Abstract
A large number of evidence-based guidelines are drawn up all over the world to improve standards of healthcare and to reduce inequalities in access to effective treatment. Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. Despite widespread circulation and publicity of these guidelines, often they are not implemented effectively. Consequently, there is a substantial difference between evidence and practice, with best health outcomes not being achieved. The aim of this chapter is to describe and discuss the methodological process, development, and implementation of the Italian Guidelines for psychology activities in Cardiac Rehabilitation and Prevention, published in 2003 by the Working Group of Psychology of the Italian Society of Cardiac Rehabilitation and updated in the 2005 National Cardiac Rehabilitation guidelines issued by the Italian Programme for Guidelines.
TopBackground
Heart disease is the leading cause of death in the world. In the recent published European Guidelines (Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice, 2007), the Task Force shows that cardiovascular diseases were the direct cause of 4 million deaths in Europe around the year 2000 (1.9 million in the EU), accounting for 43% of all deaths of all ages in men and for 55% in women (Petersen et al, 2005). Cardiovascular diseases were also the major cause of hospital discharges, with an average rate of 2557 per 100 000 population around the year 2002. Of these, 695 per 100 000 were caused by coronary heart disease and 375 per 100 000 by stroke, but more than half were due to other forms of chronic heart disease. The estimated total cost of cardiovascular diseases in the EU countries was €168 757 million in 2003 (Leal, Luengo-Fernàndez, Gray, Petersen, Rayner, 2006).
Key Terms in this Chapter
Implementation: Creation of strategies and systems to operationalize the knowledge and recommendations set forth by guideline developers.
Guidelines: Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. They are designed to help practitioners assimilate, evaluate and implement the ever increasing amount of evidence and opinion on best current practice.
Systematic Review: An efficient scientific technique to identify and summarise evidence on the effectiveness of interventions and to allow the generalisability and consistency of research findings to be assessed and data inconsistencies to be explored.
Cardiac Rehabilitation: The ‘sum of activity and interventions required to ensure the best possible physical, mental, and social conditions so that patients with chronic or post-acute cardiovascular disease may, by their own efforts, preserve or resume their proper place in society and lead an active life’ (WHO).
Evidence Based Practice: It is an approach which tries to specify the way in which professionals or other decision-makers should make decisions by identifying such evidence that there may be for a practice, and rating it according to how scientifically sound it may be. Its goal is to eliminate unsound or excessively risky practices in favour of those that have better outcomes. focus on decision-making about individual patients in psychology, medicine, nursing, social work.
Psychological Intervention: The treatment of mental illness or related issues based on psychological theory. Psychological interventions can form part of comprehensive cardiac rehabilitation programmes. These interventions may include stress management interventions, which aim to reduce stress, either as an end in itself or to reduce risk for further cardiac events in patients with heart disease.
Evidence-Based Medicine: It is an approach that categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. The strongest evidence is provided by systematic review of randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports, and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, difficulties in ascertaining who is an expert, and more.