Issue: December 2019
November 12, 2019
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Dissemination and implementation science underutilized in ID

Issue: December 2019
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Jason Burnham, MD 
Jason P. Burnham
Raghavendra Tirupathi, MD, FACP 
Raghavendra Tirupathi

Dissemination and implementation science is underutilized in the field of infectious diseases despite its demonstrated positive impact on clinical practice in other specialties, according to researchers, who described reasons and recommendations for its use.

Writing in Clinical Infectious Diseases, Jason P. Burnham, MD, an assistant professor of medicine in the division of infectious diseases at Washington University School of Medicine in St. Louis, and colleagues characterized dissemination and implementation (D&I) science as seeking “generalizable knowledge about closing the gap between clinical discovery and actual use in routine practice and public health.”

It is a “relatively new discipline,” said Cornelius (Neil) J. Clancy, MD, an associate professor of medicine and director of the extensively drug-resistant pathogen lab and mycology program at the University of Pittsburgh.

“The goal of D&I is to maximize the efficiency of using evidence-based interventions while removing or replacing ineffective or inefficient practices,” Clancy, who was not involved in the article, told Infectious Disease News. “The discipline is built upon quantitative, qualitative and mixed-model research designs and analyses.”

D&I “gets the evidence where it is needed,” Burnham told Infectious Disease News.

Gap between research and practice

According to Infectious Disease News Editorial Board Member Raghavendra Tirupathi, MD, FACP, medical director of Keystone Infectious Diseases/HIV, chair of infection prevention at Summit Health and clinical assistant professor of medicine at Penn State University School of Medicine, the gap between research and practice can be explained by the environments in which each is conducted.

“Most research takes place in controlled settings with a well-defined population that is motivated to participate by incentives. In real-world practice, the environment of the intervention is less rigid,” Tirupathi, who was not involved in the paper, said. “We have several examples in ID and HIV where we have highly effective interventions, but we are unable to make an end impact due to several barriers to implementation. D&I science helps to bridge the gap by [providing] carefully crafted strategies to maximize the benefit of evidence for the maximum number of populations or settings.”

Burnham also noted the tendency of research “to focus on populations that have met strict inclusion criteria, which may not mimic what providers see in real-world settings,” and cited the difficulty in disseminating research to the people who need it most — frontline providers — as well as the need to reach a consensus to determine when a practice can be considered evidence based.

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Corneilus (Neil) J. Clancy, MD
Cornelius (Neil) J. Clancy

“An important aspect of D&I science is that it can measure whether an intervention fails because it is not effective or whether it is not effectively implemented,” Burnham said.

Critically, he said, D&I science focuses on external validation instead of traditional clinical trials.

Opportunities for implementation

Burnham and colleagues listed five research areas that could benefit from a D&I approach: hand hygiene, antimicrobial stewardship, HPV vaccination, pre-exposure prophylaxis for HIV and hepatitis C virus management.

“As a field, ID has many areas with robust evidence of clinical efficacy and effectiveness that lack only implementation science to get the evidence to patients,” they wrote.

Other areas also could benefit from D&I science, including uptake of clinical practice guidelines, and problems related to linking patients to care and losing them to follow-up.

“It's a positive feedback loop,” Burnham said. “The more D&I science we use, the better the quality of research, which in turn reaches patients more quickly and improves their health to a greater extent.”

Clancy mentioned yet another area where D&I science could be useful — the slow uptake of effective new antibiotics into clinical practice. He said D&I science helps to answer the question, “How can we do better?”

In their paper, Burnham and colleagues included a table of resources where clinicians can find articles and trainings related to D&A science.

“I think the time is ripe for ID to make better use of D&I,” Clancy said. “The paper performs an important function by bringing the discipline to the attention of the ID community.” – by Marley Ghizzone

Reference:

Burnham JP, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz1011.

Disclosures: Burnham and Tirupathi report no relevant financial disclosures. Clancy reports being awarded investigator-initiated research grants from Astellas, Cidara, Melinta and Merck for projects unrelated to this study, serving on advisory boards or consulting for Astellas, Cidara, the Medicines Company, Merck, Needham & Company, Scynexis, Shionogi and Qpex, and speaking at symposia sponsored by Merck and T2Biosystem.