The theory-practice gap
There is often a long gap of many years between strong evidence and change in clinical practice. This is caused by a combination of:
- Limited time
- Clinicians have limited time to regularly read and assimilate large amounts of information for clinical decision making. In 2017, approximately 1.3 million English language medical articles were added to PubMed.
- Access and ability
- Research is presented in a way that is not easy to access and clinicians may not be able to assess the quality of information.
- Personal opinion
- Research findings may be disbelieved or discounted if they are not congruent with clinicians’ beliefs or experience.
- Lack of authority
- Clinicians may feel they lack authority to bring about change.
Additional material
Read about an example of clinical evidence being integrated into routine clinical practice:
Corticosteroids for Preterm birth.
History of Corticosteroids for Preterm birth
| 1972 | A Randomised trial (RCT) |
|---|---|
| 1972 - 1989 | Six more RCTs were published, all confirming the 1972 findings. During this time most obstetricians were still unaware that corticosteroid treatment was effective and so did not treat women experiencing threatened preterm birth with corticosteroids. |
| 1989 | The first systematic review |
| 1989-1991 | Seven more studies were published. |
| 1994 |
NIH (National Institutes of Health) Consensus Development Panel. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273: 413-8. |
Conclusion
Corticosteroid treatment has reduced preterm mortality by 30-50%, but there was a long gap of many years before the study results were combined in a meta-analysis and the benefits became clear. This treatment is now routine for women where pre-term labour is suspected.
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