It has been shown that implementation of evidence into practice is one of the most challenging things to do when compared with finding the evidence and appraising it (Bergus et al. 2004).
There are a number of reasons why it is difficult to apply evidence to practice, but it ultimately comes down to to the availability of essential resources (Sackett and Straus 1996) and the motivation of the individual clinician to make the changes (Kiefe et al. 2001).
Studies in the medical field have shown that, despite these challenges, it is possible to integrate evidence into practice at the patient side (Sackett and Straus 1996).
A study conducted by Sackett and Straus (1996) examined whether it was feasible to find and apply evidence during clinical rounds in the Nuffield hospital, University of Oxford, UK. An ‘evidence-cart’ containing multiple sources of evidence (a computer, projector, database compact discs, critically appraised topics, etc.) was wheeled around during rounds. Despite some physical challenges with the cart, clinicians were mostly (90% of cases) able to search for and find relevant evidence within the time available to them. In a post-exercise questionnaire, it was found that most clinicians who reported making use of the sources on the cart found them to be beneficial and easy to use.
Clinicians are trained to assimilate information gleaned from taking a clinical history, performing a clinical exam on an animal or group of animals, interpreting diagnostic tests, monitoring previous responses to treatments and understanding client circumstances and expectations (Holmes and Cockcroft 2004). Integrating evidence works on the same principles that veterinarians use every day, with the evidence becoming an important component of the decision-making, alongside the circumstances of the owner and animal in front of you.
An example of assimilating evidence is given in Holmes (2009), where parallels are drawn between treating equine lameness in a champion dressage horse and in a Thoroughbred mare at stud. Even if the condition were the same in both animals, it may be unlikely that the same treatment regime would be selected in each circumstance, for a number of reasons. The evidence behind prognosis and outcomes for the specific lameness condition may become crucial in the decision-making around treatment approaches for these cases because of the differing requirements for each owner and animal.
It is perceived that there are three main areas of importance that come between appraising the evidence and implementing strategies for determining how effective the implemented changes have been:
- evaluating the relevance of the evidence;
- discussing important outcomes with colleagues, clients or others;
- preparing strategies for change.