Medical Device Daily Washington Editor

BETHESDA, Maryland – Translating best practices into standard clinical practice is a notoriously difficult exercise, as Carolyn Clancy, the director of the Agency for Healthcare Research and Quality (AHRQ), noted at a recent Senate hearing (Medical Device Daily, June 26, 2006). Clancy said that at least one study indicated that the migration of best practices to daily practice can take long as 17 years.

Rather than wait for every last bit and byte of evidence-based medicine to find their way into the routine of the typical practitioner, various governmental entities are engaged in attempts to bring best practices to the patient directly via the Internet. While the effort is not without pitfalls, this activity might help nibble away at the nation's healthcare tab by putting the tools of modern science where they are most needed – in the hands of patients.

AHRQ and the National Cancer Institute of the National Institutes of Health (Bethesda, Maryland) are holding a three-day conference to explore the potential of various non-traditional channels to make smarter patients of us all.

On Monday, the first day of the conference on “Translating Research Into Practice and Policy“ (TRIPP), Donald Steinwachs, PhD, director of the health services research and development center at Johns Hopkins University Bloomberg School of Public Health (Baltimore), discussed a recent study to evaluate the possible role of the Internet in educating consumers on best practices in schizophrenia care. Not surprising is that most patients and their loved ones depend “a lot“ on providers as sources of information at almost 45%, with 20% of respondents saying that they relied heavily on books and television as their primary source.

Dubbed the Schizophrenia Patient Outcomes Research Team (Schizophrenia PORT), the study revealed that practitioners' conformance to evidence-based treatments was a bit erratic.

“We found that overwhelmingly, patients got medication“ as suggested by the latest standards, but that “only about a third of the time did the dose level match“ best-practice recommendations, according to Steinwachs.

If in-practice compliance was not universal, the recommended interventions outside the provider's office fared even worse. In assessing providers' compliance with recommended therapies and interventions, the PORT team discovered that the more labor-intensive interventions, such as vocational rehabilitation, were not routinely followed.

Steinwachs told Medical Device Daily that two parts of the problem are, rather predictably, compensation and full schedules. Undertaking this work is not as remunerative as the standard in-office care, and “generally, referring a patient to someone else is a disincentive because they may not come back,“ he noted.

He pointed out that while dissemination of best practices via the Internet is inexpensive compared to most other communications channels, many will approach the task with little or no experience with the web. He added that some patients, including those with schizophrenia, “have had difficulties with the mouse“ and may suffer from low reading comprehension. The very busy layout of many web pages is also an impediment for many would-be users.

While the trial in question is still under way, Steinwachs noted that a few lessons are already fairly clear.

One is that “web pages should be simple and uncluttered,“ and another is that the material should be written to “a reading level at eighth grade or below“ to assist those with cognitive difficulties. On the other hand, the subjects to date testify that they “like getting information about how their care“ should go.

While consumers are generally fairly comfortable with the idea of going to the web for information on medical conditions – and healthcare has been shown in many studies to be one of the top searches – some sales work is still necessary. Those with backgrounds in marketing may end up playing a decisive role in such an effort.

Kristen Warr-Wing, dissemination specialist for the Veterans Affairs (VA) research center in Gainesville, Florida, pointed out that the private sector has practiced healthcare marketing for years and has become quite adroit at it.

“Pharmaceutical companies are [already] changing dissemination by marketing to consumers,“ she pointed out, adding that “commercial marketing strategies have been underutilized in health promotion and disease prevention.“

However, the channels of communication have to be carefully chosen, partly due to budget constraints, commonplace in communications work. Any entity that wants to mold patient behavior will usually “rely heavily on the people you involve to get the message out,“ she said, a recommendation that those seeking to improve health-seeking behaviors should pursue collaboration with other parties having similar interests.

Warr-Wing described a program in progress by the VA to improve the health of veterans, including partnerships with the American Stroke Association (Dallas) and the National Stroke Association (Centennial, Colorado).

Sen. Larry Craig (R-Idaho) also was slated to take part until the disclosure of data loss at the VA. The timing of the effort, which debuted in May, was also key. May is National Stroke Month, and this program involved the use of three channels for veterans to request information on stroke prevention, namely by mail, phone and Internet.

“The veteran population is so dispersed,“ Warr-Wing said, that a collaborative effort and the use of many mediums to reach the population in question are also essential, lessons that perhaps might be applied to any such efforts.