Implementation science: a tool to narrow know-do gap and widen equity in kidney diseases and transplantation
Authors: Ekamol Tantisattamo
Journal: Kidney International (2024)

I read the 2024 World Kidney Day editorial 1 Luyckx V.A. Tuttle K.R. Abdellatif D. et al. Mind the gap in kidney care: translating what we know into what we do. Kidney Int. Mar 2024; 105: 406-417https://doi.org/10.1016/j.kint.2023.12.003 Abstract Full Text Full Text PDF Scopus (0) Google Scholar with interest and agree with the authors regarding the current situation where there is a lack of effective implementation of available scientific knowledge into real-world clinical practices. In addition to health behavioral changes to improve clinical outcomes, 2 Tantisattamo E. Kalantar-Zadeh K. PRECEDE/PROCEED framework for public health program planning in preparation for current and future unprecedented events for patients with kidney failure and living with a kidney transplant. Kidney Int. Jul 2023; 104: 202-203https://doi.org/10.1016/j.kint.2023.03.020 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar the field of implementation science has rapidly advanced to expedite the know-do gap of any field in general and of nephrology and transplantation in particular given our kidney patients can suffer from the complications of chronic uremic conditions even after receiving kidney replacement therapy, which may neither provide immediate benefits nor reverse the diseases but rather only maintain the kidney diseases in a stable condition. Several models, frameworks, and theories have been proposed to implement the knowledge into practice; however, the Implementation Research Logic Model (IRLM), 3 Smith J.D. Li D.H. Rafferty M.R. The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects. Implement Sci. Sep 25 2020; 15: 84https://doi.org/10.1186/s13012-020-01041-8 Crossref PubMed Scopus (177) Google Scholar which integrates the classic Proctor process model 4 Proctor E.K. Landsverk J. Aarons G. Chambers D. Glisson C. Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. Jan 2009; 36: 24-34https://doi.org/10.1007/s10488-008-0197-4 Crossref PubMed Scopus (1175) Google Scholar and the Consolidated Framework for Implementation Research (CFIR) (Supplementary References S1) that help identify barriers and facilitators for implementation success, appears to provide a comprehensive and practical framework for clinicians to systematically think of the achievable goal into implementation, service, and clinical outcomes (Figure 1). It is arguable that implementation success cannot be reached if inequity in healthcare delivery and access remains. While research needs to be continued, the application of the interventions or implementation strategies in a pragmatic way should be implemented in parallel, and hybrid effectiveness-implementation study designs, especially incorporating mixed methods should be considered to close the know-do gap and end-disparity in kidney diseases and transplantation. Mind the gap in kidney care: translating what we know into what we doKidney InternationalVol. 105Issue 3PreviewHistorically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Full-Text PDF Open AccessResponse to Implementation Science: A Tool to Narrow Know-Do Gap and Widen Equity in Kidney Diseases and TransplantationKidney InternationalPreviewResponding to the letter from Tantisattamo et al, we are very grateful for the interest in our paper on improving kidney care through effective implementation of available scientific knowledge into real-world clinical practices. The author highlighted a framework to help clinicians to systematically think of the achievable goal into implementation, service, and clinical outcomes [1]. We agree that implementation science is advancing and certainly may help to promote the usage of effective drugs in real-world settings such as the use of sodium glucose cotransporter 2 inhibitors [2]. Full-Text PDF Response to Bridging the Knowledge – Practice Gap in Kidney Care: Insights from a Medical Student in ThailandKidney InternationalPreviewWe thank the author for his interest and comments on this important topic on translating what we know into what we do in kidney care [1], and for highlighting Thailand's success in integrating dialysis and kidney care within its universal health coverage [2]. We agreed that this may be a commendable model for extending critical healthcare services, especially for middle-income countries. Indeed, this was shown in the ESCORT studies in Thailand, where an integrated comprehensive multidisciplinary kidney care program was shown to delay kidney disease progression, even in resource-limited settings [3]. Full-Text PDF