
All the other types of evidence included in the survey were seen as very important or important in informing practice to a large degree: research from employer bodies such as the Chartered Institute of Personnel and Development and the Work Foundation (87%); articles from occupational medicine journals (77%); and articles from practitioners in related fields (64%).
How is it used?
The most important reason to refer to the evidence base is to inform clinical practice and quality, according to respondents, with 97% citing this as important or very important. This was closely followed by the need to comply with the law and regulations, cited by 95%. However, evidence guidelines were highly relevant in all the areas covered by the survey: OH management and service delivery (88%); multi-disciplinary working (86%); and OH education and registration (84%).
The response suggests that the most useful way to present guidance on the evidence base is news about new research or guidelines in the form of articles written by practitioners. All respondents (100%) said that articles by practitioners on new research or guidelines were the most useful or very useful. The next most useful formats were academic papers by nurses (95%) or by other practitioners (92%), policy guidelines (95%), and abstracts or summaries of academic articles (90%).
Survey respondents were also asked to rate the importance of a range of OH topics. While all of those listed were seen as important by 89% or more of respondents, the survey was useful to establish that evidence on how best to manage absence and return to work was a key information need, with 98% of respondents saying it was important. There is still sometimes resistance among OH nurses in ‘policing absence’, but the majority obviously feel that this is an important area for developing a strong evidence base.
Other topics seen as important or very important included mental health and stress (98%); musculoskeletal disorders (98%); health promotion and wellbeing (93%); health surveillance (91%); health and safety (90%); and risk management and compliance (89%).
NICE was selected by the majority (92%) as the most important source of evidence-based guidance, perhaps a reflection that the guidelines launched this year on long-term sickness absence and mental health at work have been received positively by OH practitioners (see feature, page 24-25). The Health and Safety Executive was also chosen by a high percentage as important or very important (89%) with BOHRF (82%) and the Health Protection Agency (80%) also proving popular.
The results of this survey will help to ensure that Occupational Health readers are kept up to date with developments in the evidence base, and as far as possible in the format you find most useful.
It is clear that the respondents to this survey will not be impressed by OH practitioners whose activities ignore credible guidelines, and that everybody has responsibility for ensuring that OH practice is based on sound evidence where it is available.