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IT is worth integrating clinical trials into routine health care to improve health outcomes and lead to a more sustainable health system, say experts who have called for greater and more consistent government investment in clinical trials.
In an editorial published in the MJA, Professor John Simes, director of the NHMRC Clinical Trials Centre, and Professor Steven Webb, of the University of WA’s school of medicine and pharmacology, wrote that allocating 0.5% to 1% of the health care budget to clinical trials, phased in over several years, could help to provide evidence to guide future practice and policy. (1)
The authors wrote that the “notional funding for research” in the existing health budget was often subsumed within operational budgets or allocated in a poorly coordinated way. They said reducing clinical trial activity when resources were scarce was a false economy.
Professor Simes told MJA InSight that projections of a fivefold increase in Australian Government health care expenditure over the next 40 years underlined the importance of building in additional support for clinical trials.
He said factoring in expenditure for evaluation and clinical trials in the health care budget would, over time, deliver improved health outcomes for the same total health investment.
However, Professor Simes said while clinicians acknowledged the value of conducting clinical trials, there were often barriers to integrating research into routine care.
“There are sometimes disincentives to making clinical trials an integral part of health care because it’s regarded primarily as research, as something extra”, he said. Even though it was recognised that clinical trials would provide better quality care in the long term, sometimes the systems were not in place to facilitate them.
In a Perspectives article in the same issue of the MJA, Professor Mark Nelson, chair of the discipline of general practice at the University of Tasmania, said general practice was an “excellent environment” in which to conduct clinical trials, with about 90% of Australians seeing a GP each year. (2)
However, he said research needed to be relevant to general practice and tailored to GPs’ needs. Professor Nelson recommended including at least one experienced GP researcher on research management committees and considering GPs for co-investigator status.
“Providing researchers engage with GPs and practice staff, clinical trials can be conducted efficiently in the primary care setting”, he wrote, adding that results from such trials were more generalisable to the community than those conducted in tertiary care settings.
In response to the papers, a spokesman for Federal Health Minister Tanya Plibersek said the government believed clinical trials were a vital way to further medical knowledge, with flow-on economic benefits including job creation.
“That is why we are always looking to improve the way we do things”, he said.
The government commissioned the independent Strategic Review of Health and Medical Research in Australia in May 2011 and the final report was due soon. (3)
The spokesman said the review’s consultation paper had highlighted that Australia needed a stronger connection between health and medical research and the delivery of health care services, and that health and medical research needed to be embedded within the health system.
Shadow Minister for Health and Ageing Peter Dutton said the Coalition would also consider the findings of the review to help inform future policy on medical research.
He said the Coalition recognised that medical research was one of the most important investments government could make to improve the health and wellbeing of the Australian people.
“Improving the accessibility and delivery of clinical trials will assist Australia to build on its strengths in the area”, he said.
Mr Dutton said despite budgetary pressures, the Coalition would protect Australia’s medical research funding if elected to government.
– Nicole MacKee
1. MJA 2013; 198: 127-128
2. MJA 2013; 198: 136-137
3. Strategic Review of Health and Medical Research
Posted 18 February 2013