Gap between research, implementation and policy

Transcription

1 Gap between research, implementation and policy Juan Carlos Llodra Calvo Preventive and Community Dentistry. University of Granada Former Chairman of Public Health Committee (FDI)

2 Contents Gap between research, implementation and policy Clarifying language and terminology What we know about translating evidence into practice Why translating evidence into practice How to translate evidence into practice Barriers to implementing evidencebased dentistry in practice Advantages of evidencebased dental practice Some practicals examples

3 01 Clarifying language and terminology Knowledge transfer Translational science Knowledge translation Knowledge exchange Implementati on science Knowledge mobilization Different terms to define this important goal

4 02 What we know about translating evidence into practice Generally not rational Robust evidence is not sufficient to drive implementation Complex and multifaceted Strong contextual effects

5 Jordan Z, Lockwood C, Aromataris E, Munn Z. The updated JBI model for evidence-based healthcare. The Joanna Briggs Institute The literature on this subject is very abundant

6 02 What we know about translating evidence into practice Pearson A, Jordan Z & Munn Z, (2012) Translational Science and Evidence-Based Healthcare: A Clarification and Reconceptualization of How Knowledge Is Generated and Used in Healthcare 3 translational gaps 1 Knowledge needs Discoveries 2 Discoveries Clinical application 3 Clinical application Policy and practice

7 02 What we know about translating evidence into practice The gap between research and practice is real and frustrating Some practitioners deride the research results as coming from an ivory tower, interesting perhaps, but irrelevant for anything practical. And some researchers proudly state that they are unconcerned with the dirty, messy, unsavory details of commercialization while also complaining that practitioners ignore them. Sometimes the gap is accidental, caused by a misunderstanding by both sides of the requirements and goals of the other.

8 02 What we know about translating evidence into practice Society Problems The conventional conceptualization of research implementation Science Solutions Local knowledge, values and behavior Decisionmaking Society Research-implementation spaces: Science Decisionmaking Local knowledge, values and behavior

9 02 What we know about translating evidence into practice Research Why most clinical research is not useful? Bias Random error Most clinical research is not true Management error Most clinical research is not useful Problems of funding

10 Implement ation Evidence based Practice Although considerable resources are spent on clinical research, little attention has been paid to the implementation of research evidence into clinical care McGlone P, Watt R, Sheiham A. Evidence-based dentistry: an overview of the challenges in changing professional practice. Br Dent J. 2001;190: EBP may not be a concept that every dentist is familiar with, but increasing consumer pressures and the present economic, social, and political changes, will necessarily demand that evidence based principles are implemented Iqbal A, Glenny AM. General dental practitioners knowledge of and attitudes towards evidence based practice. Br Dent J. 2002;193: "The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade "

11 02 What we know about translating evidence into practice Memory-Based Medicine American on average receive just 55% of recommended care Up to deaths annually would be prevented if all Americans were receiving the same consistent care Lapses, mistakes, and non-uniform or poorly evidence cares Deaths Lapses Mistakes Non-uniform cares

12 02 What we know about translating evidence into practice

13 02 What we know about translating evidence into practice From dental science to optimal oral health for communities From knowledge to action KNOWLEDGE What we know KNOWING ACTION What we do DOING The knowledge translation process The application of the best available evidence to benefit health and well-being.

14 02 What we know about translating evidence into practice Unfortunately, implementation of an evidence-based practice (EBP) by dentists is very limited due to its complexity

15 Evidence-Based Practice: Improving Practice, Improving outcomes 02 What we know about translating evidence into practice Global healthcare challenges today The biggest challenge faced by healthcare institutions today is providing evidence-based, cost-effective, quality care that will improve practice and improve patient outcomes Only 20% of healthcare providers do it based on evidence and 80% is not

16 Defining evidence-based practice (EBP) Evidence-based practice and evidence-based decision making is based on: External evidence: systematic reviews, RCT, best practice, and clinical practice guidelines that support a change in clinical practice. Scientífic Evidence Internal evidence: healthcare provider expertise Dentist s Expertise Patient: Preferences: what does the patient really want when given several different options Patient values: quality of life Patient Needs & Preferences

17 The myth of Evidence-based Practice (EBP) 02 What we know about translating evidence into practice DELIVERING CONTENTS PROVIDING EBP COCHRANE = EBP EBP resources DO NOT make an EBP dentist!

18 03 Why translating evidence into practice Leads to the highest quality care and patient outcomes Reduces health care costs Reduces geographic variations in the delivery of care Increases clinician empowerment and role satisfaction Reduces healthcare provider turnover rate Meets the expectations of an informed public Quality care Reduces costs Increases satisfaction Reduces geographic variations

19 03 Why translating evidence into practice For every $1 spent on new discoveries, about $0.01 is spent on disseminating information

20 03 Why translating evidence into practice Need for knowledge translation 1/3 1/4 3/4 About one-third (30 45%) of patients are not treated with interventions of proven effectiveness About one-fourth (20 25%) of patients receive unnecessary or risky interventions As many as three-quarters of patients do not receive the proper information for decision-making

21 Evidence-Based Practice methodology 04 How translating evidence into practice Develop the research question Search: Find the research/e vidence Evaluate practice changes and patient outcomes Improve Health Appraise the evidence Implement the evidence

22 04 How translating evidence into practice Implement the evidence

23 Clinical Practice Guidelines

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25 05 Barriers to implementing evidence based dentistry in practice Lapses in communication between researchers and practitioners * Lack of public awareness * Poor financing * Non-supportive political atmosphere

26 05 Barriers to implementing evidence based dentistry in practice Environmental In the practice: There are limitations of time and organization of the practice (for example, a lack of disease registers or mechanisms to monitor repeat prescribing). In education: Due to inappropriate continuing education and failure to connect with program to promote better quality of life. In health care: Due to lack of financial resources and defined practice populations. Ineffective or unproved activities promoted by health policies. Failure to provide practitioners with access to appropriate information. In society: Due to influence of the media on patients in creating demands or beliefs. There is impact of disadvantage on patients access to care. Personal Factors associated with the practitioner: Due to obsolete knowledge and influence of opinion leaders (such as health professionals whose views influence their peers) along with beliefs and attitudes (for example, a previous adverse experience of innovation). Factors associated with the patient: There are demands for care by the patient and perceptions or cultural beliefs about appropriate care The most common barriers to implementation of early-adopting dentists are difficulties in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research

27 06 Advantages of evidence-based dental practice YOU Journal of Clinical and Diagnostic Research Feb, Vol-8(2): Gained improved clinical decision-making ability Achieve greater confidence in treatment planning More opportunity to provide treatment choices selected for minimizing risks of harm and maximum treatment safety More peace of mind that comes from doing the right thing Increased day to day enjoyment with a happier team motivated by working to a higher standard that puts the patient first in the dental care processes BETTER TREATMENTS, BETTER SAFETY, PEACE OF MIND, BETTER HEALTH FOR OUR PATIENTS

28 06 Advantages of evidence-based dental practice YOUR DENTAL TEAM AND PRACTICE Journal of Clinical and Diagnostic Research Feb, Vol-8(2): Increased staff confidence, pride, trust, and personal satisfaction Enhanced recognition in the community and with peers as a thought leader practice Greater opportunity to conserve practice financial resources by establishing wiser decisions in product and equipment selection INCREASED STAFF CONFIDENCE, PERSONAL SATISFACTION LEADER PRACTICE

29 06 Advantages of evidence-based dental practice YOUR PATIENTS Journal of Clinical and Diagnostic Research Feb, Vol-8(2): Most trust and confidence in their dentist and his/her own practice Greater incentive to invest in quality oral health care Increased pride from being a patient of a community thought leader and distinctive practice Maximum safety CONFIDENCE AND SAFETY GREATER INCENTIVE TO INVEST IN QUALITY ORAL HEALTH CARE

30 Oh, research is research, practice is practice, and never the twain shall meet. Donald Norman

31 07 Some practicals examples Fissure sealants * Safe * Effective * Cost-effective Less than 40% of dentists follow the recommendations of ADA Level I evidence The lack of dentists doing sealants is probably the most significant issue to care we face among children,

32 07 Some practicals examples Powered toothbrushes Powered toothbrushes Sonic Ultrasonic Vibration Rotation-oscillation There is evidence that rotation oscillation brushes reduce more plaque and gingivitis than side to side brushes in the short and medium term Level II of evidence Many dentists limit the use of powered toothbrushes only to disable patients

33 07 Some practicals examples Fluoride toothpastes Fluoride toothpastes Concentration of fluoride 1000 ppm or above Types of fluoride ppm Ns ppm ppm 23 % 36 % There is evidence that using fluoride toothpaste prevents caries but only significantly for fluoride concentration of 1000 ppm and above. The caries preventive effects of fluoride toothpaste of different concentrations increase with higher fluoride concentration. Level II of evidence Many dentistas continue to recommend lowfluoride concentration toothpastes in patients under 3-years-old

34 07 Some practicals examples Prophylactic Extraction of Third Molars * Surgical risks * Unnecessary * Painful * A lot of variability concerning the decision * There is a lack of reliable evidence to support the prophylactic removal No evidence Due to misinformation and myths, this clinical procedure continues to be promulgated by many dental practitioners worldwide

35 Art vs Science There is a huge gap between research and practice. To bridge the gap we need a new kind of practitioner: the translational developer. There is a strong need for the science behind our treatment decisions Thank you

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