When Is Evidence Sufficient for Decision-Making?

National Pharmaceutical Council Chief Science Officer Robert Dubois, MD, PhD, recently co-authored a special report in the Journal of Comparative Effectiveness Research, "When is evidence sufficient for decision-making? A framework for understanding the pace of evidence adoption," that outlines key factors for why the translation of medical evidence into practice has not kept pace with the growth of medical technology and knowledge.

Given that multiple stakeholders influence evidence adoption, the authors, who include Dr. Dubois, Dr. Michael Lauer (National Heart, Lung, and Blood Institute) and Dr. Eleanor Perfetto (formerly of Pfizer Inc., now with the University of Maryland School of Pharmacy), represent public, private and academic backgrounds.

Using three well-documented cases in which new information was disseminated to the public—statins, drug-eluting stents and bone marrow transplantation for breast cancer—the authors developed a framework to determine which factors were most influential in changing clinical practice. They combined an approach that considers health care access and utilization with an approach that considers diffusion of innovation. The conceptual framework they developed includes the following five distinct domains:

• Validity, reliability and maturity of the science: whether the current understanding of the disease, its treatments, and the measured effectiveness in improving clinical outcomes are sufficiently mature to incorporate the newly released evidence;
• Communication of the science: whether the study results are amplified through the media or other communication vehicles;
• Applicability: patients’ or providers’ ability to apply published scientific evidence to specific clinical needs;
• Economic drivers that might influence adoption (who gets paid? Was it reimbursed? What marketing or detailing efforts were influential?); and
• Rapid (or slow) incorporation into practice guidelines (which might be influenced by other factors like maturity of the science and has the potential to influence clinical behavior).

The authors conclude that in order to achieve the desired improvements in patient care, appropriate adoption of well-substantiated evidence needs to occur.  The framework developed by the authors may help identify the barriers to the translation of medical evidence into practice and assist in encouraging that adoption to happen in a timely fashion.

NPC will host a webinar to discuss the research and a related white paper developed by IMS Health on July 31, 2013, from 1 pm – 2 pm ET. Register for the webinar today!