Journal of Community Medicine & Public Health Care Category: Medical Type: Review Article
Clinical Epidemiology in Developing Countries: Current Situation and Suggestions for the Indian Context
- Rajamohanan K Pillai1*
- 1 Department Of Paediatrics, Dr. Somervell Memorial CSI Medical College, Kerala, India
*Corresponding Author:Rajamohanan K Pillai
Department Of Paediatrics, Dr. Somervell Memorial CSI Medical College, Kerala, India
Received Date: Mar 31, 2016 Accepted Date: Jun 06, 2016 Published Date: Jun 20, 2016
Background: In India Epidemiological services are well developed and epidemiology teaching is very much part of the curriculum from undergraduate level. Clinical Epidemiology (CE) is not popular and the initiatives to sensitize physicians towards clinical epidemiology were started by International Clinical Epidemiology Network (INCLEN).
Objectives: This review article is aimed to describe the evolution of CE in India and critically look in to the concept and scope of CE and Evidence Based Medicine (EBM) in the Indian setting.
Methods: This paper is a review of the status of clinical epidemiology popularisation and the scope for further progress in this direction.
Results: The development of clinical epidemiology has taken a new pace after the introduction of Evidence Based Medicine (EBM). Both CE as well as EBM is propagated by INCLEN trained faculty and the paper also looks in to the linkages between public health epidemiology and clinical epidemiology in the context of involvement of clinical epidemiologists in public health programs.
Conclusions: After discussing the directions for future, the paper proposes the inception of clinical epidemiology unit at each medical college and also the objectives and structure of such a unit. The article concludes emphasizing the need of public health orientation of clinical epidemiology, the importance of promotion of epidemiology in developing countries through capacity building and allocation of dedicated funds and replication and scale up of CEU model to other medical colleges.
Epidemiology in medicine or Clinical Epidemiology (CE)
Public health and clinical epidemiology
INCLEN and CE in India
In India, epidemiology is very much a part of curriculum in undergraduate courses and presently the department of community medicine is primarily the agency to teach epidemiology. The very purpose of establishment of Clinical Epidemiology Units (CEUs) in medical colleges initiated by INCLEN was to sensitize the clinical faculty towards these broader branches of health sciences which are new and conceptually cross cutting across different specialities of medicine . This was also to introduce the concepts of outcome based research, critical appraisal, cost effectiveness and other qualitative and quantitative research methodologies. Presently we have nearly 20 such CEUs working in India under the leadership of India-CLEN, which is a country level partner of the INCLEN. The qualified clinical epidemiologists and those fellows trained in clinical health economics and social sciences continue to serve as resource persons in their vicinity. India-CLEN started in 1990 with initial six CEUs continue to propagate CE and EBM in the country through teaching learning activities like regularly conducted journal clubs and seminars.
How far is the idea of clinical epidemiology sold in the Indian context?
The uncertainty continues
The role of EBM and other new concepts
Thoughts for the future
Proposed structure of CEU
Objectives of CEUs
2. To conduct affiliated courses in clinical epidemiology like MPhil like the courses in CE centres in McMaster, UPEN (University of Pennsylvania) etc. The curriculum includes clinical epidemiology, biostatistics, health economics, health social sciences information technology and management. The awardees of this course can function as consultants for research projects as well as teachers in epidemiology and occupy the posts of epidemiologists and assist the Government in policy matters related to health problems and priorities.
3. To achieve capacity building through necessary modification of human resource infrastructure and influencing for modification of curriculum for graduate and postgraduate course in medicine.
4. To undertake good quality research projects for primary data generation in selected areas for addressing the gaps in data for public health planning.
5. To undertake collaborative clinical trials. The network capacity and expertise helps for this. At present the pharmaceutical industry is supporting clinical research and units like research clinical centre in some western hospitals can be adapted as role models for functioning of CEUs.
For scientific practice of medicine in developing countries, research methodology need to be widely promoted, epidemiology need to be more popularised and more funds need to be channelized. Local research capacity building is fundamental to this and generation of evidence also need to be more context specific than imported from other areas.
Public health orientation of clinical epidemiologists is important because as CE is application of principles of epidemiology in bedside, the domain of CE may continue as the story of the so called ‘abnormal’. Physicians should have a say in the maintenance of health, because they are the primary advocates and advisers of people in all matters of health. The linkage to public health activities is only a means for that. The new group of clinicians with more public health orientation will certainly take lead in development of clinical epidemiology. The CEU model is perhaps the easily replicable one for propagation of CE and EBM and facilitating public health orientation of clinicians especially for the developing countries.
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Citation:Pillai RK (2016) Clinical Epidemiology in Developing Countries: Current Situation and Suggestions for the Indian Context. J Community Med Public Health Care 3: 017.
Copyright: © 2016 Rajamohanan K Pillai, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.