From best evidence to best practice — what are the obstacles?

There are numerous obstacles to overcome when implementing measures resulting from new evidence in clinical practice — some relate to practitioners in hospitals and primary care, others to patients, their relatives and public opinion. Many post-myocardial infarction (MI) patients are still discharged from hospital without any specific recommendations for risk-factor management, despite the fact that the hospital stay provides an excellent window of opportunity for treatment. Conversely, the primary-care physician may assume that as these measures were not implemented in hospital, they are unimportant. Even if recommendations for risk modification are made, the patient’s attitude towards risk reduction can reduce its effectiveness. The HELP study found that the public had a reasonable knowledge of coronary heart disease (CHD) and the risks involved. However, their attitude was remarkably indifferent; even in post-MI patients, 24% were aware of lipid-lowering treatments, but did not take them, while 38% were not even aware of this form of therapy. Despite this, the medical profession was found to be the most credible source of information about CHD. Healthcare professionals, therefore, have an obligation to ensure patients receive the maximum benefit from medical advances by working together to overcome the barriers.