Clinical indicator prioritisation for the ACTMed trial: a modified nominal group technique approach for primary care research in the electronic age.

Research in primary care is not customary [1] although in the Nordic countries there have been efforts to enhance primary care research [2]. Special challenges are associated with research within general practice and primary care. Research has traditionally not promoted the general practitioner's (GP) or other professionals’ careers in primary care, thus demotivating research [3]. Further, primary care is usually not well connected to universities or other research units. Therefore, research training, support, and supervision may not be easily available. Although developmental projects are often appreciated in primary care, rigorous research projects are not commonly accepted in the busy working culture. However, there are several potentialities in primary care that could make research highly attractive [4]. Primary care has a wide range of unselected patients – from those with mild symptoms and early stages of diseases to those with chronic illnesses and multimorbidities. We have those “normal” patients on whom the common care guidelines should be implemented [5]. The working approach in primary care is comprehensive, coordinated, promoting continuity and it is simultaneously patient-centred and population-oriented. These approaches are markedly different from specialized care and should be highlighted. Consequently, there are multitudes of original research topics and representative materials available. Fortunately, the internet has brought researchers and supervisors closer to each other making networking easier. However, we do need a research culture, funding, and good networks of senior researchers in primary care to make it academic and more valued. At the University of Helsinki we have worked for several years with a multilevel strategy to promote primary care research. In 2002 the University of Helsinki entered into contracts with several communities to build a network, the Academic Health Center. The idea is to support and enable multidisciplinary research within primary health, combined with support from the university. The researchers identify research projects within their own area in primary care. A 12-module research course for professionals working in primary care was initiated in 2007, the aims being to prepare researchers to understand the methodology of clinical epidemiology and scientific thinking, to develop their own research plans, and to provide them with peer support. The courses are multidisciplinary including nurses, nutritionists, physiotherapists, and dentists in addition to primary care physicians. This has enriched the discussions and interactions. We also aim at identifying suitable supervisors for the participants. The ongoing course is our seventh and over 60 people have completed the course and developed their own research plans. We have also been able to help participants to get funding and grants for doing research. Researchers in the post-doctoral phase also need support. For this group we have arranged courses supporting their continued research including topics on how to supervise PhD students, how to make a good research plan, and how to apply for funding; the courses also offer support on their road towards docentships. This network has provided us with a network of senior researchers working in primary care who are capable of supervising PhD students and having an impact on research in primary care. At the moment our primary health care department is able to give support and supervise about 40 PhD students. Simultaneously, we have cooperated with primary health care and used it as a platform to perform randomized controlled trials. Our senior researchers have developed and tested care models that are especially suitable for primary health care including prevention of metabolic syndrome and gestational diabetes, the enhancement of self-management and self-efficacy in dementia families, exercise as rehabilitation in dementia, and psychosocial intervention for loneliness among older people. These care models, their implementation, and our network of researchers have provided visibility and recognition to research among health authorities. Further, networking with researchers in specialized care has provided academic recognition. In Finland, the updated Healthcare Act in 2011 stated that multidisciplinary research should be a task for health centres. This, along with a higher number of researchers and good research plans within primary health care, has resulted in more funding for primary care research. At the moment we are establishing a research network in the primary care sector of the metropolitan area of Finland. A research network has been emphasized to be a key factor to promote primary care research [5,6].

Reform, Reform Everywhere and Not a Primary Care Dollar to Drink

The aims of this investigation were to evaluate the interests of primary care dental practitioners within the Mersey Postgraduate Deanery in research and their views on research, their experience and research training needs. A questionnaire was sent to all practitioners in the Mersey Deanery asking for views on dental research, whether they had been involved in any research projects or had any research training, and whether they would be interested in research training and being part of a primary dental care research network. A total of 192 practitioners from the 1120 in the Mersey Deanery expressed an interest in being involved in primary care research. Most believed that primary care research was very important in providing a stronger evidence-base in dentistry and improved quality of dental care. Over 50% of respondents were interested in collaborative research, provided that their income and time could be protected and it was part of the normal working day. Almost 25% had some research experience and a number had undergone research training, ranging from informal training to part of a degree. A number of GDPs in the Mersey Deanery are interested in primary care research. With appropriate training, support and recognition within the new Personal Dental Services (PDS) contracts, there is a golden opportunity for more primary care dentists to participate in research. This, in time, will add to the evidence base in dentistry and should improve patient care.

Editorial by Green and Dovey The evolution of the academic discipline of primary care throughout the world is resulting in more primary care practitioners taking part in research. Primary care...

In the UK, primary care groups and trusts (PCG/Ts), also known as primary care organizations (PCOs), are the organizations that will drive forward the primary care development agenda outlined by the government. We undertook a study to investigate the views of PCOs on the place of research in primary care development and their role as participants in the research process. The study population consisted of all PCOs in south London ( n = 23). An initial structured questionnaire explored the organizations’ perceived research needs, the potential of the primary care research community to meet those needs and their current research activity. This was followed by semistructured interviews during which the participants were asked to discuss their views on the place of research in their primary care development agenda and in particular how research might inform the development of clinical skills and services in the short and medium term. The third stage of the project was an action based workshop at which general practitioners (GPs) and primary care nurses developed research questions arising from the earlier stages of the study. The PCOs identified three key areas of research support: public health, health economics and nursing research expertise. Research support was needed to help them identify population health needs and to evaluate new models of care and shifting professional boundaries. In contrast to traditional primary care research, PCOs required rapid delivery of research results, particularly when these were used to inform the commissioning of services. Our study has highlighted that PCOs have a development agenda requiring rigorous research and evaluation to ensure the best outcomes for patients. The differing skills, roles and responsibilities of PCOs, PCRNs and academic departments show how partnerships might develop to further research and development in primary care.

In the UK, policy changes in primary health care research and development have led to the establishment of primary care research networks. These organizations aim to increase research culture, capacity and evidence base in primary care. As publicly funded bodies, these networks need to be accountable. Organizational science has studied network organizations including why and how they develop and how they function most effectively. This paper draws on organizational science to reflect on why primary care research networks appear to be appropriate for primary care research and how their structures and processes can best enable the achievement of their aims.

Plain English summaryPatient engagement in primary care research is an increasingly common requirement, as it helps make research more relevant to patients and therefore more valuable. However, there is limited evidence about the outcomes on engagement and actually how it affects research. In Canada, the Canadian Institutes of Health Research has a Strategy for Patient-Oriented Research (SPOR), which in 2016 funded Ontario’s INSPIRE-PHC centre of excellence and its Patient Engagement Resource Centre (PERC). PERC conducted an online survey of the three INSPIRE-PHC studies that engaged patients to guide their research. We found that patient partners (PPs) were positive about their experience during research meetings, the value of collaboration, and the support that was provided. They were more involved in early stages of their research projects than in ongoing research activities. PPs valued their experience and also felt they had improved the research process and outcomes. This case study showed how PPs perceive their roles, but a more diverse group of PPs might have more differences in their experience.BackgroundPatient engagement in primary care research is increasing and is now an expectation in many countries and funding agencies. In Canada, the Canadian Institutes of Health Research (CIHR) has mandated that patients be included as partners to guide the research process. Ontario’s Patient Engagement Resource Centre (PERC) was established in 2016 by the INNOVATIONS STRENGTHENING PRIMARY HEALTH CARE THROUGH RESEARCH (INSPIRE-PHC), one of 12 centres of excellence in the province funded under the CIHR’s Strategy for Patient-Oriented Research (SPOR) initiative. PERC’s mission is to support the authentic engagement of patients in primary care research. The present case study examines patients’ experience of engagement in INSPIRE-PHC research studies.MethodsPERC conducted a web-based evaluation survey across the three INSPIRE-PHC studies that engaged patient partners (PPs). We used data collection tools developed by McMaster University (the Public and Patient Engagement Evaluation Tool (PPEET)) and the Patient-Centred Outcomes Research Institute (Ways of Engaging- ENgagement ACtivity Tool (WE-ENACT)) to assess patient experience and areas of involvement. These included both closed- and open-ended questions.ResultsThe quantitative data showed that PPs were positive about their experience during research meetings, the value of collaboration, and the support that was provided to facilitate engagement. Most of them were highly involved in the initial stages of their research projects but much less involved in operational activities. The qualitative findings showed that, overall, PPs valued their experience, felt prepared to contribute and that their contributions were welcomed. In particular, they considered that they had improved the research process and outcomes. The majority also reported that they had learned from the experience and found it valuable.ConclusionsThis case study shows that patients engaged in three primary care research studies found the experience to be positive and felt that they had contributed to the research. This study adds to the literature on the evaluation of patient engagement in primary health care research. However, a study of a more diverse sample of PPs might elucidate differences in experience that could enrich future patient engagement activities.

A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in primary care is essential to inform practice and to develop better health systems and health policies. Among the challenges for primary care, especially in countries with limited resources, is the need to enhance the research capacity and to engage primary care clinicians in the research enterprise. These caregivers need to be an integral part of the research enterprise so the right questions will be asked, the results from research will be used in practice, and a scholarly and evidence-based approach to primary care will become the norm. The challenge of developing research in primary care can be met only by creating a strong infrastructure. This will include strengthening academic departments, enhancing links to researchers in other fields, improving training programs for future primary care researchers, developing more practice-based primary care research networks, and increasing funding for research in primary care. A greatly increased commitment on the part of international organizations both within and outside of primary care is needed, in particular those organizations involved with funding research. We provide suggestions to improve the global primary care research enterprise for the benefit of the world's population.

Primary care research is central to the successful transformation of care delivery, providing the crucial evidence to overcome the longstanding and widespread threats and challenges to the realization of primary care's full potential. The Agency for Healthcare Research and Quality (AHRQ), as the federal agency specifically charged with conducting and supporting primary care research, plays a pivotal role in supporting the research and generating the evidence needed to advance primary care. Drawing upon decades of AHRQ-supported research studies, extensive stakeholder consultation, and a Primary Care Research Summit held in fall 2020, we discuss the primary care research central to successful primary care transformation and for realizing the vision of a high-performing US health system to effectively serve all Americans and their communities while advancing health equity.Realizing the potential of primary care will require wise investments in primary care research. Newly generated evidence needs to be rapidly incorporated into the design of the delivery system, clinical care, and community interventions. Investments in evidence-informed primary care redesign can catalyze progress to achieving the quintuple aim-improved health outcomes, increased value, better patient and clinician experience, and health equity. Primary care research can provide the evidence to help stem the twin epidemics of clinician burnout and lack of trust in the health system. Actualizing this vision will require a concerted and coordinated effort by policy makers, researchers, clinicians, and community members and a commitment to ensuring people and communities have ready access to primary care.Appeared as Annals "Online First" article.

General practice p 24 A health service that is led by primary care must be able to inquire into the practice of primary care; let research in primary care blossom....

The trio of recent government white papers heralds a new world for primary care. Many changes in the education of future primary health care professionals and in the research ethos...

For the past 30 years, the Agency for Healthcare Research and Quality (AHRQ) has continuously supported primary care research, funding the first ECHO grant, pioneering patient-centered medical home models, and supporting primary care practice-based research networks. Until recently, these efforts were dispersed across AHRQ's centers and difficult to recognize as a unified portfolio of work. In 2022, the National Center for Excellence in Primary Care Research (NCEPCR) was funded to act as the home for primary care research at AHRQ. NCEPCR has recently developed a mission and vision and begun to coordinate primary care research efforts across AHRQ, curate and disseminate information and materials about primary care research, build a robust primary care research workforce, and convene key primary care partners. In the future, NCEPCR plans to continue to grow its work in each of these areas and expand its role as a national hub for primary care research.

To describe the citation impact and characteristics of Canadian primary care researchers and research publications. Citation analysis. Canada. A total of 266 established Canadian primary care researchers. The 50 most cited primary care researchers in Canada were identified by analyzing data from the Scopus database. Various parameters, including the number of publications and citations, research themes, Scopus h index, content analysis, journal impact factors, and field-weighted citation impact for their publications, were assessed. Information about the characteristics of these researchers was collected using the Google search engine. On average, the 50 most cited primary care researchers produced 51.1 first-author publications (range 13 to 249) and were cited 1864.32 times (range 796 to 9081) over 29 years. Twenty-seven publications were cited more than 500 times. More than half of the researchers were men (60%). Most were clinician scientists (86%) with a primary academic appointment in family medicine (86%) and were affiliated with 5 universities (74%). Career duration was moderately associated with the number of first-author publications (0.35; P=.013). Most research focused on family practice, while some addressed health and health care issues (eg, continuing professional education, pharmaceutical policy). Canada is home to a cadre of primary care researchers who are highly cited in the medical literature, suggesting that their work is of high quality and relevance. Building on this foundation, further investments in primary care research could accelerate needed improvements in Canadian primary care policy and practice.

Is primary care research a lost cause?

Plain English summaryIn the UK, more patients go to primary care than other parts of the health service. Therefore it is important for research into primary care to include the insights and views of people who receive these services. To explore the extent, quality and impact of patient and public involvement (PPI) in primary care research, we examined documents of 200 projects and surveyed 191 researchers.We found that about half of studies included PPI to develop research ideas and during the study itself. Common activities included designing study materials, advising on methods, and managing the research. Some studies did not undertake the PPI activities initially planned and funded for. PPI varied by study design, health condition and study population. We found pockets of good practice: having a PPI budget, supporting PPI contributors, and PPI informing recruitment issues. However, good practice was lacking in other areas. Few projects offered PPI contributors training, used PPI to develop information for participants about study progress and included PPI to advise on publishing findings.Researchers reported beneficial impacts of PPI. Most impact was reported when the approach to PPI included more indicators of good practice. The main cost of PPI for researchers was their time. Many reported difficulties providing information about PPI.In partnership with PPI contributors, we have used these findings to develop:a new Cost and Consequences Framework for PPI highlighting financial and non-financial costs, benefits and harms of PPIFifteen co-produced recommendations to improve the practice and delivery of PPI.Background: To improve the lives of patients in primary care requires the involvement of service users in primary care research. We aimed to explore the extent, quality and impact of patient and public involvement (PPI) in primary care research.Methods: We extracted information about PPI from grant applications, reports and an electronic survey of researchers of studies funded by the NIHR School for Primary Care Research (SPCR). We applied recognised quality indicators to assess the quality of PPI and assessed its impact on research.Results: We examined 200 grant applications and reports of 181 projects. PPI was evident in the development of 47 (24%) grant applications. 113 (57%) grant applications included plans for PPI during the study, mostly in study design, oversight, and dissemination. PPI during projects was reported for 83 (46%) projects, including designing study materials and managing the research. We identified inconsistencies between planned and reported PPI. PPI varied by study design, health condition and study population.Of 46 (24%) of 191 questionnaires completed, 15 reported PPI activity. Several projects showed best practice according to guidelines, in terms of having a PPI budget, supporting PPI contributors, and PPI informing recruitment issues. However few projects offered PPI contributors training, used PPI to develop information for participants about study progress, and had PPI in advising on dissemination.Beneficial impacts of PPI in designing studies and writing participant information was frequently reported. Less impact was reported on developing funding applications, managing or carrying out the research. The main cost of PPI for researchers was their time. Many researchers found it difficult to provide information about PPI activities.Our findings informed:a new Cost and Consequences Framework for PPI in primary care research highlighting financial and non-financial costs, plus the benefits and harms of PPIFifteen co-produced recommendations to improve PPI in research and within the SPCR.Conclusions: The extent, quality and impact of PPI in primary care research is inconsistent across research design and topics. Pockets of good practice were identified making a positive impact on research. The new Cost and Consequences Framework may help others assess the impact of PPI.