Finding Evidence-Based Practices

In our state, the Health Department is strongly encouraging providers to use evidence-based practices in treatment. Have you come across that?”

Yes. Where we are, there’s a big push to use the Matrix Model for intensive outpatient services. That’s a classic EBP, developed at UCLA, initially for stimulant abusers and later for a wider range of substance disorders. Here’s a link for those interested.

SAMHSA is a good source of information on EBPs for addictions. I was taught to do my own investigating, since the research is usually online anyway, and it’s a good learning experience. Here’s one method:

Start by framing a good clinical question. Example: “In detox patients who are also experiencing depression, is it more effective to start an antidepressant medication early, or wait to see if the depression improves with detoxification?” That yields two interventions to compare: medicating with antidepressants, versus watchful waiting. The desired outcome would be improved relief from symptoms of depression.

That leads to a literature search. There’s probably quite a bit of literature out there. Not uncommon to find studies that seem to support different approaches. In that event, we have to compare. Sample questions:

• How close was the study population to ours?
• Are there age or gender differences?
• What about prior history of depression?
• Was one study done on hospitalized persons, another on outpatients?
• What about long-term or short-term follow-up?
• Were there other interventions offered to study participants that might affect the results?

Finally, look carefully at the outcomes. Many interventions produce improvement compared to doing nothing. But how much improvement? And how lasting?

And of course, your docs still have to exercise clinical judgment. Perhaps a patient has already tried the medication she wants to recommend, without good results. What about side effects? And does the patient want to take an antidepressant?

It’s not as precise in behavioral health as in the more procedure-oriented areas of general medicine or nursing. But seeking evidence, and applying practices based on evidence to your clinical interventions, can help making decisions that increase the chances of a desired outcome.