Dissemination and implementation of clinical trial results are needed to encourage recommended practices
Research Activities, May 2012, No. 381
Disseminating results from clinical trials to clinicians is critical to bring new guidelines and therapies into practice. This is certainly the case for HIV/AIDS care, where new drugs and treatments can be life-saving to patients. Recently, researchers investigated the diffusion, dissemination, and implementation of findings from an AIDS clinical trial. Their knowledge-transfer initiative resulted in changes in routine clinical practice brought about by active dissemination and implementation from department leaders.
The clinical trial results used in this study were from an AIDS Clinical Trials Group (ACTG) protocol. This trial found that giving antiretroviral therapy (ART) within 14 days after a diagnosis of the opportunistic infection Pneumocystis jirovecii pneumonia (PCP) reduced AIDS progression and mortality by 50 percent. After the findings were released at a major meeting (diffusion), leaders from the HIV/AIDS Division at the University of California at San Francisco undertook a major initiative to get clinicians to adopt this practice. Efforts included establishing guidelines, disseminating educational materials, meeting with opinion leaders, and other activities.
The researchers evaluated 162 patients with PCP to determine time to initiation of ART. Before the clinical trial protocol, the proportion of patients receiving ART within 14 days of their PCP diagnosis was just 7.4 percent. After trial results were released, this proportion increased to 50 percent, which rose to 83 percent following the knowledge-transfer initiative. The researchers noted that, while diffusion is important, targeted information transfer and modification of local conditions were required to ensure maximum change in clinical practice. The study was supported in part by the Agency for Healthcare Research and Quality (HS17784).
See "The effect of AIDS clinical trials group protocol 5164 on the time from Pneumocystis jirovecii pneumonia diagnosis to antiretroviral initiation in routine clinical practice: A case study of diffusion, dissemination, and implementation," by Elvin H. Geng, M.D., James S. Kahn, M.D., Olivia C. Chang, M.P.H., C.P.H., and others, in the November 2011 Clinical Infectious Diseases 53(10), pp. 1008-1014.