Bridging the Research – clinical practice Gap with EBM

“It is not our differences that divide us; but the inability to recognize, accept and celebrate those differences” said writer Audre Lorde.

For decades, there has been a gap between researchers and clinical practitioners. Lately, Evidence-based healthcare is increasingly gaining popularity to bridge this gap.

Globally, Clinical Practice Guidelines have been formulated to guide clinicians. These guidelines are usually systematically developed statements designed to help healthcare providers, payers, consumers and policy-makers in deciding ways to prevent, diagnosis and treat diseases.¹ However, today is an era of personalized medicine.

While formulating and implementing guidelines or clinical decision making algorithms, one needs to be aware of the multiple clinical variables that apply to an individual patient and/or a specified population. Genetic variations, ethnic differences, differences in diet and climate, etc. are all responsible for different pattern of diseases and varied responses to same set of treatments².

It has been stated that ‘We are more microbes than cells’, when infact, the gut microbiota alone carries 150 times genes than the entire human genome.³ Hence, the effect of one’s microbiome on health and diseases cannot be underestimated.³ The role of epigenetics, a mechanism of expression of genes without altering the genome, combined with knowledge about technologies like CRISPR/Cas9 gene editing and next-generation sequencing have enabled a better understanding of the epigenetic change and gene regulation in human diseases, thus, giving way to newer approaches for molecular diagnosis and targeted treatments,⁴ although the impact to patient care and outcomes is still to be observed.

The gap between research and practice is more fundamental; and can be attributed to a host of other factors like lack of communication between research-scholars and clinicians, reluctance of practitioners to change from traditional methods of practice, inadequate practitioner training, misfit between treatment requirements and available organisational structures, insufficient administrative support and clear understanding of co-morbidities.^4,5 The answers to such challenges can be addressed by ‘Translational research’.⁵ The practical utility of researchers can be increased by facilitating two-way communicating through the translation of research findings into language of practical use as well as clearly communicating the research needs of a community. Real life messy variables such as co-morbidities, financial constraints, inadequate insurance coverage, cultural and family issues need to be fully understood.

Possible solutions that may help close this gap include:

• Involving private practitioners directly in the research loop may facilitate a better understanding and addressing of real-world challenges in practice.
• Facilitating working relationships between researchers and clinicians to work as equal partners in community-based interventions.
• Community intervention programmes be based on results from Multi-centric well designed Randomised Control Trials.
• Training of practitioners, wherever required, for eg. including modules on Evidence based practice in predoctoral internships, postdoctoral fellowships, and continuing education programs .
• Journals and publishers should emphasize detailed descriptions of the community applicability of research findings⁶.
• Negative findings and limitations should be disclosed and published.

While the gap between the research and clinical practice is real, there are potential solutions that can close this gap!

References:

• Clinical Practice Guidelines We Can Trust—Standards for Developing Trustworthy Clinical Practice Guidelines (CPGs)(www.nationalacademies.org)
• Vasseur E, Quintana-Murci L. The impact of natural selection on health and disease: uses of the population genetics approach in humans. Evol Appl. 2013;6(4):596–607.
• Baohong Wang, Mingfei Yao and LongxianLv, etal. The Human Microbiota in Health and Disease.Elsevier Publication. 2017;3(1):71-82.
• Alexander Osborne. The role of epigenetics in human evolution. Horizons. 2017;10:1-8.
• Estape ES, Mays MH, Harrigan R, Mayberry R. Incorporating translational research with clinical research to increase effectiveness in healthcare for better health. Clin Transl Med. 2014;3:20. Published 2014 Jul
• S Mallonee, C Fowler, G R Istre. Bridging the gap between research and practice: a continuing challenge. Injury Prevention. 2006;12:357–359.

Conflicts of Interest: None

Bio:  I am a practicing clinician based in Mumbai, India. I have a keen interest in research activities, content writing and medical emergencies. My educational background includes a Bachelors degree in Medicine and a fellowship in Industrial Health along with a couple of original researches. Having a craving for knowledge and passion for learning new ideas, I am actively involved in free lance medical content development for publication houses and companies. I also enjoy contributing my service in managing on-field medical emergencies in various events. I am currently exploring potential avenues that may help me ‘make a difference’!.. “