By Joseph A. Cantlupe
While scientists frequently study and map out future healthcare models for pharmacists and physicians, something is often missing for years: delivering clinical care. “We are taking a long time to translate evidence into routine practice,” Dr. Geoffrey M. Curran, director of the Center for Implementation Research at the University of Arkansas Medical Sciences (UAMS), said of traditional bench-to-bedside practice. “One of the ironies is we study two areas, both how ‘things’ (i.e., interventions) work and how to actually help people/places to implement the thing, which often happens separately and adds to the time in making it happen in routine care.”
When healthcare models are finally translated into clinical care practice, it takes an average of 17 years, Curran said. With that lengthy gap, there is frustration and stilted innovation. Curran, a sociologist who worked in psychiatry for years, wanted to find out the “whys” and “why nots” of what makes new clinical practices translate, or not, into routine care. His work evolved into pharmacy practices, and he found “there is a growing urgency in health services research to address the seemingly intractable research to practice gap,” Curran said. “The urgency has fueled the development of implementation science.”
Implementation science. What does that mean in pharmacy? Essentially, it delves into the how and why of practice transformation, involving various measures and quality assurance metrics needed to roll out advanced pharmacy services at a scale to improve healthcare outcomes that result in cost-effectiveness, according to Curran. Curran’s work, his job title, his Center, is wrapped around the term. He is a leader in the field of implementation science, especially for academic pharmacy. He pores over the whys and wherefores of evidence-based medicine, medication prescribing and dispensing and medication adherence against the backdrop of a wide range of target diseases, such as cardiology or mental health concerns. By having pharmacists become more deeply involved in conversations with patients and having a greater role in clinical care (e.g., screening and testing), the process of implementation science takes hold, he explained. He introduces the notion that “implementation science has its own primary outcome measures, distinct from clinical/preventative/outcomes used in effectiveness research."
"I refer to those outcomes of how much and how well they (implementers) ‘do the thing.’ Verbally, I then explain that these measures focus on the extent (how much) and the quality (how well) of implementation,” he wrote. And then, there’s the rub: “We are trying to speed up the process,” Curran said simply.