Five steps from evidence to effect: exercising clinical freedom to implement research findings

Abstract

Clinicians read medical journals to keep up to date with new evidence.1,2 To do this effectively means getting through many articles every month. Help with assimilating primary research is available from critically appraised syntheses or meta-analyses published in specialty databases,3 the Cochrane Library4 and other secondary journals.5,6 Some research will have implications for their current clinical practice. As clinicians accumulate new information, they must take it forward for implementation into practice. If they do not, the benefits for patients of research evidence will not be realised. There is clear evidence that clinicians lack confidence in implementing research findings.7,8 Simply making research evidence available through publication is not sufficient to improve care. This is what leads to frustration for researchers, research funders, peer-reviewers and journal editors. Transfer of research into clinical practice often takes too long.9,10 On a worldwide scale, effective evidence-based interventions remain underutilised.9 Unless clinicians keep up to date and have skills in appraising and applying valid and potentially valuable published findings, the journey from evidence to effect will not be shortened. Evidence-based medicine (EBM)11 encourages integration of contemporaneous patient-oriented clinical research knowledge into medical decision-making. EBM also integrates concepts of problem based-learning and lifelong learning because evidence changes over time.12,13 Despite the fact that EBM is highly regarded by many healthcare professionals, it is not widely used.14 With local efforts,11,15–17 where clinicians feel empowered to exercise clinical freedom high levels of evidence-based practice are achievable.18 This commentary will provide a brief overview of the journey from evidence to effect and will outline the hurdles that impede and factors that aid in the implementation of evidence. Using the rational approaches that have been shown to work in diffusion of innovations, clinicians will be able to develop a practical strategy for putting evidence into practice realising the benefits of new research for their patients.