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Waste not, want not? What to do when clinical research doesn’t change practice

Almost two-thirds of AMRC member charities fund clinical research – this isn’t surprising as all AMRC members fund studies into diseases and conditions affecting people, and this often takes place in the clinic. We like to think that a clinical research project provides undisputable evidence for change, and this change is immediately rolled out and embraced across the entire NHS. But the reality is different - even if the results show a clear benefit, it may not be adopted by the NHS.

So how can charities focus on supporting research that drives change resulting in real improvements for patients? It’s a tough question and one that can’t be answered simply. This blog looks at some of the issues – and our workshop on 30 October will go in to them in more detail.

How clinical practice is changed

In order for research to change practice, it needs to be reflected in the National Institute for Health and Care Excellence national guidance which provides evidence based advice to improve health and social care.  NICE guidelines are developed using a standard process including stakeholder representation. Charities can be involved as stakeholders, or by supporting the research that provides clear evidence that changes will result in better standards of care for patients than the current standard.  

But if it doesn’t change practice is the research wasted? 

Possibly - some figures suggest that as much as 85% of health research funding is wasted - this is something we’ve blogged about before. While it’s difficult to verify the exact scale of the problem, there are things funders can do to reduce this ‘waste’:

  • making sure the right questions are being asked - this could mean ensuring high priority questions are answered, important clinical outcomes are assessed and clinicians and patients are involved in the setting of research themes
  • ensuring the design, methods and analysis are robust and that the research is grounded in existing evidence
  • checking that research is published properly - this also involves updating systematic reviews, ensuring publication guidance is followed (e.g. the CONSORT statement), publishing all results (regardless of outcome) and publishing results in full
  • monitoring research to ensure that it’s carried out efficiently to time and target.

Innovation to stimulate adoption and reduce waste?

It’s important to recognise that there are many hurdles that can prevent adoption in the NHS. Our workshop on 30 October will examine the different ways in which funders can overcome these barriers by:

  • looking at commissioning research - whereby the funder sets a very specific question that it would like answering to drive forward new or understudied areas where applicants have traditionally been reluctant to stray
  • working more closely with the new NIHR adoption infrastructure - the CLAHRCs and AHSNs that are tasked with improving outcomes for patients by encouraging innovation in the NHS.
  • examining the findings of the NICE Implementation Collaborative that is looking at the system level barriers to adoption.

To sign up to this workshop, click here

We’re entering a new era where funders can take an increasingly hands-on approach to ensure that funding spent gives the most value for patients. In many cases this will involve changing practice and getting research adopted by the NHS. By working to ensure that waste is reduced and research is focussed on questions that matter the most, this can only be a good thing to bring benefits to patients sooner.