Education And Debate Getting research findings into practice

When to act on the evidence

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7151.139 (Published 11 July 1998) Cite this as: BMJ 1998;317:139
  1. Trevor A Sheldon ([email protected]), professora,
  2. Gordon H Guyatt, professorb,
  3. Andrew Haines, professor of primary health carec
  1. a NHS Centre for Reviews and Dissemination, University of York, York YO1 5DD
  2. b Departments of Medicine, and Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
  3. c Department of Primary Care and Population Sciences, Royal Free and University College London Schools of Medicine, London NW3 2PF
  1. Correspondence to: Professor Sheldon

    This is the second in a series of eight articles analysing the gap between research and practice

    Series editors: Andrew Haines and Anna Donald

    There is increasing interest in providing evidence based health care—that is, care in which healthcare professionals, provider managers, those who commission health care, the public, and policymakers consistently consider research evidence when making decisions. 1 2 Purchasers, for example, should be able to influence the organisation and delivery of care (such as for cancer3 and stroke services4) and the type and content of services (such as using chiropractic for back pain or dilatation and curettage and drug treatment for menorrhagia5). Policymakers should ensure that policies on treatment reflect and are consistent with research evidence, and that the incentive structure within the health system promotes cost effective practice. They must also ensure that there is an adequate infrastructure for monitoring changes in practice and for producing, gathering, summarising, and disseminating evidence. Clinicians determine the day to day care patients receive in healthcare systems, and user groups (for example, patients, their families, and their representatives) are also beginning to play an important role in influencing healthcare decisions.6

    The factors described below should be considered when deciding whether to act on or promote the implementation of research findings.

    Summary points

    • There is increasing interest in making clinical and policy decisions based on research findings

    • Not all research findings should or can be implemented; prioritisation is necessary

    • The decision whether to implement research evidence depends on the quality of the research, the degree of uncertainty of the findings, relevance to the clinical setting, whether the benefits to the patient outweigh any adverse effects, and whether the overall benefits justify the costs when competing priorities and available resources are taken into account

    • Systematic reviews that show consistent results are …

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