快猫短视频

In many ways, we are living in a golden age of medicine. At 快猫短视频, we regularly report on breakthroughs and innovations that enable us to subdue previously untreatable conditions, rethink our understanding of diseases and roll out new life-saving medicines faster than we ever thought possible.

Yet even in these thrilling times, the fact remains that many people worldwide 鈥� including those living in the wealthiest nations 鈥� receive medical care that can be up to out of date. The reasons for this are as varied as they are voluminous, stretching from the way research is conducted in the first place to the not small challenge of getting human beings, let alone institutions and whole societies, to change their habits.

In recent years, though, a new field has emerged specifically dedicated to closing the yawning gap between what we know and what we do in medicine and healthcare. It pulls together expertise from doctors, behavioural scientists, policymakers and many others who have placed themselves into what some are calling 鈥溾��.

That new lane goes by the name of implementation science. Its practitioners certainly have their work cut out for them, but they are starting to make some meaningful progress: already they have slashed the number of patients hospitalised for , updated practices for reducing and improved .

Clinical psychologist has been part of the field since its inception, at a meeting of a few dozen scientists at the US National Institutes of Health in 2007. Now at Northwestern University鈥檚 Feinberg School of Medicine in Chicago, she was previously the founding director of the at the University of Pennsylvania in Philadelphia. She spoke to 快猫短视频 about why she believes everyone should have access to the best quality care possible 鈥� and what it will take to make that a reality.

Corryn Wetzel: What is implementation science?

Rinad Beidas: ChatGPT has given the clearest definition of implementation science that I鈥檝e ever heard. [When a colleague asked ChatGPT] to explain implementation science in a way a 10-year-old could understand, it described it as being detectives. And we are. We try to better understand why a particular thing isn鈥檛 being used: Why don鈥檛 clinicians want to use it? Why don鈥檛 patients want to receive it? What about the setting doesn鈥檛 support the delivery of that thing? Then we design strategies to try to address those barriers that we detect, and we test the most effective approaches to do that.

We鈥檙e constantly coming up with incredible scientific discoveries, but we know that there鈥檚 a 15-to-17-year gap between when things are discovered and when they actually meet the needs of people 鈥� sometimes called the 鈥渒now-do鈥� gap.

Implementation scientists identify a care gap where we know we should be doing something and we鈥檙e not, then we go into that setting.

How did you get involved in the field?

Hindsight tells me I always was going to end up as an implementation scientist, but it鈥檚 easy to look back and decide that. My parents immigrated to the United States when I was 2 years old. My dad is an infectious disease physician and he did his medical training at a large medical centre in Brooklyn. He was at the front lines of the AIDS epidemic in the late 80s and early 90s. I remember my dad coming home every night and talking to me about the things that he saw and the inequities that impacted his patients. I couldn鈥檛 understand how people would have different access to healthcare and healthcare quality. I became very passionate about this idea that healthcare is a human right, and that everybody should have access to the highest quality care.

Fast forward to my training as a clinical psychologist: I was in a lab that had developed the gold standard treatment for paediatric anxiety, cognitive behavioural therapy. While I was there, I kept seeing anxious kids who had seen a number of different providers in the community and hadn鈥檛 gotten better. By the time they came to us to get services, they were often hopeless. Nothing else had worked because they hadn鈥檛 gotten access to best practices.

I went to grad school thinking I was going to develop new treatments for paediatric anxiety, but I realised that we already had treatments that worked and people weren鈥檛 getting access to them. It totally changed the trajectory of my career, and right when I got interested in this topic, the field of implementation science was starting.

Why does this 鈥渒now-do鈥� gap exist?

First, one of our biggest mistakes is that we don鈥檛 learn from the literature or the science that we鈥檝e developed. The second thing is, everyone always assumes it鈥檚 a training or education problem. If someone鈥檚 not doing something, we jump immediately to thinking they don鈥檛 know how to do it, so we should just train them and they鈥檒l do it, and that鈥檚 not the case.

Third, we just try to push something from the top down. We don鈥檛 actually find out from the people on the ground what they care about, what they want, what their priorities are. The entire model of medical research is not set up to produce findings that are easily deployable within the community and our healthcare environment. There鈥檚 this huge chasm between how we develop our discoveries and how we actually get them into the world. People in universities developing things seldom include the end users. So they show that it works in very tightly controlled environments, but then it all falls down when they go out into the real world.

Lastly, people in academia get promoted based on publications and grants 鈥� that鈥檚 our currency, not necessarily impact or partnerships. There are a lot of scientists who believe that their end goal is to produce a paper in Nature, Science or The New England Journal of Medicine and that the work stops there. That鈥檚 when the work starts, in my mind.

How do you close these gaps?

There is no silver bullet, but we do have general principles that we know are true. We need leaders to endorse and prioritise things that we鈥檙e asking people to change. That includes leadership support, organisational culture and climate and psychological safety. All of these things are important because if a [healthcare] organisation isn鈥檛 functioning well, it鈥檚 really hard to get clinician behaviour change or patient behaviour change.

We know that we have to make it easier for people. We can鈥檛 be layering on really complex things and making their jobs harder, particularly within the context of all of the kind of burnout that we see in healthcare right now.

Can you give me an example of a 鈥渒now-do鈥� gap you鈥檙e working to close?

Firearms are now the leading cause of death for children and adolescents in the United States. I was personally affected by a firearm suicide in our family in 2013. After that had happened, I had taken my 6-week-old son to a paediatrician appointment and my paediatrician asked me all these questions about safety, like did the baby sleep on its back? Did I use a car seat? But they didn鈥檛 ask me any questions about if we had a firearm and if we kept it securely stored.

I had this light bulb moment. I went into the literature and it turns out we have an evidence-based practice to talk to parents about secure firearm storage during paediatric primary care and offer free cable firearm locks. It鈥檚 been tested in large trials and the American Academy of Pediatrics supports it, and yet people don鈥檛 do it.

So we did all this detective work to understand why this program was not being implemented and designed a set of strategies to deploy it. We are analysing the data now, but I can tell you that we did this in 30 clinics with over 40,000 annual check-ups, and the majority of the visits included at least a discussion of secure firearm storage.

Who is facing the biggest gap in care?

In 2020, following the murder of George Floyd, there were a number of really influential thought pieces in the implementation science field that came out, calling out that we haven鈥檛 done as well as we could at centring equity alongside implementation efforts. If we only implement in highly resourced environments that serve highly resourced individuals, we actually stand to worsen and exacerbate inequities, or we could create new ones that don鈥檛 even exist yet.

What that means for me as a scientist is, whenever I鈥檓 going to launch an implementation trial, I want to scour the literature and talk to clinicians and patients to understand what kinds of inequities might be present. For example, when we were starting our firearm trial, we heard from clinicians that young people with complex medical conditions might be less likely to receive the discussion around secure firearm storage because annual check-ups have to be done in such a short period of time.

How has this played out during the COVID-19 pandemic?

I think science really got pretty battered over the past few years. I think [what happened with] COVID has actually made it harder for us as scientists to have credibility.

I believe that closing the gap between what we know and what we do is the challenge of our time.

We had a miracle where we developed a vaccine for a global pandemic in less than a year, and we couldn鈥檛 get people to take it. Implementation might have been able to offer some helpful nuggets about how to proceed in a way that might have turned out differently. It鈥檚 my prime example of why not having implementation scientists at the table created inequities and uneven distribution of vaccines.

I believe we should have had an implementation scientist in the Biden task force on COVID-19. But the public didn鈥檛 know about implementation science then. I鈥檓 sure the policymakers didn鈥檛 know about it.

With outdated practices so commonplace, what can patients do to get the best care?

I think it鈥檚 the responsibility of healthcare systems to ensure that the care is high quality, but that being said, people should ask questions of their clinicians. Is this the best practice for me? Why is it the best practice for me? Are we collaboratively deciding the course of action? Or am I just being told what is going to happen? Being informed and understanding how to navigate the healthcare system is important.

Given the many challenges, are you optimistic that your field can truly make a difference?

I believe that closing the gap between what we know and what we do is the challenge of our time. I know that there is a community of people who are really dedicated to this and want to ensure that every discovery has impact. That community keeps growing and getting more diverse and having more perspectives at the table. I think of implementation science as a way to advocate for the needs of our communities and amplify voices that aren鈥檛 always heard. It鈥檚 hard work, but it鈥檚 good work.