Family Medicine Research Research Articles

The Research Domain of Family Medicine

This article characterizes the large research domain of family medicine. It is a domain that can be productively explored from different perspectives, including: (1) the ecology of medical care and its focus on the environments of health care and interactions among them; (2) the realm of causation and important opportunities to discover how people lose and regain their health; (3) knowing medicine in different ways, focusing on what things mean in the inner and outer realities of individuals and groups of individuals; (4) the nature of the work of family physicians, such as first-contact care for any type of problem, sticking with patients regardless of their diagnoses, incorporating context into decision making, development of relevant technologies, articulating useful theory, and measuring what happens in family medicine; (5) the standard research categories of basic, clinical, health services, health policy, and educational research; and (6) thinking of family medicine research as both a linear process of translation and a wheel of knowledge with iterative loops of discovery that come from within family medicine. The domain of family medicine research is important and ripe for fuller discovery, and it invites the thinking and imagination of the best investigators. It seems unlikely that medical research can ever be complete without a robust family medicine research enterprise. As the domain of family medicine research is explored, not a few, but billions of people will benefit.

In This Issue: The Patient Voice, Clinical Research, Clustered Data, and the Wonca Research Conference

This issue of Annals brings together methodology, rigorous review, and relevant research. It also provides an opportunity to reflect on the Annals’ first year of publication, and to present our second supplement: papers from the first international conference on family medicine research.

How the Philosophies, Styles, and Methods of Family Medicine Affect the Research Agenda

Family physicians provide person-centered, continuous, comprehensive care that is accessible and available at the time of need. Although this core philosophy is shared around the world, its translation into actual practice can vary greatly with time and from place to place as family physicians adapt to local constraints and conditions. Factors driving these local variations include entrenched habits and patterns of care, funding systems, patient expectations, public policy, and the availability and quality of other critical health system components. This diversity provides both an opportunity and a challenge for family medicine research. The potential for fruitful comparisons and contrasts arising from natural experiments may require investigators to use multiple research methods capable of evaluating complex interventions and comparisons. Family medicine has the capacity to be an excellent laboratory in which research in representative populations can offer the pragmatic answers needed by practicing physicians. The nature of the research questions and interventions require the involvement of clinicians in the formulation of research questions and evaluation of the applicability of research results. The variations in implementation of the family medicine philosophy can be a potential asset because of the research opportunities they provide.

Changing research culture.

Although there is general agreement that family medicine has a lot to offer to the health care system, the academic dimension is still not widely understood. There are two main reasons why family medicine needs to develop its scientific potential: to address the true nature of the discipline, and to help in its recognition. The academic establishment benefits from academic family medicine by gaining new questions that are necessary to be answered and by gaining new research approaches.Many problems are encountered when introducing family medicine into the academic arena. Two main strategies for developing family medicine research can be identified. The first is to adapt to the existing structure of the academic world by claiming equal rights with the developed disciplines, collaborating with other university departments in their research projects, publishing articles in established journals, and participating in established faculty development programs. The other, more demanding, strategy is to introduce changes to the academic arena by developing specific research questions, by collaborating on research within family medicine, and by developing family medicine's own success criteria for academic excellence. The two approaches are not mutually exclusive. The World Organization of Family Doctors plays an important role in supporting both approaches through its international affiliations and contacts with policy makers.

Family Medicine research revisited in Kingston

Asia Pacific Family MedicineVolume 2, Issue 3 p. 133-135 Family Medicine research revisited in Kingston Lee Gan GOH, Corresponding Author Lee Gan GOH Wonca Regional Vice President for Asia PacificProfessor Lee Gan Goh, College of Family Physicians Singapore, College of Medicine Building, 16 College Road, ♯01–02, Singapore, 169854, Singapore. Email: cofgohlg@nus.edu.sgSearch for more papers by this author Lee Gan GOH, Corresponding Author Lee Gan GOH Wonca Regional Vice President for Asia PacificProfessor Lee Gan Goh, College of Family Physicians Singapore, College of Medicine Building, 16 College Road, ♯01–02, Singapore, 169854, Singapore. Email: cofgohlg@nus.edu.sgSearch for more papers by this author First published: 15 August 2003 https://doi.org/10.1046/j.1444-1683.2003.00084.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume2, Issue3September 2003Pages 133-135 RelatedInformation

Psychosocial impact of serological diagnosis of herpes simplex virus type 2: a qualitative assessment

Objectives: To assess the emotional and psychosocial responses to a serological diagnosis of HSV-2 infection in individuals without previous history of genital herpes. Methods: 24 individuals who had a positive...

La tutoría en investigación en la medicina de familia de México

En este trabajo se hace una revision de algunas caracteristicas de la investigacion en la medicina de familia mexicana; asimismo, se analiza y reflexiona sobre la importancia del tutor de medicina familiar (TMF), la tutoria en investigacion y los modelos de tutoria en la disciplina. Finalmente, se presenta una sintesis de la propuesta del modelo de tutoria en investigacion asesor/tutor/residente, que se realiza en el programa de Especializacion de Medicina Familiar, en el Departamento de Medicina Familiar de la Facultad de Medicina, de la Universidad Nacional Autonoma de Mexico (UNAM). El proposito de este comunicado es el de contextualizar y exponer las caracteristicas de la tutoria en la investigacion de la medicina de familia de nuestro medio.

Clinical practice guideline on the diagnosis and management of insomnia in family practice

Background: Insomnia is noted to occur in 10‐40% of patients seen in primary care practice. It has a number of daytime consequences and affects quality of life. Furthermore, it may herald an underlying psychiatric or other medical comorbidity. As such, any primary care physician should be equipped with a simple problem-based approach for this problem. Methods: A technical research committee of the Department of Family and Community MedicineFamily Medicine Research Group of the Philippine General Hospital developed recommendations after performing a thorough review of the medical literature using a Medline search. Articles retrieved were appraised and validated and used as evidence for the various recommendations made. Recommendations: This is the first of a two part article. In this article, the guideline covers recommendations on the definition and differential diagnosis. In the second article, diagnostic examinations and therapeutic options for patients with insomnia will be covered. © 2002 Blackwell Publishing Asia

Is an indexed database publications database for the Asia Pacific region feasible?

Abstract: The need to share information and raise the profile of family medicine and general practice in the Asia Pacific can be addressed by Asia Pacific Family Medicine journal and an indexed database of Asia Pacific publications and reports, accessible via the Internet. A collaborative project to develop and maintain the Asia Pacific Indexed Database (APID) will facilitate ongoing international collaboration and the sharing of information among Asia Pacific countries and, if implemented within the Wonca (World) Internet-based resource and portal, the world. The technical design, management and organization policies and strategies will be user focused and guided by the needs of member countries. The APID will add value to member countries’ publication databases by providing international peer review, creating an English language version where the original publication is in the local language, and making them available to a wider audience. Index terms will be derived from Medical Subject Headings and International Classification of Primary Care Version 2. Viable and sustainable partnerships among publishers, pharmaceutical companies, medical equipment suppliers, information and communication technology companies, and universities are common strategies. These partnerships often require long term sponsors such as governments, commercial organizations or aid agencies such as World Health Organization, World Bank and Reuters. The Wonca (Asia Pacific) indexed database of publications and reports is a symbolic, yet practical, concept with the potential to facilitate a convergence of the activities and expertise of the Asia Pacific region to coordinate and enhance multicultural family medicine research, education and care.

Using E-mail based Continuing Medical Education for Family Physicians – Can it work?

Objective: In 1994, the Family medicine Education and Research Network (FERN) was developed to support on-line discussion among London and area family physicians. FERN-D (FERN Dissemination) was introduced as a closed sub-group of FERN to support educational case discussions focused on prevention. The present study reports results of a pilot FERN-D intervention. Design: Preand Post- intervention mail-out surveys combined with an e-mail feedback questionnaire and a modified focus group. Setting: Rural and urban family physicians in the London Ontario area. Participants: Initial survey mailed to all area family physicians (N=480). 40 volunteer physicians recruited to the intervention group. Response rate was 50.4% to the pre-survey, and 68% to the follow-up survey (only mailed to responders) Main findings: A higher percentage of the FERN-D group indicated accurate knowledge for seven of the items than the comparison group. Both groups improved their preventive practice scores from pre- to post intervention. The majority of the FERN-D group felt that they had become aware of new techniques or relevant research (58.8%) and had made changes in their practice (64.7%). In both the e-mail feedback and the modifed focus group convenience (89.2%) and interaction with family physician colleagues (86.5%) were cited as advantages to this method of CME. Conclusion: On-line case-based discussion is a promising strategy for enhanced research transfer to family physicians: more research is needed to determine if it can be effectively utilized to change physician behavior.

General practice activity in Australia 1998?1999

A report of the first year’s data from the Bettering the Evaluation And Care of Health program (BEACH), a continuous national survey of general practice activity, was released recently by the General Practitioners Statistics and Classification Unit. The unit is a collaborating unit of the University of Sydney’s Family Medicine Research Centre and the Australian Institute of Health and Welfare.

A comparison of country and metropolitan general practice

This paper is a summary of a report of a comparison of country and metropolitan general practice undertaken by the Family Medicine Research Unit, University of Sydney, and published as a supplement to the Medical Journal of Australia. The identified differences were not consistent across small medium and large country towns. The morbidity patterns were similar between all areas, but country GPs were generally busier and undertook more hospital and procedural work.

Scientific rigour in qualitative research--examples from a study of women's health in family practice.

The increase in qualitative research in family medicine raises a demand for critical discussions about design, methods and conclusions. This article shows how scientific claims for truthful findings and neutrality can be assessed. Established concepts such as validity, reliability, objectivity and generalization cannot be used in qualitative research. Alternative criteria for scientific rigour, initially introduced by Lincoln and Guba, are presented: credibility, dependability, confirmability and transferability. These criteria have been applied to a research project, a qualitative study with in-depth interviews with female patients suffering from chronic pain in the locomotor system. The interview data were analysed on the basis of grounded theory. The proposed indicators for scientific rigour were shown to be useful when applied to the research project. Several examples are given. Difficulties in the use of the alternative criteria are also discussed.

Pharmacoepidemiology of warfarin use and deep venous thrombosis

AbstractThree Southern California hospitals from the Center for Studies in Family Medicine research network participated in a study of the characteristics of patients using warfarin and of patients hospitalized with deep venous thrombosis. Computerized hospital and pharmacy data bases were searched to identify warfarin users and patients with deep venous thrombosis who received care between July 1987 and July 1990. Information on patients was abstracted from medical records.Of 337 warfarin users identified, 50% were male and the mean age was 51.6 years. The most common indications for warfarin therapy were cardiovascular conditions (45.8%) and deep venous thrombosis (31.8%). Warfarin therapy was initiated in the hospital for most patients (82%). Sensitivity to warfarin, as measured by the mean dose‐adjusted prothrombin time ratio, was 0.30. Female gender (p < 0.001) and increasing age (p = 0.03) were associated with increased sensitivity to warfarin (higher mean dose‐adjusted prothrombin time ratio). Regression analysis indicated that certain groups were significantly more sensitive to warfarin: females more than males (p < 0.0005); patients of other race/ethnicity more than blacks, hispanics, and whites (p < 0.05).Among the 114 patients hospitalized for deep venous thrombosis, there were 134 hospitalizations and 98 patients had only one hospitalization. Fifty‐eight per cent of the patients were male; the mean age was 44.2 years. The mean dose‐adjusted prothrombin time ratio was 0.28 for hospitalized patients.

Problems and issues in family medicine psychosocial research.

The authors believe that, despite their complexity, psychosocial factors should be included with biological variables in family medicine research. To aid this process, this article reviews some problems and issues in selected areas of psychosocial research relevant to family medicine. Basic background material, dimensions, models, intra-individual, intra-familial physiological mechanisms of transmission, and factors related to stress, support and coping, are discussed. This is followed by methodological issues that include research design, psychometric properties of measures, data collection, quantitative and qualitative methods, family assessment problems and techniques, and analytic procedures. The latter includes scoring problems, global versus specific questions, and statistical analyses issues. Finally, a discussion of biological relationships and potential biological markers for psychosocial processes or variables concludes this review.

Risk management in the community: lessons for family medicine.

Three polyurethane factories in Israel were examined using a combination of qualitative and quantitative methodologies. The study contrasts the effects of differing factory social and economic organization on occupational health and safety conditions as well as workers' attitudes and awareness. The central focus of the research addresses how each factory and community manages the risks associated with a particular industrial process. Surprisingly, the results show that the worker-owned and -operated plant, where knowledge and control of hazards was broadly shared and awareness high, had the worst safety, health, and hygiene conditions and outcomes. Worker involvement does not ensure worker protection and safety. These findings can be explained only by a careful examination of the social, economic, cultural and environmental settings in which they are embedded. Such an approach is well suited to family medicine research and training since it emphasizes the role of context on illness and disease.

Establishment of Research in Primary Health Care in Greece. Experiences of Greek-Swedish Collaboration

The last few decades have seen great changes in health care and medical care in Greece, as well as in the Greek university system. A new law on health care and medical care has come into force, a new university hospital and new health centres have been built, and a faculty of medicine has been established at Heraklion in Crete. People are speaking of a change of paradigm. Simultaneous with the introduction of the new national health care system, the Department of Family and Social Medicine (DFSM) in Crete started a major project on public health, known as the Primary Health Care and Nutrition Programs (abbreviated as PPD). The purpose was to chart the state of health and living conditions of the Cretan population in the period 1986-1990. Cooperation in research and training began between DFSM and the Dalby Health Sciences Centre, Lund University in 1987. This was natural since there was a shared interest in research into family medicine and social medicine. In addition, a new Health Care Act had come into force in Sweden in 1982. The establishment phase of primary health care started in Sweden at the end of the 1960s. In the 1970s health centres were established, along with research and training in family medicine, in a way that is comparable in many respects to the situation in which Crete found itself a decade later. This paper concerns the organization and implementation of PPD and the research cooperation between Greek and Swedish institutions. This can be seen as an expression of the internationalization of research for which the two universities have striven.

Family Medicine Research:

Family Medicine Research:

Values, paradigms and research in family medicine.

Family medicine continues to struggle for a legitimate place in academic medicine, largely because it has not yet built a research base to compare with other medical disciplines. The problem lies in a conflict between the research method and the interests of traditional medicine, which is dominated by the disease model of health, and the new principles of health care evolving within the discipline of family medicine. The disease model is not just a research model but also the basis of the political structures of modern medicine in academic medicine and society at large. It, therefore, has political and value implications that will need to be confronted if family medicine is to establish its research agenda successfully.

Characteristics of the successful researcher and implications for faculty development.

To understand better the role of faculty development in training family medicine researchers, the authors examined in a comprehensive literature review the characteristics of productive researchers, their training, and their work environment. Areas reviewed were faculty development and evaluation, career development, professional socialization, organizational development, and faculty vitality in higher education, medicine, and corporate research and development. Findings reveal that, besides prerequisite knowledge and skills in a research area, successful researchers have academic values and attitudes derived from specific socialization experiences. They also receive meaningful support from their organization, mentors, and peers.