FIP 2009: Evidence-to-practice gap will widen

by Lin-Nam Wang and Pamela Mason

Research from several countries shows that pharmacists are not doing as good a job as they should and a significant disparity exists between pharmacists’ everyday practice and recommended clinical best practice, according to Cecilia Bernsten, associate professor of public health at Uppsala University, Sweden, during the 69th World Congress of Pharmacy and Pharmaceutical Sciences.

For example, patients do not get enough counselling or counselling is of poor quality. Nevertheless, we should not be judgmental about such gaps and, instead, use them to develop good practice, she said.

However, evidence-to-practice gaps are common and may grow wider, warned Shane Jackson, director of the Pharmaceutical Society of Australia: “Given the ever growing sophistication of our scientific knowledge and the additional new discoveries that are likely in the future, many of us harbour an uneasy, but quite realistic, suspicion that the gap between what we know about diseases and what we do to prevent them will become ever wider,” he said.

“Research results, both old and new, are not finding their way into clinical practice and public health behaviours.”

Dr Jackson highlighted evidence-to-practice gaps in prescribing, including underuse (eg, of angiotensin-converting enzyme inhibitors and beta-blockers in heart failure), overuse (eg, of antibiotics in middle ear infections) and misuse (eg, of beta-blockers in airways disease).

Research from Australia suggests that 30 to 40 per cent of patients do not receive treatments of proven effectiveness while up to a quarter have treatments that are unnecessary or harmful.

Such gaps exist because there are barriers to implementing the evidence, Dr Jackson said. He divided barriers into four main areas: doctor, patient, healthcare system and guidelines.

The mere existence of guidelines, particularly if they are poorly developed and implemented, will not change patient care, he said. A key barrier to implementing evidence in practice is that researchers and policy makers identify the wrong series of interventions for best practice.

Reducing know-do gaps should be based on solid research. Strategies should be multifaceted and involve groups of people (eg, pharmacists, doctors, patients, managers). In particular, pharmacists have an important role in putting clinical trial findings into practice, he concluded.

Lyle Bootman, dean of the College of Pharmacy at The University of Arizona, US, described the economic consequences of the know-do gap: in the US, the cost of drug-related morbidity and mortality increased from $76bn in 1995 to $170bn in 2001 and was expected to reach $300bn in 2008. The cost of non-compliance alone is $100bn he said.

For example, evidence shows a patient takes a statin for an average of 130 days. The benefits of statins are long term, so money is wasted if the statin is discontinued, he said.

Pharmacists could save huge amounts of money in both direct and indirect costs, but they do not have the incentive, he said. “We get paid whether or not something works. We are not paid to deliver outcomes. But this is likely to change as increasing emphasis is put on value for money,” he predicted.

Citation: The Salvadore URI: 10980609

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