TRANSLATIONAL RESEARCH AND THE CONTRIBUTION OF CLINICAL PHARMACISTS TO HEALTH SERVICES

Pesquisa translacional e a contribuição de farmaceuticos clínicos nos serviços de saúde

Abstract

Translating the results of medical research into clinical practice in healthcare services is a
considerable challenge faced by health systems1,2. To fill this gap, translational research (TR) has been
emphasized as a way to transform the results of basic and applied research into real alternatives for the
prevention, diagnosis and treatment of disease2,3,4.
When considering the scope of TR, we tend to think of the so-called ‘bench to bedside’, which
aims, for example, to build a bridge between basic research and the introduction of a new pharmaceutical
formulation to the market4
. Nevertheless, there are other phases of TR such as using the best available
evidence in clinical practice, as well as assessing the implementation of new care guidelines in health
outcomes4,5. These phases have the utmost importance in the field of pharmacy, especially with regard to
pharmaceutical services.
In general, new drugs afford only incremental improvements, and patients may actually gain
greater clinical benefit if established therapeutic alternatives are used properly4,6. In Brazil, despite advances
in the elaboration of clinical protocols and therapeutic guidelines for high complexity care, serious problems
remain owing to pressure in the process of incorporating new health technologies within the scope of the
services7
. Intensive processes of adoption and marketing can be associated with such technologies, which
do not always have a health impact but are often in demand from the public and profitable for the industry,
entailing methodological challenges to guarantee the safety of patients4
.
The transfer of knowledge from basic research to application is stimulating and depends on the
close integration of researchers and health, government and academic institutions, which is a challenge
for most countries8
. Several postgraduate programs in Brazil and around the world have sought to bring
the researcher closer to the field of practice9
. Nevertheless, Bornstein and Licinio8
have highlighted how
both the distance between research and clinical practice and their financing by different entities reduce the
effectiveness of translation initiatives. In Brazil, this is compounded by the challenge of running a public
health system for approximately 200 million inhabitants across 5565 cities with 491,603 hospital beds.
In the United Kingdom, Germany, Australia, Singapore and the United States, the best
universities, health services, and medical research institutes have worked together to achieve progress in the
way that health care is delivered to the community8
. Recently, the American College of Clinical Pharmacy
underscored the importance of developing capabilities for pharmacists to be able to perform research
that meets the growing demands of society10. TR that incorporates methods in clinical pharmacology can
generate new skills that guide the decisions in selecting and following-up drug therapy11. However, there is
a need to train pharmacists and to expand the number of graduate programs that encompass this area, as
well as increasing the number of qualified mentors11.
In the United Kingdom, the National Institute for Health Research (NIHR) financed a fiveyear program called Adverse Drug Reactions in Children (ADRIC), resulting in improvements in the
management and understanding of adverse drug reactions in both children and adults within the health
syste12. Researchers from universities and health institutions in London and Liverpool have developed new
tools for assessing the causality and avoidability of adverse drug reactions, in addition to developing better
strategies for communicating with the families of patients when an adverse drug reaction is suspected. The
role of clinical and research pharmacists in study design, study implementation and data interpretation is
essential in such research programmes.
On the one hand, the academic output in the first phase of TR has shown exponential growth5
.
On the other hand, the output of other phases has been sometimes slow, although it is apparent as protocols,
guidelines and handbooks of great importance for the health system8
. In addition to the required efforts in
inter-institutional cooperation and financing of these studies in Brazil, scientific communication journals
in this field also are needed. In this respect, the Brazilian Society of Hospital Pharmacy and Health Services
(RBFHSS), hopes to contribute directly to the disclosure of knowledge derived from TR in health services
in Brazil and Latin America.