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Book Reviews   |    
The Advanced Handbook of Methods in Evidence Based Healthcare ? Evidence-Based Counselling and Psychological Therapies: Research and Applications
Reviewed by Scott E. Provost, M.M., L.I.C.S.W.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.12.1664
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edited by Andrew Stevens, Keith Abrams, JohnBrazier, Ray Fitzpatrick, and Richard Lilford; London, Sage Publications, 2001, 507 pages, $99.95 • edited by Nancy Rowland and Stephen Goss; London, Routledge, 2000, 216 pages, $29.95 softcover

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Throughout the history of psychiatry, critics have questioned the effectiveness of and the need for certain treatments. Well-known examples include hydrotherapy, insulin shock therapy, frontal lobotomy, and long-term psychoanalytic therapy. While many such controversies have been resolved, psychiatry and medicine overall face new challenges amid growing concerns about the prevalence of medical errors, variations in practice patterns, and the fragmentation of care. These concerns have fueled efforts nationwide to monitor and improve the quality of health care and have formed part of the impetus for the use of evidence-based treatment.

Quality-of-care issues are familiar to readers of this journal. Its articles typically cover the organization, financing, and delivery of care, including the underuse, overuse, and misuse of treatment. Although the journal has been at the forefront of efforts to provide information about evidence-based mental health services, evidence-based medicine is a relatively new concept in the field.

The publication of these two books, The Advanced Handbook of Methods in Evidence Based Healthcare and Evidence-Based Counselling and Psychological Therapies, seems especially timely given that Psychiatric Services has devoted the 2001 volume to the principles and practice of evidence-based psychiatry. Both books examine the theory, methods, and application of evidence-based treatment in the context of the United Kingdom's National Health Service; in so doing, they offer a lens through which to view evidence-based medicine in other contexts. In addition, the material covered in these books encourages professionals to question customary practice, systematically assess research findings, and incorporate the best available evidence into clinical care.

The Advanced Handbook of Methods in Evidence Based Healthcare is organized into six general themes: the quantitative and the qualitative methodologies used to generate clinical evidence; cost-benefit analyses; consensus guideline development; meta-analyses; and the identification of emerging health care technologies. Contributors include well-respected methodologists, economists, and ethicists. The book is intended for researchers and managers, but it is more suitable for use as a primary text or as a supplemental resource for seasoned health services researchers and graduate students in epidemiology and health services research. Most managers and policy makers are likely to find the book too long and dense to read cover to cover.

A number of the chapters in this book may be of value for producers and consumers of mental health services research. For researchers, the chapters "The Potential Use of Routine Data Sets in Health Technology Assessment" and "Methods for Evaluating Organization- or Area-Based Health Interventions" offer useful methodological strategies for conducting research in naturalistic settings. For readers of research, the chapters entitled "Assessing the Quality of Reports of Randomized Trials Included in Meta-Analyses: Attitudes, Practice, Evidence and Guides" and "Identifying New Healthcare Technologies" provide useful guides for evaluating research evidence and forecasting trends in health care technology.

Each chapter includes useful references, and as a whole the book is comprehensive. However, it is weakened by the fact that it emphasizes breadth over depth, does not include a concluding chapter to summarize the book's content, and does not examine how evidence-based treatments are applied in clinical practice.

Readers will find Evidence-Based Counselling and Psychological Therapies to be more readable and applicable to mental health research, policy, and practice. Contributors include researchers and clinicians from psychology, psychiatry, epidemiology, and economics. The book is organized into three sections. The chapters in the first section provide meaningful definitions of evidence-based health care, and those in the second debate the merits of quantitative and qualitative research methods. The third section describes how research evidence can be synthesized and disseminated into clinical practice.

The introductory and concluding chapters, written by the volume editors, are clear and concise, and they can provide less ambitious readers with an overview and a thoughtful summary of evidence-based counseling and mental health care. Clinicians, clinician-managers, researchers, and policy makers will find this book to be a practical introduction to evidence-based mental health care. It would also serve as a useful supplemental text for graduate courses in psychology, mental health policy, and mental health services research.

As concerns mount about quality of care and health care costs, it is important that the profession balance the science of evidence-based practices and the art of tailoring treatment to individual patients. Although both of these books shed light on the methods used to produce, assess, and disseminate evidence, they do not review the clinical, management, and policy challenges that are required to translate evidence-based research into routine practice settings—a fruitful topic for future books.

These books are also useful texts for comparing and contrasting the centralized health system in the United Kingdom with the decentralized system in the United States. The use of evidence-based medicine is likely to increase in both countries (1) as long as the current call for reducing variability in the quality of care is sustained. However, differences between the experiences in the two countries may ultimately reveal worthwhile lessons for ensuring that evidence-based practices remain on the research, policy, and practice agendas.

Mr. Provost is associate director for research at the Center for Quality Assessment and Improvement in Mental Health in Cambridge, Massachusetts.




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