Practice Policies: Their Place in Practice and in Curricula for Preparation of Physical Therapists

Abstract

This article explores the concept of policies and the role of policies as a topic in physical therapist education programs. It includes the relationship of policies to evidence-based and the dimensions that describe policies. Examples of policies from health care in general and physical therapy in particular are offered, with a focus on the Guide to Physical Therapist Practice. The expectations for teaching about policies found in educational are presented. The article concludes with an analysis of the knowledge and skills needed by students and some examples of teaching strategies that could be used to develop these skills. Key Words: Practice Evidence-based practice. EVIDENCE-BASED PRACTICE AND PRACTICE POLICIES Evidence-based practice1-4 is designed to encourage clinicians to make the best possible decisions with their patients based on available evidence. Yet, literature supports that not all practitioners use evidence on a regular basis to improve their practice.5 One of the barriers to use is lack of time, particularly related to accessing and evaluating research literature one article at a time. If this barrier could be overcome, it seems more likely that clinicians would turn more often to the literature to help answer questions.6 It also would be most efficient if each clinician did not have to review all the literature to find evidence each time he or she encountered a question that was common to other practitioners. For these reasons, there is increased emphasis in the literature on the development of systematic reviews, such as the Cochrane Reviews7 and the Evidence in Practice section of Physical Therapy. These systematic reviews summarize a body of literature related to a particular question, providing a recommendation for behavior. When these reviews indicate that there is sufficient evidence that one or more particular approach(es) is superior to other approaches, then policies can be formulated. If these policies are promulgated, evaluated, and determined to be appropriate, they increase the efficiency of practitioners in several ways. One, physical therapists do not have to search the literature themselves, but can rely on the framers of the policy. Two, use of a well-formed policy can reduce unwarranted variation in patient care by reducing reliance on individual decision making that is fraught with the potential for biases.8 Most important, physical therapists have increased assurance that they are choosing best practices for their patients. This article explores the concept of policies and the role of policies as a topic in physical therapist education programs. DEFINING PRACTICE POLICIES There is a broad range of recommendations for that all fall under the heading of polices. These policies can be called pathways, protocols, parameters, or algorithms. Policies can be put forward as narrative statements or in the form of algorithms or decision trees. A search in Ovid in the following databases: MEDLINE, All EBM Reviews, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) on the terms practice policies, clinical guidelines, algorithms, and critical pathways produced over 57,400 results. A search on Google.com on the term clinical guidelines alone produced 1,950,000 results. With this breadth of information, there is certainly confusion about policies and what they actually are. This article will use the definitions put forward by Eddy.9 He defines policies themselves as preformed recommendations issued for the purpose of influencing decisions about health interventions.9(p5) Generally, policies are put forward as both doing the right thing and doing the right thing well. …