Bridging between basic medical science and clinical practice.
Bosn J Basic Med Sci 2012; 12 (1)
Bridging between basic medical science and clinical practice
Translating the extraordinary scientifi c and technological advances from the biomedical research laboratory into actual patient care practices
and other processes aimed at promoting health has been a major challenge, particularly for patients in community settings. Because of that the
increased participation of clinicians from primary health care in clinical research would have a number of benefi ts. As experts in the delivery of
clinical care in one society, they have much to contribute providing health care for patients in the whole spectrum of illnesses. Th ey are among
the fi rst to recognize changes in patients’ which come us as result of disease and conditions associated with demographic shiftings. Very often
these are unexpected events such as trauma, natural disasters, pandemic infections, etc. Th ey are also directly in contact with the policy-related
matters (e.g., health consequences associated with increase in price of medications or the clinical consequences of war, such as the rapid in-
crease in the number of individuals with prosthetic limbs and post traumatic stress syndrome). Finally, participation in clinical research would
benefi t clinicians from primary health care in more ways, such as: contributing the mission of medicine and improving the scientifi c basis for
medical practice; allowing clinicians to stay with new innovations ie. the development up to-date of information systems to improve data-
gathering associated with the research.
A major goal is the development of teams of investigators from various research disciplines, is to turm the scientifi c discoveries from the labo-
ratories into treatments and strategies for patients in communities. However, even with that introduction only a small part of the community
will provide participation in clinical research. Th e barriers for this in USA recognised from clinicians community and showed in down table.
Editor in Chief
Professor Bakir Mehić, MD, PhD
Higashi T, Shekelle PG, Adams JL, et al: Quality of care is associated with survival in vulnerable older patients. Annals of Internal Medicine , ():-.
Tufts Center for the Study of Drug Development: Number of principal investigators in the U.S. is declining. [http://csdd.tufts.edu/NewsEvents/News-
Article.asp?newsid = ], Accessed July , .
Green LA, Hickner J: A short history of primary care practice-based research networks: from concept to essential research laboratories. J Am Board Fam Med
Kahn et al.: Bridging the gap between basic science and clinical practice: a role for community clinicians. Implementation Science :.
Addressing professional values:
Study design feasibility
Clinician’s relationships with clinical/
scientifi c communities
Study questions are not pertinent to topics of interest for clinicians, their practice, or their patients.
Study inclusion and exclusion criteria make most community practice patients ineligible.
Clinicians need reassurance that research engagement does not threaten the doctor-patient relationship.
Clinician and patient distrust of research
Equitable access to research opportunities & to care refl ecting research fi ndings will help address longstanding
mistrust by clinicians and patients for research endeavors.
Developing necessary infrastructure:
Assuring data quality in offi ce settings is challenging, particularly given the lack of uniformity of study design
Adequate and effi cient training for successful research participation is not readily available or pertinent to clinician
Costs and eff ort associated with transient research engagement are excessive.
Local research training eff orts are not rigorous enough.
Accessing IRB† and HIPAA‡ certifi cation is burdensome and time-consuming.
Research participation is isolating without systematic feedback about performance, data quality, and research
Design effi ciency
Realigning fi nancial incentives:
Th ere is no time to do research in a busy practice.
Clinical research participation will not be reimbursed adequately.
Th e adequacy of legal liability (insurance?) for research participation for practicing clinicians is murky.
Unpredictable nature of research (sporadic study availability, changes in costs and reimbursement rates).
Information is not readily available (study questions, protocols, reimbursement schedules, study-specifi c enroll-
ment, data quality).
† IRB = institutional review board
‡ HIPAA= Health Insurance Portability and Accountability Act
TABLE: Barriers clinicians have identifi ed regarding participation in clinical research4