HONOLULU – The way Dr. Robert C. Griggs sees it, neurology lags behind other medical specialties when it comes to practice-based research that emphasizes changing physician and patient behavior to optimize outcomes.
During his presidential address at the annual meeting of the American Academy of Neurology, he said that while surgeons, cardiologists, and other nonneurology specialists have implemented checklists, patient safety measures, system engineering, and outcome reporting, neurologists have been slow to adapt standardized care algorithms.
Dr. Robert C. Griggs
"I sometimes worry that when our academy practice guidelines state that there’s a lack of evidence [for a certain treatment], we say to ourselves, ‘Great. I can continue to do it my way,’ " said Dr. Griggs, professor of neurology, medicine, pathology, laboratory medicine, and pediatrics at the University of Rochester (N.Y.). "Changing physician and patient behavior has to move to the top of our agenda in order for us to bring the benefits of what we’ve worked hard to do for all of our patients."
He made his remarks while giving a progress report on the categories of T1, T2, and T3 translational science research in the neurology field. He defined T1 as laboratory work that translates the understanding of disease into new diagnostic tests, new treatments, and disease prevention, from mice up to the first work in humans.
"For T1 we’re brilliant" as a field, said Dr. Griggs, who also is a professor in the center for human experimental therapeutics at the university. "We’ve defined hundreds of mutated genes, we can make animal models, and we can find possible treatments off of small molecules that improve a mouse model. We’re not as good yet on gene-modified treatments, but on the whole, we’re confident that we will be able to do it soon."
He defined T2 as translating basic research into clinical trials for a diagnostic test, prevention strategy, or new treatment. This consists of phase 2, 3, and 4 clinical trials and includes cost/benefit analyses, as well as research on disparities and outcomes.
"We’re not quite as good at T2 research as we are in T1 research, but we have many new treatments, some that are truly breakthroughs," Dr. Griggs said. "However, lots of tough questions remain. The big one is dealing with those which we can afford and which we can’t afford, and ultimately who should receive the expensive new treatments."
He described T3 as practice-based research focused on disseminating and implementing research advances, and changing physician and patient behavior through quality and safety measures, checklists, and being mindful of economic and health policy considerations. T3 may be "less familiar territory to neurologists" than T1 or T2 research, he added, but he recommended that it become a priority.
"In preparing this talk over the past 2 years I realized over a year ago that I had not been sufficiently aware of [this] key aspect of treating patients," said Dr. Griggs. "I knew but hadn’t realized how important it is to teach in the context of what has been termed by oncologists as ‘the teachable moment,’ or riding the crest of the teachable moment, taking advantage of the time when a patient is first diagnosed, to get your messages across to the patient and to their family and friends. How do we get our patients to do what they should, take what they should, prevent what they should? How do we change neurologist behavior so that they set a high priority on changing the behaviors of patients?"
One easy way to implement T3 research into your clinical practice, he said, is to advise your patients to follow the American Heart Association’s "Life’s Simple 7" ways to prevent stroke. Those seven steps are get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.
"We see hundreds of patients who are worried about having a stroke, and hundreds of patients who have had a stroke," Dr. Griggs said. Imparting this recommendation is a "teachable moment."
Dr. Griggs said that he had no relevant financial disclosures.