‘It’s important that Cochrane works with fellow health organisations to ensure our research reaches a broad audience, translates into improved clinical care and results in better health outcomes for patients,’ says Sally Green, Co-Director of the Australasian Cochrane Centre. ‘Our contribution to The Royal Australian College of General Practitioners’ excellent online resource for GPs is a great example of the practical benefits of working together to put evidence into action.’
The RACGP’s Handbook of Non-Drug interventions, or HANDI for short, was launched in 2013 with the aim of making ‘prescribing’ a non-drug therapy almost as easy as writing a prescription. Based on the idea of modern pharmacopoeias, the web-based formulary features non-drug interventions for a broad range of ailments and afflictions commonly seen in everyday practice. While the conditions covered vary in terms of symptoms and severity, their commonality lies in the availability of evidence-based non-pharmacological treatment options. A third of all HANDI entries are underpinned by Cochrane reviews, which cover conditions as diverse as osteoarthritis, depression and vertigo (see the full list below).
Professor of Evidence-Based Medicine at Bond University Paul Glasziou is the chief architect behind HANDI and chairs the project team of notable clinical experts that develop four additional interventions each quarter. ‘Almost half of the thousands of clinical trials conducted each year are for non-drug treatments,’ explains Paul. ‘But in reality effective non-drug interventions are less well-known, less well-promoted and less well-used than their pharmaceutical cousins. HANDI aims to address this imbalance in a practical and accessible way. It enables GPs to offer a greater choice of credible treatment options to patients – many of whom would like to avoid drug treatment regimes if it’s possible to do so.’
Each HANDI entry is subject to a rigorous review and drafting process and must be supported by at least two trials or one trial and supportive evidence. Additional resources and tools such as videos, websites, illustrations and instructions are also included where possible, and have proved particularly popular with GPs and patients alike.
‘I find I’m consulting HANDI more and more Jenny Doustoften for guidance on treatment and for access to excellent consumer resources that aren’t readily accessible anywhere else,’ says Brisbane-based GP and academic Jenny Doust. ‘The additional tools add a dimension you don’t get from the evidence alone. I recently used a HANDI behavioural therapy intervention for a patient suffering from chronic insomnia, and recommended he use the sleep diary resource featured on the HANDI website. We monitored his sleep patterns as recorded in the diary, and could then identify and address some of the recurring issues behind his condition. This was an effective approach that I wouldn’t have necessarily taken had I not consulted HANDI. The Mediterranean Diet and the Cochrane review-based exercises for musculoskeletal conditions and mood disorders would be the other interventions I most frequently prescribe with excellent results.'
The RACGP HANDI Team are now interested in hearing from Cochrane Review Groups around the world who may be working on or about to publish review on a non-drug intervention that could be used as the basis for future HANDI interventions. If you would like to find out more or share research that could inform a non-pharmacological intervention, please contact Joanna Ong at the RACGP at handi@racgp.org.au.
A snapshot of HANDI interventions underpinned by Cochrane reviews:
> Advice to stay active: acute low-back pain
> Behavioural interventions including alarms: bedwetting (enuresis)
> Exercise for depression
> Exercise: intermittent claudication and peripheral arterial disease
> Exercises: falls prevention
> Exercise: knee osteoarthritis
> Graded exercise therapy: chronic fatigue syndrome
> Honey: cough in children with Upper Respiratory Tract Infection
> Manipulation: sublaxation of radial head (pulled elbow)
> Pelvic floor muscle training: urinary incontinence
> Pulmonary rehabilitation: Chronic Obstructive Pulmonary Disease
> Sweet solutions: procedural pain in infants
> The Epley manoeuvre: vertigo