Medical care has improved beyond recognition over the past half century. An important contribution to this improvement has been through clinical research. Clinical research includes different stages from basic-oriented research, disease-oriented research with animal models, translational research, patient-oriented research and outcome research.
When clinical research has been successfully implemented in clinical practice it can answer important questions relevant to practitioners and provide the evidence necessary to underpin practice.
It is important however, not to remain complacent and to strive for continual improvement. There is still much clinical decision-making that is not informed by evidence, and research which is carried out in a way that is not methodologically robust.
This Forward Look examines how the quality of research can be improved, and how research results can better be implemented in practice. These issues were comprehensively analysed and finally discussed and debated by more than 90 leading experts from Europe and the rest of the world in a series of workshops culminating in a consensus conference held in October 2010 at the Council of Europe in Strasbourg.
After rigorous debate and discussion, identifying gaps and highlighting best practice, a number of recommendations and conclusions were drawn, the principal of which were as follows:
Patient-oriented research questions should be framed so that they address problems that are relevant to end-users of research: patients and the public. It is important not to waste resources on duplicating research - seeking to answer questions that have already been answered; this can be avoided by carrying out systematic reviews of the literature.
Research must be methodologically sound so that the answers it delivers can be viewed with confidence and used with confidence. The protocols and results of all clinical trials should be made publicly available and reported in an unbiased way and with adequate detail.
There need to be more studies on the comparative effectiveness of drugs and other technologies and toxicological and clinical information should be made public.
Education and training for clinical researchers are not well developed and there is an insufficient number of professionals with expertise in methodology, or an understanding of evidence-based medicine (EbM), health technology assessment and health economics.
Clinical practice guidelines are one important way to implement research findings. Various models exist to produce guidelines, including those produced by scientific learned societies and those produced by central government agencies; the different approaches have advantages and disadvantages. However, in general there is little evidence relating to the best way to ensure that research is implemented and research in this area is needed. For the future, systematic clinical practice guidelines of the highest quality is the way to go, to assure implementation of the right research results in clinical practice - so that EbM is used in each and every patient treatment, everywhere.
A key way to improve quality of care is through audit and feedback. Quality indicators can be valuable but need to be constructed with caution. Registries can also provide a rich source of information and they can be used for the generation of new research.
Primary care has a key role to play in both research and implementation, given that family doctos encouter almost the whole population, whereas fewer people go into hospital. Research results derived from specialist areas of medicine can be difficult to implement into general practice because people who see their family doctor often have a multiplicity of medical conditions that influence each other. There is a need to gain better knowledge relating to primary care.
We need greater involvement of the public at all stages of research, and healthcare professionals should be well equipped to communicate about research - including issues such as risk. Funding agencies should require researchers to report their plans for involving patients and the public in their research project.
The ten recommendations in this Forward Look are our attempt to summarise the many relevant and important recommendations in the report - gathered and developed to improve the quality of research and to improve the quality of patient treatment and healthcare, for patients and the public - here in Europe and globally.
