Significant new research headed by Western Health clinicians has raised questions about translating study findings from controlled trial settings into real-world healthcare practice.
The findings, published in the prestigious JAMA Internal Medicine Journal, involved a sample of over 800 pneumonia patients during a year-long trial across Sunshine and Footscray hospitals.
The study, devised by Western Health’s Associate Professor Harin Karunajeewa, aimed to test whether best practice guidelines based on the findings of controlled clinical trials would translate into improved patient and healthcare outcomes when deployed in a clinical setting at Western Health typical of ‘real-world’ modern healthcare in Australia.
They chose to do this in the General Internal Medical service of Western Health, as this unit manages mostly elderly patients with complex care needs – precisely the population that now makes up the largest group of healthcare users in Australian hospitals.
As part of the project, Associate Professor Karunajeewa and his colleagues established a Community-Acquired Pneumonia Service that drew on expertise from multiple disciplines including physiotherapists, dieticians and medical doctors.
The service was tasked with implementing “critical evidence-based interventions” around exercise, nutrition, antibiotics and steroid use to test whether evidence-based approaches would improve treatment outcomes for patients, as well as increase efficiency of the health service’s management of patients.
Results of the trial revealed that while the service achieved significant improvements in adherence to best practice guidelines among healthcare practitioners, the revised approach did not actually result in any discernible improvements in terms of health system or patient outcomes compared to the usual care provided.
Of particular note, their findings suggested that increased use of corticosteroids (previously thought to substantially enhance treatment outcomes among pneumonia patients) were not only ineffective but also seemed to have even been associated with increased incidence of gastrointestinal bleeding among trial patients compared with a control group.
While providing important insights specifically for the care of pneumonia, Dr Karunajeewa believes the study’s main value lies in its broader implications when considering how evidence gained from clinical trials performed in a controlled environment is translated into ‘real-world’ healthcare as it is practiced in places like Western Health.
“We have all this literature telling us to do these things, but when we carefully evaluated the impact of these interventions we found absolutely no evidence of improved outcomes, and that they might possibly even have caused some harm” he said.
Describing it as a “very impactful” research project which was “owned and driven” by staff at Western Health, Associate Professor Karunajeewa says the findings have also contributed directly to service improvement across the organisation.
“We’re aiming to be an organisation that is actively learning from its experiences, and this research really fits in with that ethos,” he added.
Associate Professor Karunajeewa reserved particular praise for the involvement of Allied Health staff in the trial, particularly physiotherapists Melanie Lloyd, Elizabeth Skinner and Melina Shackell. The study also received some support from researchers from the University of Melbourne and Monash University.
You can access the full study at this link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2737749
