Healthcare systems around the world are failing to use evidence obtained through research, according to Sharon E. Straus, MD, MSc, FRCPC, a geriatrician and director of knowledge translation at St. Michael's Hospital in Toronto. The result: reduced length and quality of life, she and her colleagues write in a recent paper.
Straus was the guest editor of the January issue of the Journal of Clinical Epidemiology, which featured articles on knowledge translation. Knowledge translation is the term for closing the gap between evidence and data obtained through research and healthcare practice and policy.
More simply, it addresses the gap between what we know and what we do.
Failure to use research-based evidence to inform healthcare decision making are is prevalent among patients, caregivers, managers, and policymakers across all disciplines and in developed anddeveloping countries, she and her colleagues note in one of the articles.
Extrapolating data from the United States, they estimate that about 55 percent of adult patients do not receive recommended care. Studies have shown that only 40 percent of people with osteoporosis get appropriate therapy, Straus points out.
Moreover, only two-thirds of stroke patients receive appropriate, evidence-based care. She offers the following example: Although research indicates that statins can decrease the risk of death after strokes, they are “considerably under-prescribed.”
Overprescribing is also a problem. For instance, antibiotics continue to be prescribed for children with upper respiratory tract infections despite evidence they are ineffective.
She tells HealthLeaders Media that more than 250 barriers to implementation of guidelines by physicians have been identified. They can include cost, education, scarce healthcare resources and the sheer volume of research evidence being produced.
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.”