Wednesday, 21 November 2012

Knowledge translation / utilisation / transfer - getting research into practice

I am sitting on a train speeding back down from Edinburgh to London after attending a conference called "Improving Quality in Healthcare: Translating Evidence into Practice".

It has become increasingly interesting to me that even where there is good evidence for some things it often isn't used or its used inconsistently. There is what is called a 'knowledge gap' between what the research suggests we should be doing to improve patient care and what we are actually doing.

Now, you'll be aware that in EBD research isn't everything. Just as crucial are the patient's values and aspirations and our own clinical expertise and experience. So there are many points between when a researcher (or bunch of researchers) demonstrates convincingly that we ought to be doing something we're not and that thing being applied to our patients' care.

First we need to find or be made aware of the research. Then we consciously or subconsciously accept or reject it or decide it isn't appropriate to our environment or our patients. Then (if we accept it) we might decide to use it and then we have to overcome the barriers that stop us putting it into practice. And even then the way the research says we should do things doesn't fit with what our patients want. If we do manage to change the way we do things we then we have to work out how to keep on using it and not slip back into the 'old ways'.

It's amazing we ever change what we do faced with all that.

Well, this conference was concerned with this field. And I think it's fascinating for what is the point in spending millions of dollars on research, putting patients through the trials and wrapping up clinicians in conducting the research if it never gets used?

Now we don't teach much about this in the undergraduate course but if you find that you've read something that sounds like good evidence and yet you see clinicians around you doing something else, think about that long chain of events from research to the patient. This field is demonstrating that there are effective ways to change behaviour for the better but there's much to more to be done. Keep an ear to the ground...

Some pertinent references if you're interested in learning more...

Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. The Medical journal of Australia. 2004 Mar 15;180(6 Suppl):S57-60. PubMed PMID: 15012583.

Mickan S, Burls A, Glasziou P. Patterns of 'leakage' in the utilisation of clinical guidelines: a systematic review. Postgraduate medical journal. 2011 Oct;87(1032):670-9. PubMed PMID: 21715571.

Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. PubMed PMID: 21513547. 

A PICO lecture - helping a customer buy the "right" phone

I have uploaded a lecture I recorded on using PICOs to help turn problems into structured questions.

It is aimed at 1st year undergraduates and so I have used instead of a clinical problem one that involves someone buying a phone. I hope it works...

Please take a look at it here.

Feedback always welcome