NURS 350 Week 5 Discussion Diseases and Conditions
NURS 350 Week 5 Discussion Diseases and Conditions
Visit the Center for Disease Control website and go to the Diseases and Conditions pages.
Choose a topic of interest and review any data or statistics provided under that topic. Discuss how evidence-based practice and epidemiology are used to improve prevention and health promotion in your chosen topic.
n ever-expanding evidence base, detailing programs and policies that have been scientifically evaluated and proven to work, is available to public health practitioners. The practice of evidence-based public health (EBPH) is an integration of science-based interventions with community preferences for improving population health (1). The concept of EBPH evolved at the same time as discourse on evidence-based practice in the disciplines of medicine, nursing, psychology, and social work. Scholars in these related fields seem to agree that the evidence-based decision-making process integrates 1) best available research evidence, 2) practitioner expertise and other available resources, and 3) the characteristics, needs, values, and preferences of those who will be affected by the intervention (Figure) (2-5).
Figure. Domains that influence evidence-based decision making. Source: Satterfield JM et al (2). [A is also available.]
Public health decision making is a complicated process because of complex inputs and group decision making. Public health evidence often derives from cross-sectional studies and quasi-experimental studies, rather than the so-called “gold standard” of randomized controlled trials often used in clinical medicine. Study designs in public health sometimes lack a comparison group, and the interpretation of study results may have to account for multiple caveats. Public health interventions are seldom a single intervention and often involve large-scale environmental or policy changes that address the needs and balance the preferences of large, often diverse, groups of people.
The formal training of the public health workforce varies more than training in medicine or other clinical disciplines (6). Fewer than half of public health workers have formal training in a public health discipline such as epidemiology or health education (7). No single credential or license certifies a public health practitioner, although voluntary credentialing has begun through the National Board of Public Health Examiners (6). The multidisciplinary approach of public health is often a critical aspect of its successes, but this high level of heterogeneity also means that multiple perspectives must be considered in the decision-making process.
Despite the benefits and efficiencies associated with evidence-based programs or policies, many public health interventions are implemented on the basis of political or media pressures, anecdotal evidence, or “the way it’s always been done” (8,9). Barriers such as lack of funding, skilled personnel, incentives, and time, along with limited buy-in from leadership and elected officials, impede the practice of EBPH (8-12). The wide-scale implementation of EBPH requires not only a workforce that understands and can implement EBPH efficiently but also sustained support from health department leaders, practitioners, and policy makers.
The Need for Evidence-Based Public Health
Calls for practitioners to include the concepts of EBPH in their work are increasing as the United States embarks upon the 10-year national agenda for health goals and objectives that constitutes the Healthy People 2020 initiative. The very mission of Healthy People 2020 asks for multisectoral action “to strengthen policies and improve practices that are driven by the best available evidence and knowledge” (13).
Funders, especially federal agencies, often require programs to be evidence-based. The American Recovery and Reinvestment Act of 2009 allocated $650 million to “carry out evidence-based clinical and community-based prevention and wellness strategies . . . that deliver specific, measurable health outcomes that address chronic disease rates” (14). The Patient Protection and Affordable Care Act of 2010 mentions “evidence-based” 13 times in Title IV, Prevention of Chronic Disease and Improving Public Health, and will provide $900 million in funding to 75 communities during 5 years through Community Transformation Grants (15).
Federal funding in states, cities, and tribes, and in both urban and rural areas, creates an expectation for EBPH at all levels of practice. Because formal public health training in the workforce is lacking (7), on-the-job training and skills development are needed. The need may be even greater in local health departments, where practitioners may be less aware of and slower to adopt evidence-based guidelines than state practitioners (16) and where training resources may be more limited.
Core Competencies for Public Health Professionals (17) emerged on the basis of recommendations of the Institute of Medicine’s 1988 report The Future of the Public’s Health. Last updated in May 2010, these 74 competencies represent a “set of skills desirable for the broad practice of public health,” and they are compatible with the skills needed for EBPH (3). Elements of state chronic disease programs and competencies endorsed by the National Association of Chronic Disease Directors are also compatible with EBPH (18).
In addition to efforts to establish competencies and certification for individual practitioners, voluntary accreditation for health departments is now offered through the Public Health Accreditation Board (PHAB). Tribal, state, and local health departments may seek this accreditation to document capacity to deliver the 3 core functions of public health and the Ten Essential Public Health Services (19). One of 12 domains specified by the PHAB as a required level of achievement is “to contribute to and apply the evidence base of public health” (19). This domain emphasizes the importance of the best available evidence and the role of health departments in adding to evidence for promising practices (19).
