Faculty of Health and Medical Sciences

Apply the evidence

Can this practice be implemented in this healthcare setting?

Studies may incorporate practices that are ideal, but are not available in your ‘real world’ setting.

Your setting includes the healthcare funding environment, the expertise available, and the resources in your practice and institution. Sometimes simple changes in practice or training can allow you to implement something new.

Click on each of the tabs below to explore ways of customising study practices to your setting:

Clinical setting

Consider whether the intervention or test is available and realistic in your setting:

  • Medicare or PBS reimbursement or your patients’ financial or insurance status may need to be considered.
  • Consider the experience of your surgical, diagnostic or procedural colleagues and whether the right equipment is available to them.
  • Appraise honestly whether you can reproduce a complex inpatient or outpatient regimen.
  • Ask whether a diagnostic test will get done in a timely manner if resources are limited in your setting (e.g. MRI scanning for breast cancer screening).
  • Check that you would be able to monitor patients frequently enough for side effects.
  • Ensure the comparator reflects your standard practice.
  • Establish whether the other concurrent treatments and supportive care are standard in your setting.
  • Acknowledge what else the study incorporated that your patient may not have access to, and whether this will affect outcomes.

Influence your setting

If the best intervention for your patient is not available in your setting, consider how you can influence this:

  • Make extra training available to all staff.
  • Facilitate a staff member to develop a special interest or expertise.
  • Make a business case for the introduction of new technology.
  • Obtain an administrative exception for an individual patient.

Alternatives

Identify alternatives:

  • Other equally effective interventions may be more readily available in your setting.
  • Find out whether the patient could go to a different centre for the test or intervention.
  • Ask the patient if they would consider paying for a highly effective test or intervention themselves.

Efficacy vs Effectiveness

Efficacy measures the effect of an intervention conducted under ideal conditions. Most clinical trials with controlled inclusion and exclusion criteria and carefully monitored drug administration and compliance test efficacy, but not always effectiveness. These trials can have high internal validity, but may have low external validity.

Effectiveness refers to results obtained under the conditions of a routine clinical care situation. ‘Effectiveness studies’ may be done to test interventions in a situation that is closer to a real clinical situation, with generous inclusion criteria and many centres and settings involved. Such studies have better external validity than efficacy studies and allow results to be generalised. These are particularly important in mental health and general practice settings, removed from the artificial environment of clinical research.

Efficacy and effectiveness may be similar or very different.