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EDITORIALS

Evidence-based Clinical Practice

The Role for Professional Societies

Twa, Michael D.

Author Information
Optometry and Vision Science: January 2020 - Volume 97 - Issue 1 - p 1–2
doi: 10.1097/OPX.0000000000001469
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The positive effects of implementing evidence-based clinical practices are well accepted and include better patient outcomes, reduced disability, and lower health care costs to name a few.1 However, it can be difficult for individuals, clinics, institutions, and professions to embrace and ultimately to implement evidence-based clinical practices. The central challenge to address is the difficult problem of changing culture and human behavior. Given that it is beneficial to practice according to evidence-based standards, why is there not a wider use of evidence-based practices, and how can a profession leverage the available resources within the community to encourage change and more widespread adoption? Moreover, what can professional societies do to support the creation, understanding, and use of evidence-based clinical practice standards?

PUBLICATIONS

Peer-reviewed journal articles are the accepted standard for scientific evidence. A key role that professional societies serve is to support peer-reviewed scientific publishing. This investment helps to define the knowledge base of the discipline, establish common language within the community, and define the quality and standards of scholarship in the field. It is fair to say that professional society journals are the voice and discussion forum for the community. Consequently, peer-reviewed journals play a vital role in establishing the standards and expectations for evidence in a discipline.

Reporting Standards

To help implement accepted reporting standards for evidence-based publications, Optometry and Vision Science has partnered with the Cochrane Eyes and Vision initiative to align our publication standards with expected best practices and to increase the quality and usability of evidence published in the journal. This collaboration has taken two forms: establishing publication standards for evidence-based submission types and adding appropriate reviewer talent and editorial experience to our team. The journal now has instructions for authors requiring adherence to best practices for reporting results from the most important evidence-based publication types: clinical trial outcomes as defined by the CONSORT statement2 and meta-analyses and systematic reviews as defined by the PRISMA statement.3

New Editorial Board Members

I am pleased to announce that the journal has added two new members to our editorial board: Kathryn Richdale, OD, PhD, and Laura Downie, BOptom, PhD. Dr. Richdale is an experienced clinical trialist with a wide range of research interests spanning myopia development, accommodation, and diabetes. Likewise, Dr. Downie is a clinician scientist experienced with anterior and posterior segment diseases of the eye as well as study methodologies related to meta-analyses and systematic reviews. Dr. Downie has recognized expertise in evidence-based research methods and has also been an invited speaker to the Oxford University's Center for Evidence-Based Medicine to lecture on the application of evidence-based practice in the management of macular degeneration.

Education and Communication

Optometry and Vision Science has promoted the communication of evidence-based publication standards in previous educational courses on conducting meta-analyses and systematic reviews held during the annual meeting. The journal editorial staff has also hosted multiple meetings to communicate journal standards and priorities to the members of the academy and will continue to do so. Look for future courses on publishing and evidence-based practices in publishing at the next annual academy meeting in Nashville, Tennessee, later this year.

REWARDS AND RECOGNITION

Another way that professional societies can promote evidence-based clinical practice is through the awards and recognitions that they provide. The American Academy of Optometry currently provides awards for teaching, research, and prominent publications. These awards reflect the values of the society and can be an authoritative voice to drive cultural change within the profession. It would be a small but significant shift to focus these awards on recognizing not only excellence in teaching, research, and clinical practice but also the application of evidence-based clinical practices in each of these fundamental areas.

EDUCATION

Professional education is a primary component of what the American Academy of Optometry provides to the community, thereby shaping the standards and values of the profession. The educational course review committee does consider evidence-based practice concepts during its vetting of course submissions, and there are COPE guidelines that encourage appropriate referencing to incorporate relevant evidence-based standards for materials that are presented at the annual academy meeting. Nevertheless, how could we raise the bar? Would it be possible to develop a grading system and incorporate badges that would convey the level of evidence-based content provided in courses? This sort of recognition could motivate presenters to do more and just might stimulate a useful spirit of competition among educators to strive for top grades.

Other professional societies, such as the American Optometric Association, devote time and resources to the creation of evidence-based practice standards. The standards that result from this arduous and valuable review process are important to share. There should be more collaboration between professional societies to participate in the development of these standards and better dissemination of the resulting standards through peer-reviewed publications, educational courses, and incorporation of evidence-based standards into clinical education in the schools and colleges of optometry. There is a need for a more coordinated strategy of implementation, communication, and education of new evidence-based clinical practice standards.

RESEARCH

To advance the scientific basis for clinical practice, we must arouse our curiosity, ask, and answer a lot of questions. The critically thinking practitioner can find valuable questions everywhere. Why use this medication? What follow-up schedule leads to optimal outcomes? Does adherence improve when the doctor is involved in patient education? Learning and encouraging others to ask questions is important. Providing the education needed to structure the question such that it can be addressed through systematic study is another thing. There is often a chasm between the curious mind and what is required to definitively answer questions. What bridges that chasm is methodological rigor grounded in the principles of scientific investigation. Research related to evidence-based clinical practice can take many forms but often involves systematic reviews or meta-analyses. To advance evidence-based practice within the profession, professional societies should invest in developing and disseminating educational resources related to the research methods needed to conduct evidence-based reviews. The community should seek to provide access to the information and tools necessary to conduct these reviews and facilitate their use by interested users.

FINAL THOUGHTS

There are many participants interested and invested in improved clinical outcomes: patients, practitioners, health insurers, governmental agencies, and many more. Professional societies have an important voice and a responsibility to demonstrate leadership with respect to the promotion and implementation of evidence-based clinical practice. Because professional societies act in many ways to define the culture, values, standards, and priorities of the profession, they are also essential agents of change who must recognize their authority and act responsibly and with purpose to embrace a culture of evidence-based clinical practice. Optometry and Vision Science is committed to this purpose and will continue to adopt publication standards that reflect this purpose. We will collaborate with others who share this objective. We will engage authors, reviewers, and editorial board members who can further enhance the talent and experience needed to attract and publish top-quality evidence-based content in our discipline.

REFERENCES

1. Fineout-Overholt E, Melnyk BM, Schultz A. Transforming Health Care from the Inside Out: Advancing Evidence-based Practice in the 21st Century. J Prof Nurs 2005;21:335–44.
2. Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials. BMJ 2010;340:c332.
3. Moher D, Liberati A, Tetzlaff J, et al. Preferred Reporting Items for Systematic Reviews and Meta-analyses: The PRISMA Statement. PLoS Med 2009;6:e1000097.
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