The Clinical Research Working Group was established in 2001 by the Research Committee to address issues relating to medical clinical research. The Working Group, chaired by Professor John Chalmers, undertook extensive consultations with the Australian health and medical research community, and with a wide range of academic, professional, charitable and government organisations with an interest in clinical research. The Working Group presented its findings to the Research Committee in a report entitled Clinical Research in Australia. Report of the NHMRC Clinical Research Working Group. The Report is now known as the 'Chalmers Report'.
While the Chalmers Report concentrated on a review of clinical research training and workforce development of medical graduates, it was agreed that an examination of issues affecting clinical research in other disciplines would be undertaken. A discussion document inviting feedback from all health professionals was placed on the NHMRC website in November 2002. Associate Professor Michael Frommer was commissioned by the Research Committee to review and summarise the responses to the discussion document.
The Research Committee will consider the findings and recommendations of the two reports to plan a strategy to include clinical research in its business plans for the 2003-05 triennium.
Report on the consultations undertaken by the Clinical Research Working Group, and recommendations to address issues facing clinical research.
Review of the feedback in response to the discussion document Clinical Research in Australia, November 2002.
The Evidence Based Clinical Practice Research Program as at December 2003
The SRDC established this program in the last triennium, in recognition of the fact that millions of dollars are spent each year on health and medical research, but that rapid developments in research do not always translate quickly or readily into clinical practice.
The purpose of the program was to identify barriers that may impede research outcomes being adopted. Specifically, researchers were asked to examine what structures and processes are required to implement and sustain evidence-based clinical practice in different health care settings across Australia, and whether the application of evidence-based practice in clinical settings leads to improved outcomes.
The Federal Minister for Health and Aged Care approved 14 projects for funding under this program in December 1998 at a total outlay of $1 million dollars. In December 1999, a workshop was held at which researchers presented their preliminary findings. Participants, including clinicians, researchers, administrators, academics and consumer and Government representatives, obtained a fuller appreciation of the complexities of effecting change in clinical practice. The importance of drawing on established organisational management practices was emphasised. For more information on the proceedings and outcomes of this forum, please refer to theReport of the Evidence-Based Clinical Practice Research Workshop.
Pathways to Progress
As a result of its Evidence Based Clinical Practice Research Program, the SRDC has concluded that significant health services or systems problems impeded the uptake and use of evidence based guidelines in clinical practice. The SRDC convened a forum in April 2001 of all relevant bodies to inform them of the issues, and to promote and stimulate a cooperative approach to addressing the problems.
The forum provided an opportunity for the National Institute of Clinical Studies, the Australian Council for Safety and Quality in Healthcare, the other Principal Committees of the NHMRC, and representatives of the Commonwealth Department of Health and Aged Care to work collaboratively to make evidence based medicine a reality in practice.
The major conclusion from the Forum was that while EBCPRP had been successful in identifying key factors which were critical in influencing the implementation of evidence based changes to clinical practice, relatively little knowledge had been gained on the sustainability, transferability and outcomes of the evidence based changes.
To address the deficit in knowledge on the sustainability, transferability and outcomes it was proposed to draw upon the expertise and information available within the network of Chief Investigators from the 14 previously funded projects. Thirteen of the former Chief Investigators have been awarded additional funding to write an 'epilogue' of their research projects so that the insights can be recorded and propagated to further the push towards addressing the identified issues.
On completion of the epilogues, a review and analysis of the outcomes will be conducted in early 2003.
Review of Unsuccessful Expressions of Interest for Funding under the Evidence Based Clinical Practice Research Program
Under the Strategic Research Development Committee's (SRDC), 1998 Evidence Based Clinical Practice Research (EBCPR) Program, 343 expressions of interest were received. Of these, 38 were shortlisted, of which 14 projects were funded under the EBCPR Program.
In 2002, the SRDC agreed to conduct a survey to determine the ultimate fate of the 329 expressions of interest which were not funded under the SRDC's EBCPR Program. The purpose of the survey was to:
- determine if the research had been pursued with or without alternative sources of funding;
- provide the SRDC with additional information on the impact of evidence based research in terms of changes to guidelines, policy, implementation of changes to clinical practice and patient outcomes; and
- assist the SRDC in determining whether Australia's research capacity in this important discipline is sufficient to be suppported via the mainstream investigator initiated process and/or to identify specific areas within the discipline where a strategic targeted approach to research is required.
- The following report is the outcome of the survey.
International Society for Quality in Health Care – 19th International Conference
Between the 5 and 8 November 2002, the International Society for Quality in Health Care (ISQua) held its 19th International Conference in Paris. The focus of the program for this conference was on building bridges and crossing boundaries in the development of quality health care. Dr John Best, Chair of SRDC, attended the conference and presented a poster entitled ‘Implementing Evidence Based Clinical Practice – The Way Forward’ which provides an overview of the rationale underpinning SRDC initiatives in evidence based clinical practice research, and a synopsis of the outcomes of those initiatives to date. Over 1000 delegates, representing over 70 nations attended the 19th International ISQua Conference.