Bridging the gap between basic science and clinical practice: a role for community clinicians

Abstract

BackgroundTranslating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans.MethodsWe interviewed over 200 clinicians and other healthcare stakeholders from 2004 through 2005 to develop a conceptual framework and set of strategies for engaging a stable cadre of community clinicians in a clinical research program.ResultsLack of engagement of community practitioners, lack of necessary infrastructure, and the current misalignment of financial incentives and research participation emerged as the three primary barriers to community clinician research participation. Although every effort was made to learn key motivators for engagement in clinical research from interviewees, we did not observe their behavior and self-report by clinicians does not always track with their behavior.ConclusionsA paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required.

Engagement in research: an innovative three-stage review of the benefits for health-care performance

“…This is the initiative discussed in the RAND series of articles referred to earlier in this section. 131,147,148 Inevitably, such initiatives overlap with the network and collaborative approaches discussed later in this chapter. We did not identify any articles that show whether or not the research engagement encouraged by this NIH initiative has led to improved health-care performance.…”

“…More generally, they suggest that 'Clinician participation in research builds infrastructure that can facilitate engagement with managed care' (p. 2). 131 …”

“…Kahn et al 131 suggest engagement in research can benefit community clinicians by helping them to remain current with new innovations and to learn and implement what is best for their patients. They also suggest some factors that might be particularly relevant for the USA context but can have wider application.…”

“…It is also important to note, however, that the wider review provides evidence that many clinicians do not view research engagement as a way of improving the health care they provide. Following an extensive series of interviews, Kahn et al 131 list many barriers that clinicians in the community identified regarding participation in research, including the view that the study questions were not pertinent to topics of interest to themselves, their practice or their patients. Furthermore, they report 'Clinicians need reassurance that research engagement does not threaten the doctor-patient relationship' (p. 6).…”

“…131 from a set of three papers [131][132][133] describing a RAND Corporation (RAND) study funded by the National Institutes of Health (NIH) in the USA that explored a range of issues related to translational research. Neither of these two analyses specifically associate themselves with the by-product concept, but some of their thinking helps to inform the analysis here.…”