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Bridging the GAP

Michael W. Rich, MD

JAMA. 2002;287:1321-1323.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Evidence-based medicine. The concept seems so simple. Take the best available information from clinical trials and observational studies and apply the results in clinical practice. What in medicine could be more rational or straightforward? Yet despite a rich evidence base for management of cardiovascular disorders,¹ study after study has demonstrated disconcertingly low rates of compliance with widely disseminated evidence-based treatment guidelines for managing common cardiovascular conditions including coronary heart disease, heart failure, and hypertension.^2-4

The manifest difficulty in translating clinical trials into clinical practice suggests the presence of multiple barriers to implementation. Although there is substantial overlap, these barriers fall into 3 general domains: physician-related, patient-related, and health system–related. Physician-related barriers include lack of knowledge of the "best" current evidence, which is not surprising given the plethora of studies that have been completed, with new studies reported every week, as well as time constraints and the . . . [Full Text of this Article]

Author Affiliation: Cardiovascular Division, Washington University School of Medicine, St Louis, Mo.

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