Dr Gillian Leng explains how the changes to NHS Evidence will provide healthcare professionals and those they care for with a greater range of quality, clinical and non-clinical information
  • NHS Evidence has been reconfigured to bring together related clinical resources
  • The following resources can be accessed from NHS Evidence:
    • British National Formulary
    • National electronic Library for Medicines
    • electronic Medicines Compendium
    • National Prescribing Centre
    • Medicines and Healthcare products Regulatory Agency
    • UK Medicines Information
  • NICE Pathways allows the user to browse associated NICE products, such as:
    • technology appraisals
    • interventional procedures
    • clinical guidelines
    • medical technology and diagnostics guidance
    • public health guidance
    • quality standards
    • accompanying tools produced by NICE to support implementation
  • Patients can also access NHS Evidence, thereby helping them to make informed decisions about their care
  • Users can register to receive regular updates on changes to guidance, recently published evidence, and the latest research.

Picture the scenario: a new patient—a 55-year-old man who had a myocardial infarction (MI) 2 years ago—comes in for a check up. He was initially prescribed a range of medicines for his condition, including a statin (atorvastatin), an angiotensin-converting enzyme inhibitor, aspirin, and a beta blocker. Over the past few months:

  • he has not been taking his medicines as recommended
  • his weight has been steadily increasing
  • his cholesterol levels are rising
  • he has become borderline hypertensive.

Where would you access evidence-based information to ensure that you are managing the patient in line with current best practice guidance?

NHS Evidence (www.evidence.nhs.uk) would be a good place to start.1 Following an overhaul of the information resource, which was completed earlier this month, the presentation of information has been reconfigured to bring together related clinical resources, with a new focus on medicines (see Figure 1). This helps you easily access evidence-based information on best practice, care pathways, and information for patients.

So what types of information would be useful in dealing with your patient case study? For starters, you could access accredited shared-decision aids directly from NHS Evidence to explore your patient's perspectives of his medicines and the reasons why he may not want to or is unable to take them. NHS Evidence can also provide access to information from the British National Formulary (BNF)2 presented in a format that recognises the everyday demands of clinical life. So, by running a search on your patient's statin, atorvastatin, you would be directed to a series of panels displaying key BNF information split by content areas including best practice guidance and news (see Figure?2).

NHS Evidence provides quick and easy access to resources collated by the National electronic Library for Medicines (NeLM) and the electronic Medicines Compendium (eMC) and products developed by the National Prescribing Centre (NPC). You can also obtain patient information leaflets (PILs) for your patient and summaries of product characteristics (SPCs) to help you improve and broaden your knowledge and skills. The medicines Q&As from UK Medicines Information (UKMi) can provide advice in response to an unusual medical query.

NICE Pathways

Keeping up to date with NICE guidance can be a difficult task. Since its formation, NICE has produced a vast amount of separate but interrelated guidance, but up until now there has been no easy way for you to see 'at a glance' what NICE has recommended on a specific condition or subject across all products. NHS Evidence now provides you with access to NICE Pathways to allow visualisation and browsing of associated NICE products online (see Figure 3).

The pathways cover all NICE products including:

  • technology appraisals
  • interventional procedures
  • clinical guidelines
  • medical technology and diagnostics guidance
  • public health guidance
  • quality standards
  • accompanying tools produced by NICE to support implementation.

Figure 1: NHS Evidence homepage

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Figure 2: Accessing British National Formulary information through NHS Evidence

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NHS Evidence Accreditation Scheme

A key vision for the NHS is to achieve quality and outcomes that are among the best in the world. To realise this goal, you need to know which sources of guidance have been produced to the highest standards. Organisations that have applied and fulfilled the criteria for high-quality guidance production, are awarded the NHS Evidence Accreditation Mark, which can be displayed on relevant guidance as a quality standard.3 Around 30 organisations have already been or are going through the scheme and many guidance producers are reviewing their processes in line with the accreditation criteria.4 I am delighted that the revised accreditation methods enable NHS Evidence to encompass a broader range of products in the accreditation scheme.

It is clear that the accreditation scheme is gaining recognition as applications are currently being considered from international guidance producers including Duodecim, a Finnish publisher in medicine and the Joanna Briggs Institute from Australia. Final accreditation decisions on these guidance producers are expected in autumn 2011 and we look forward to receiving interest from other organisations across the globe.

Future developments
Clinical decision support tools can bring substantial benefits to your patients. At the moment we are working on an accreditation process to assess the information that underpins clinical decision support tools and will soon undertake a pilot with a number of leading providers. The focus of the pilot is not to look at how information is surfaced in decision support tools, but instead how the information contained in them has been collected and quality assured for inclusion.

We have also been looking at how accreditation can add value for commissioners and whether our existing methods can be used to assess the quality of information that informs commissioning. Again, we are working with a number of organisations that produce different types of information covering this evolving area, which is fundamental to effective delivery of care. NICE has already shown a willingness to participate in the pilot, which makes sense given that it produces commissioning guides for national use.

Patient information

While NHS Evidence is designed for you, it is also accessible to your patients and their carers. The service empowers patients by enabling them to access trusted information to help them make informed decisions about their care. By using NHS Evidence, patients can be better informed about their condition, the lifestyle options that might improve it, and the available treatments.

Only patient information accredited under the Department of Health Information Standard is available through NHS Evidence.5 Patients want to be involved in their own care and should understand what service they can expect.

Furthermore, we are exploring accreditation of shared-decision aids, which are very specific pieces of guidance that can be used in consultations between you and your patients to inform patient decisions about their care.

Figure 3: NICE Pathway of dementia

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Other changes to NHS Evidence

The improvements to NHS Evidence have been made as a result of active engagement with primary care professionals, including GPs. We know that you actively use the internet to broaden professional development and attain core competencies. NHS Evidence supports this by enabling you to browse new clinical topic areas, which bring together the latest guidelines, high-quality patient information, ongoing trials, and other selected information.

Users can register to receive regular updates on changes to guidance, summaries of recently published evidence in the form of evidence updates, and notifications of the latest significant research in specialty areas. If you work for the NHS and have an Athens account you will continue to receive free access to paid for databases of evidence (e.g. MEDLINE, CINAHL), e-books, and key journals (e.g. British Medical Journal, Journal of the American Medical Association).

Summary

Since launching in April 2009, up to 1.2 million searches per month are performed on NHS Evidence and two?thirds of users are clinicians. Within healthcare, 80% of users believe NHS Evidence helps them find the most up?to-date information and 75% of users believe the service improves the quality of information available.

The NHS Evidence portal is a comprehensive service that provides access to the most up-to-date quality information, continuing medical education, and support tools to help implement best practice. Against the backdrop of economic uncertainty and ageing-population profiles, the demand for safe, cost-effective, and constantly improving clinical outcomes has never been more urgent. Good-quality, evidence-based information has always been at the heart of effective, safe, and efficient delivery of care, and is more important now than ever.

  1. NHS Evidence website. www.evidence.nhs.uk
  2. British National Formulary website. Available at: bnf.org/bnf/index.htm
  3. Leng G. NHS Evidence provides easy access to quality clinical information. Guidelines in Practice 2010; 13 (2): 43–44.
  4. NHS Evidence. NHS Evidence accreditation decisions. Available at: www.evidence.nhs.uk/Accreditation/Pages/AccreditationDecisions.aspx (accessed 14 April 2011).
  5. Department of Health. The Information Standard. Available at: webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/PatientChoice/BetterInformationChoicesHealth/Informationstandard/index.htmG