From research to reality: How implementation science is fast-tracking lifesaving treatments

Imagine waiting nearly two decades for a breakthrough treatment that could save your life. For patients with conditions like diabetes, cancer, and heart disease, or for those with rare conditions, this can be a difficult reality.

Despite advances in medical research, it can take up to 17 years for new treatments to become widely available. Implementation science is changing that, transforming how quickly lifesaving therapies reach those who need them. By closing the gap between research and practice, implementation science aims to improve patient outcomes.

What is implementation science?

Implementation science involves studying methods and strategies to effectively promote the use of evidence-based practices, interventions, and policies in everyday practice settings to enhance outcomes and overall population health.

Bringing a new treatment to those who need it involves a series of crucial steps that can take many years. Identifying a medical need, exhaustive preclinical research, clinical trials, regulatory review, and production considerations, are just a few of the necessary stages before a treatment can be made available to patients who need it.

“The focus of the field is to get organizations, policymakers, and the clinicians delivering health care to use evidence-based practices that we know work, instead of using things that may not work so well, but may have been in practice for a long time,” said Associate Professor of Community-based Health Berkeley Franz. "Just knowing that treatments are effective doesn't mean that they will be easy to use for healthcare professionals.”

Health organizations such as the National Institutes of Health (NIH), the Special Programme for Research and Training in Tropical Diseases (TDR), and the Centers for Disease Control and Prevention (CDC) are utilizing implementation science to better fulfill their missions.

How implementation science overcomes common challenges in medicine

The decision to use more established treatments over newer more effective ones is complex and can depend on a variety of factors. Here are just a few.

Reluctance to prescribe: Familiarity with the risk profiles associated with established treatments  can lead physicians to view these options as a preferred choice over newer treatments, even when those newer treatments may be more effective.

Implementation science can promote effective solutions such as ongoing education, clinical decision support tools, and feedback systems to encourage physicians to adopt evidence-based treatments. Engaging opinion leaders and involving patients in treatment decisions further supports the shift toward the best available care options.

High cost of newer alternatives: Considerations around expense, especially the cost of generic alternatives, may prolong the use of treatment that may not be as effective as newer options.

By analyzing the full cost picture, including long-term savings and efficient implementation strategies such as insurance options, cost-sharing programs, streamlined administrative processes, and technology integration, implementation science can identify interventions that deliver the most health improvement for the money. This approach can ultimately contribute to achieving sustainable best practices.

Patient preferences: A patient may be more comfortable with a treatment they know has been around for a while.

Implementation science explores different tools to improve adoption of evidence-based practices, collectively known as implementation strategies, and their impact on successful implementation and improved clinical outcomes. By including patient feedback and decision-making outcomes, implementation science can determine the best approach to empower patients while considering their comfort with established treatments.

Difficulty in delivering: Newer treatments may come with a higher level of complexity in dosing, administration, and monitoring.

Through iterative testing and feedback loops, implementation science streamlines treatment pathways to be more patient-friendly and simpler to adopt for clinicians, ensuring they are not overly complex and are easily navigable. By prioritizing simplicity and ease of use for both patients and clinicians, it enhances treatment adherence and increases the likelihood of successful outcomes.

New approaches are a hallmark of implementation science

As the implementation science field matures, new medical advancements and research have required its integration sooner. Rather than waiting to be handed the baton once a treatment is developed, implementation science can engage proactively during the treatment creation process.

“The goal now is to develop ways to think about implementation while studies are still ongoing to determine the effectiveness of a medication or other intervention,” said Franz. 

“So now we have different types of clinical trials called hybrid trials, which are simultaneously testing the effectiveness of something and also testing the implementation of it at the same time.”

Fighting stigma with implementation science: Tackling opioid use disorder

Franz focuses on the fight against opioid use disorder (OUD) through implementation science. This approach aims to improve health outcomes for those struggling with OUD. 

One key area of her work is tackling the issues surrounding buprenorphine, a life-saving medication that combats opioid cravings and withdrawal symptoms. While this medication has strong potential to improve health outcomes, it is underutilized by both health care professionals and patients.

"We have a highly effective medication for opioid use disorder. It literally is life-saving," Franz emphasizes. “Buprenorphine reduces mortality rates significantly, and also reduces rates of HIV and HCV and other infections, particularly with people who inject drugs.” Buprenorphine reduces mortality rates significantly and offers a safer alternative to illicit opioids with their high potential for overdose.

Despite its effectiveness, buprenorphine faces a significant hurdle: stigma. Because it is a partial opioid itself, clinicians may be hesitant to prescribe it due to misconceptions about the medication being akin to "enabling" drug use.

"Public health takes a harm reduction approach," explains Franz. "And it's much better than people using illicit opioids, which have an incredible potential for overdose and for other complications.”

To tackle the stigma, Franz utilizes strategies that go beyond simply increasing knowledge about buprenorphine. She actively works to dismantle the prejudice surrounding both the medication and the patient population it serves.

"We work with healthcare organizations to figure out how to integrate buprenorphine into everyday practice," she said.

This includes collaborating with federally qualified health centers and primary care clinics to develop strategies for patient visits.

"We help them understand how to manage buprenorphine treatment alongside other existing conditions and medications."

Franz is currently planning a hybrid trial in Ohio community health centers and is completing an R34, clinical trial planning grant, funded by the National Institute on Drug Abuse.

"This trial will simultaneously measure two crucial factors: increased buprenorphine prescribing rates and improved patient outcomes, including reduced mortality rates and infectious diseases."

This approach eliminates the need for separate trials, allowing researchers to analyze the effectiveness of implementation strategies in real-time.  

OHIO as a leader in the field of implementation science

Franz has secured professional development opportunities to further develop as a leader in the field. Currently, she is completing a two-year fellowship at Stanford University’s Center for Dissemination and Implementation, and she has accepted a two-year fellowship with the Implementation Research Institute at Washington University in St. Louis and the SPIRE Center at Brandeis/Harvard.

The main objective of both fellowships is to engage in training and mentoring within the field, with the aim of enhancing the utilization of evidence-based interventions in healthcare. These fellowships encompass mentorship, implementation site visits, didactic training, and active involvement as a collaborator in significant implementation science trials.

“My goal, when I wrote my application for these fellowships, was to bring additional implementation science leadership back to Ohio University, particularly in behavioral health,” said Franz.

Implementing the future of healthcare

As the field of implementation science steadily grows, many research institutions are establishing prominent centers with large research teams conducting groundbreaking projects and large clinical trials.

“So, we have a long way to grow at Ohio University. We have just a handful of faculty who are working on implementation-related projects but we have an incredible amount of potential,” said Franz.

Franz aims to enhance OHIO's expertise in implementation science by cultivating a robust community of researchers dedicated to addressing healthcare challenges unique to the region.

“Appalachia, the area that we're located faces incredible disparities in access to evidence-based interventions for substance use, and almost for any other type of intervention, we're going to face disparities here,” explained Franz. “There is an incredible need to lead clinical trials in this region to improve access to evidence-based interventions in rural areas.”

Franz aims to support new research projects, mentor faculty interested in implementation science, and secure more research funding to tackle disparities in access to evidence-based interventions.

Ways implementation science addresses common healthcare issues

Addressing underserved populations: The Appalachian region's unique health challenges and limited healthcare access create a crucial need for tailored interventions. Ohio University can leverage its local understanding to develop effective implementation strategies.

Community engagement: Ohio University's strong community ties foster trust and collaboration with local stakeholders, enhancing the development of culturally relevant implementation science projects with higher chances of successful adoption.

Addressing geographic challenges: Appalachia's geographic challenges can hinder healthcare access. The university can assess potential solutions such as telehealth, mobile clinics, and culturally relevant educational materials for isolated populations.

Focus on rural health: Appalachia's high rural population enables the university to pioneer tailored implementation science strategies for rural healthcare systems that could lead to applicable strategies in other rural parts of the country.

Addressing socioeconomic factors: Appalachian communities often experience challenges with poverty rates and lower levels of education compared to national averages. It is essential to develop implementation science projects that target these socioeconomic factors and guarantee that interventions are accessible and affordable for all community members.

Connecting innovation with implementation

Implementation science is vital in ensuring that effective medical interventions reach those who need them most. Franz’s work exemplifies the potential of implementation science to transform healthcare delivery, particularly in underserved regions like Appalachia.

As the field continues to grow, there is an urgent need for more institutions to invest in implementation science research and training. By doing so, the gap between discovery and practice can be minimized, ensuring that the benefits of medical advancements are realized by all.