Tuesday, February 08, 2011

The wheels of translation (of evidence into practice) turn slowly

It's well known that doctors are slow to put new evidence into practice, a tendency that is not well understood.

Home treatment of DVT with low molecular weight heparin affords a unique opportunity to document the time interval from publication of evidence to implementation in practice because information on process of care is readily obtainable from a database.

This was looked at in a recent study published in the American Journal of Medicine. The uptake of evidence, in the form of either total out patient treatment or markedly shorter hospital stays, was low and slow but did increase over time:

Eleven years after demonstration of the safety and efficacy of home treatment, there was only a 21% decrease in the population-based incidence of hospitalizations of patients with a principal diagnosis of deep venous thrombosis. The proportion of patients with a principal diagnosis of deep venous thrombosis who were discharged in less than or equal to 2 days began to increase prominently after the 1996 publication of trials showing the safety and efficacy of home treatment, and continued to increase through 2006. However, the proportion discharged early remained modest (21% to 25%).

Doctors are slow on the uptake of evidence but do assimilate it over time. Reasons are multiple and complex, and may not all be bad. Some are in the from of external barriers. Others may represent appropriate caution. No one can say how fast is fast enough.

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