Such barriers “can occur at the level of the patient/public, clinician, health care manager, and policy maker. Challenges may operate at different levels,” she says. She offers some examples: healthcare system (e.g., financial disincentives), healthcare organization (inappropriate skill mix, lack of facilities or equipment), healthcare teams (local standards of care not in line with desired practice), individual professionals (knowledge, attitudes and skills), and patients (e.g., low adherence to medical advice).
Another challenge, she says, involves the “dynamism and constant evolution of healthcare.”
Moreover, as the population ages, the challenges will grow as healthcare systems care for an aging population with complex multi-system chronic diseases, she says. “Most practice guidelines that are produced address a single clinical issue which does not reflect the real world situation in which older people often have more than one chronic condition.”
The enterprise requires a degree of discernment, Straus and her colleagues write: “We must be careful to avoid the ‘knowledge translation imperative’ that all knowledge must be translated into action. Instead, we need to ensure that there is a mature and valid evidence base before we expend substantial resources on implementation of this evidence.”
Changing behavior is a “complex process requiring evaluation of the entire health system.” They conclude: “Efforts must be made to close the knowledge-to-practice gaps by effective knowledge translation interventions and thereby improve health outcomes. These initiatives must include all aspects of care, including access to and implementation of valid evidence and organizational and systems issues.”