Improving Research Within Clinical Practice

Lisa Gren By Lisa Gren, Ph.D

We’ve all heard about the 17-year delay in translating biomedical research into daily clinical practice. Morris et al have characterized this delay as having two stages: the first is the delay that occurs between a discovery and testing the discovery in clinical trials, and the second between proving the discovery in clinic trials and implementing the finding in routine practice.1 These delays are a result of the time required for grant development, conduct of research, publication, phase I, II, and III trials, FDA approval, post-marketing testing, guideline preparation, etc. Further, many of these activities – such as grant development, publication, and clinical trials – may be repeated multiple times before a research idea is ready for every day use.
Where do family physicians find themselves in the 17-year delay? Often, it is somewhere along the continuum between clinical studies and routine practice. An increasingly common research trend is the use of comparative effectiveness trials and pragmatic trials, in order to bypass the delay that has occurred between tightly controlled clinical trials (effectiveness) and real-world use studies (efficacy). Bridging this gap between medical research and medical care holds the potential to shorten the 17-year delay, providing better care for patients in a more timely fashion. But in the context of a busy clinic, conducting research can be perceived as incredibly disruptive.
Minimizing that disruption has been the focus of collaboration between the Divisions of Family Medicine and Public Health at the University of Utah. Researchers from the University of Utah Primary Care Research Network (UUPCRN) conducted a survey of 59 clinicians and staff working in university-run primary care clinics. The purpose of the survey was to evaluate existing involvement in research among clinicians and to identify barriers to increased involvement. When asked how many studies they had been involved in, 79.7% stated 2 or fewer studies, and 49.2% indicated they had never participated in a study within the community clinics, despite broad positive perceptions of the benefits of clinic-based research.
This survey identified a number of important barriers preventing greater clinician involvement in research. As shown in the graph below, barriers deemed “significant” by greater than 30% of all respondents included lack of compensation, research training for clinicians, training of office staff on research protocols, paperwork required, and lack of time. The single greatest barrier was lack of time, with 80% reporting this as a significant barrier and an additional 17% reporting this as a slight barrier.

Gren Graph

The UUPCRN research staff decided to focus on minimizing the time barrier. We created a collaborative research workflow that outlined the roles and responsibilities of the PI and of the research team. In this workflow, the clinic-based PI starts with a clinical question, and then works with the research team to develop a researchable question, design, and implement a study. By pairing a clinical expert with research experts, we hope to dramatically reduce the time barrier for clinicians. In our model, the research team is composed of

  •  clinical research coordinator with CCRP certification (Certified Clinical Research Professional), who handles IRB submissions, consents patients, helps with protocol development, trains clinical staff on the research protocol, and assists with data collection and data interpretation;
  •  a masters-level trained research assistant, who identifies potential funding resources and assists with grant writing, develops the protocol and data collection forms, sets up the database, manages data cleaning and analysis, conducts literature reviews, assists in interpreting findings and developing dissemination materials (manuscript, poster and/or power point presentation of findings); and
  • the director of UUPCRN, a doctoral-level trained researcher, who assists the PI with study design, grant writing, data analysis and interpretation, and preparation of dissemination materials.

Our goal is to increase the number of Family Medicine providers who are involved in research in a meaningful way during the 2014-15 academic year. We believe the collaboration between clinicians and researchers is key to achieving that goal, and our mixed methods evaluation plan will help us understand where we have succeeded this year and where we have room for improvement.

1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in transitional research. J R Soc Med. 2011; 104:510-20.
Lisa Gren, PhD, MSPH is an Assistant Professor at the University of Utah, Division of Public Health, and Director of the University of Utah Primary Care Research Network.

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