Integrating research into a busy private clinical practice: A western region case study
The benefits of conducting high-quality research and translating scientific evidence into clinical practice have been demonstrated in recent decades with dramatic advances in health care. These include substantial decreases in heart disease mortality rates, improved cancer survival rates, new medications to treat mental illness, vaccines to prevent infectious diseases and many other advances.
However, a lack of integration in health care service provision, research and workforce education and training has been identified as a significant gap in regional Australia, including in the western region of Victoria. Western Alliance is working to bridge this gap by creating and enhancing opportunities for collaboration and integration in health research, clinical services, and research education and training across the region.
Clinicians play a unique role in health research. Their role in the frontline of health care enables them to form relevant research questions, gain access to participants and translate the resulting evidence into their clinical practice. But some studies suggest that clinician researchers are an ‘endangered species’ (Schafer 2010; Wilson 2007). Furthermore, ‘increasing pressure to deliver healthcare services has actually restricted research activity within the health system itself’ (Commonwealth of Australia, 2013, p. 38).
So, how difficult is it for a busy clinician to be involved in research? Despite the obvious challenges, many clinicians in the western region in fact are successful in integrating research into their everyday practice.
Take Dr Gemma Strickland, a Consultant Rheumatologist at a busy private clinical service that treats patients from across the western region. Dr Strickland and her colleagues at Barwon Rheumatology Service (BRS) are currently involved in several major research studies, including conducting clinical trials of treatments for rheumatoid arthritis (RA).
- ‘Fatigue is a debilitating, yet poorly understood symptom affecting patients with RA,’ says Dr Strickland. ‘At Barwon Rheumatology, our impression has been that patients with fatigue tend to improve with the commencement of biologic therapy, but this has never been objectively measured in our cohort of patients.’Dr Strickland is leading a new research project with the support of the BRS research team, including Deakin University medical students. The project will evaluate fatigue in RA patients on biologic therapy, using the Functional Assessment of Chronic Illness Therapy Fatigue scale (FACIT-F).
The aim of the project is to assess whether the level of fatigue in patients with RA is reduced with biologic therapy.
‘We will prospectively assess levels of fatigue and its correlations with patient demographics, DAS-28 score and modified HAQ score in a cohort of RA patients,’ says Dr Strickland. Patients will complete the FACIT-F and modified HAQ questionnaires just prior to commencing biologic therapy and at their three-monthly Medicare assessment visit.
The FACIT-F scale is a 13-item questionnaire that assesses self-reported fatigue and its effect on daily activities and function. It produces a summary score in the range 0–52, with higher scores indicative of lower levels of fatigue. The FACIT-F was initially developed to assess fatigue associated with anaemia in patients with cancer, but has subsequently been used and validated in many other conditions, including RA.
BRS aims to assess 50 patients at its Geelong clinic, where the research team is located. The BRS rheumatologists also visit Ballarat, Warrnambool and St Helen’s in Tasmania.
BRS has been running clinical trials since 2008, primarily studying treatments for rheumatoid arthritis. These studies have included:
- The effect of IL-6 suppression with Tocilizumab in RA
- The use of TNF inhibitors in very early RA
- Patient support programs for TNF inhibitor therapy
- Investigation of electronic versus hard copy patient-related outcome measures in the management of RA
- Evaluating the effectiveness of nurse education in patients who are newly diagnosed with RA.
BRS is currently in the planning stages for two new studies. The first is comparing a new (to Australia), longer lasting, intra-articular steroid preparation to usual practice in osteoarthritis treatment. This preparation has been available for many years in Europe. The second study is investigating the effectiveness and safety of a ‘biosimilar’ anti-TNF agent in RA.
For more information on how and why Dr Strickland and BRS have integrated research, education and training into clinical practice, see our Q&A interview.
- Schafer AI. (2010) The vanishing physician-scientist? Translational Research: The Journal of Laboratory and Clinical Medicine. 155(1):1-2.
- Wilson A. (2007) Are Australasian academic physicians an endangered species? Internal Medicine Journal. 37(11):778-81.
- Commonwealth of Australia (2013) Strategic Review of Health and Medical Research in Australia – Better Health through Research (‘McKeon Review’). Canberra: Department of Health and Ageing.