Implementation science contributes to adoption of new practices in public health, specialists say

Speakers of an online seminar organized by FAPESP detailed methods used to identify and remove barriers that delay or interrupt effective interventions.

By Elton Alisson  |  Agência FAPESP – The COVID-19 pandemic has shown that implementation of effective, scientifically proven public health interventions and evidenced-based practices is a far from trivial task. 

Implementation science is a new specialty that can facilitate the task by identifying and addressing barriers to the translation of knowledge into medical practice.

“Many interventions that have been shown to be effective in clinical trials are not implemented in the real world or are implemented in a very limited way. Implementation science can help bridge the gap between what we know and what we do,” said Vilma Irazola, a professor at the University of Buenos Aires (UBA) in Argentina. 

Irazola was one of the participants in a webinar on “The role of implementation science” held online on November 3. The event was part of the series of FAPESP COVID-19 Research Webinars, organized by FAPESP in partnership with the Global Research Council (GRC).

Implementation science can be defined as the scientific study of methods that support systematic application of research findings and other evidenced-based knowledge in medical practice, with the aim of advancing the quality and effectiveness of healthcare services and improving public health.

One of these methods entails analyzing variations in the implementation of interventions with proven effectiveness in small groups. “We can also think about the implementation of population-level interventions – for example, about how the population is affected by clinical health services, behavioral health promotion, and system- and population-wide policies,” said Edward Gregg, a professor at Imperial College London in the UK.

A population-level approach is particularly relevant in situations such as the COVID-19 pandemic. “Some of the questions we can answer if we keep that framework in mind are what health, environmental and behavioral factors affect exposure and transmission in high-risk individuals, and what factors in primary care management affect the risk of progression from infection to severe morbidity,” Gregg said.

Context is key

Understanding the context for interventions is a key part of implementation science, Irazola noted. “Even in the most successful intervention, context can affect its implementation. The context is dynamic and changes all the time. That’s why it is so important to know the context and have an adaptation plan before you begin,” she said.

A case in point was the initiative taken by leaders of Hospital das Clínicas in the capital of São Paulo state to convert this huge hospital complex run by the University of São Paulo’s Medical School (FM-USP) into a center for the treatment of COVID-19 patients. 

The institution already had a disaster plan, implemented for the first time in 2013 when fire destroyed part of the Latin America Memorial cultural complex and 13 firefighters were injured, and again in 2020 during an outbreak of yellow fever. The plan was triggered yet again by the pandemic in late January 2020, although it had to be adapted to deal with this extraordinary event.

“We faced lots of circumstances that forced us to be very creative, and also very resilient, in order to get 300 intensive care beds for COVID-19 patients up and running, and operate this center dedicated to treatment of the disease,” said Anna Morais, an attending physician at the hospital and a member of its COVID-19 crisis committee.

“Having a disaster plan was vitally important in enabling us to make adaptations that couldn’t have been planned in advance. We had to expand our patient care capacity very quickly.” 

One of the processes used by hospitals in Brazil and elsewhere to expand capacity to care for COVID-19 patients is telemedicine.

In Brazil, the number of online medical consults jumped 1,500% during the pandemic (a rate of growth also seen in other countries, such as the US), and is set to rise at a compound annual rate of 58% between now and 2025, said Eduardo Cordioli, a physician who is head of telemedicine at the Albert Einstein Jewish-Brazilian Hospital (HIAE) in São Paulo, and chairs Digital Health Brazil (SDB), an association that represents the main telehealth service operators here.

For Cordioli, one of the obstacles to expansion of telehealth services in Brazil is the lack of a clear regulatory framework. “Brazil is a huge market for digital innovation in healthcare, with a very fast rate of growth in the adoption of telemedicine, but we need to remove a number of hindrances, such as the absence of reimbursement for telemedicine consults [by insurers] and resistance on the part of the medical community,” he said. 

A recording of the complete event is at: covid19.fapesp.br/602.