Evidence-based practice in health and social care: where are we now?

This paper explores evidence-based practice (EBP) in health and social care in the UK from the individual perspectives of professionals in physiotherapy, midwifery, nursing and social care. The present interest in EBP emerges as a natural derivative of contemporary economic, social and political trends and concerns. There is optimism and broad acceptance of the overall philosophy of EBP and each profession demonstrates a concerted organisational attempt to bridge the research--practice divide. This includes the interpretation of research outcomes in the form of practice guidelines, protocols and standards. However, adherence to these is poor and resistance to EBP is growing. This is attributed to practical and philosophical tensions common to all of the professions. These include the continued dominance of randomised controlled trials (RCTs) in the hierarchy of evidence. RCTs often fail to capture the multi-faceted individualistic nature of health and social care interactions or the development of qualitative methodologies within the professions. Concern is expressed that professional autonomy and the art of practice will be eroded by the enforcement of guidelines and protocols. EBP is currently located within individual professions rather than the broader context of interprofessional practice. The future of EBP is dependent, at least in part, on educational initiatives, organisational commitment and support, patient/client involvement and the development of a broader interprofessional perspective.