North American Primary Care Research Group Research Articles

Fifty Years of Connection: Characterizing the Social Network of a Primary Care Research Organization.

This study marks the 50th anniversary of NAPCRG (formerly the North American Primary Care Research Group) by examining social connections among members. This descriptive social network analysis was conducted via the Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER) survey tool. Responses from 906 participants resulted in 1,721 individuals with 5,196 partner relationships. Most relationships (60%) were characterized as having an integrated level of collaboration. Many relationships led to a research paper (58%) or a grant (34%). This social network analysis of NAPCRG members' relationships described over 5,000 relationships, many producing publications, grants, and perceived advancements in primary care.

50 Years of NAPCRG: A Nurturing Home for Primary Care Researchers.

This is one of the most ubiquitous words brought forth by members to describe the North American Primary Care Research Group (NAPCRG). People at NAPCRG’s Annual Meetings often recount a common story about the joy they felt upon attending their first meeting and finding “their people.” They

Asian perspectives on NAPCRG

This is a short communication to reflect on experiences at North American Primary Care Research Group (NAPCRG) conference from the perspective of Asian family physicians. They feel that NAPCRG can...

FROM NAPCRG: FOURTH INTERNATIONAL CONFERENCE ON PRACTICE FACILITATION.

Attendees met virtually August 5-6, 2021 for the 4th International Conference on Practice Facilitation (ICPF). With continued support from the Agency for Health-care Research and Quality (AHRQ) and the North American Primary Care Research Group (NAPCRG), the ICPF aims to recognize and address the

Reliability of Peer Review of Abstracts Submitted to Academic Family Medicine Meetings.

To assess the reliability of peer review of abstracts submitted to academic family medicine meetings in North America. We analyzed reviewer ratings of abstracts submitted: 1) as oral presentations to the North American Primary Care Research Group (NAPCRG) meeting from 2016 to 2019, as well as 2019 poster session or workshop submissions; and 2) in 12 categories to the Society of Teachers of Family Medicine (STFM) Spring 2018 meeting. In each category and year, we used a multi-level mixed model to estimate the abstract-level intraclass correlation coefficient (ICC) and the reliability of initial review (using the abstract-level ICC and the number of reviewers per abstract). We analyzed review data for 1554 NAPCRG oral presentation abstracts, 418 NAPCRG poster or workshop abstracts, and 1145 STFM abstracts. Across all years, abstract-level ICCs for NAPCRG oral presentations were below 0.20 (range, 0.10 in 2019 to 0.18 in 2016) and were even lower for posters and workshops (range, 0.00-0.10). After accounting for the number of reviewers per abstract, reliabilities of initial review for NAPCRG oral presentations ranged from 0.24 in 2019 to 0.30 in 2016 and 0.00 to 0.18 for posters and workshops in 2019. Across 12 STFM submission categories, the median abstract-level ICC was 0.21 (range, 0.12-0.50) and the median reliability was 0.42 (range, 0.25-0.78). For abstracts submitted to North American academic family medicine meetings, inter-reviewer agreement is often low, compromising initial review reliability. For many submission categories, program committees should supplement initial review with independent postreview assessments.

View From the Canoe: Co-Designing Research Pacific Style.

In 2016, Rose Lamont and Tana Fishman were the first patient-clinician dyad from outside North America to attend the North American Primary Care Research Group (NAPCRG) Patient and Clinician Engagement Program workshop. They returned to New Zealand inspired and formed the Pacific People's Health Advisory Group and a Pacific practice-based research network (PBRN). They are guided by the principles of co-design, and the Samoan research framework fa'afaletui, which emphasizes a collective approach and importance of reciprocity and relationships. Their collective inquiry aims to reduce health inequalities experienced by Pacific people in South Auckland. Their community group members and PBRN are generating research questions being answered by university-based graduate students. When they embarked, they knew not the direction in which they headed. With guidance, their community members and clinicians have led the way. By giving everyone a say in where they are going and how they get there, they are modeling what they wish to achieve-an egalitarian approach which decreases disparities for Pacific people.

Travelling companions: a story told by a patient and her doctor.

The Patient and Clinician Engagement (PaCE) project1 involves collaborative dyads of North American patients and their family physicians/GPs working with university academics on participatory research projects to reduce disparities and improve community-based health outcomes.2 PaCE dyads meet annually at the North American Primary Care Research Group (NAPCRG) conference. ### Felicity: In my role as NAPCRG International Committee Chair, and Department Head of General Practice, University of Auckland, I initiated the first non-North American PaCE dyad. I approached my colleague Dr Tana Fishman, who in turn invited Rose Lamont, a patient of Pacific descent with whom she had a long-established doctor–patient relationship, to form their dyad. In November 2016 they travelled to the PaCE meeting at NAPCRG. This article describes their journey and its implications with respect to professional boundaries between doctors and their patients. ### Tana: Travelling to the airport to meet Rose felt very unusual. It was difficult explaining to colleagues and friends that I was travelling with my patient. I worried about maintaining professional boundaries and …

RELEVANT OUTCOMES FOR PATIENT-CENTERED INTERVENTIONS FOR PERSONS WITH MULTIMORBIDITY: EXPERTS’ DISCUSSION

Although patient-centered interventions for persons with multimorbidity are increasingly implemented in primary health care, evidence on effectiveness is still scarce and inconclusive.1 One potential explanation is the inconsistent use of outcome measures and a lack of a specific multimorbidity-adapted outcome measure.1,2 Using the 2015 North American Primary Care Research Group (NAPCRG) Annual Meeting, a forum was held with the goal of creating a list of relevant outcomes and to discussing methods of measurement.

NAPCRG LAUNCHES VIDEO TO PROMOTE PRIMARY CARE RESEARCH

At the 44th Annual Meeting of the North American Primary Care Research Group (NAPCRG), held in Colorado Springs, Colorado on November 12–16, 2016, NAPCRG launched a new state-of-the-art YouTube video to stimulate interest in primary care research among trainees and community clinicians and explain

Engaging with communities, engaging with patients: amendment to the NAPCRG 1998 Policy Statement on Responsible Research With Communities.

In 1998, the North American Primary Care Research Group (NAPCRG) adopted a groundbreaking Policy Statement endorsing responsible participatory research (PR) with communities. Since that time, PR gained prominence in primary care research. To reconsider the original 1998 Policy Statement in light of increased uptake of PR, and suggest future directions and applications for PR in primary care. This work contributed to an updated Policy Statement endorsed by NAPCRG in 2015. 32 university and 30 community NAPCRG-affiliated research partners, convened a workshop to document lessons learned about implementing processes and principles of PR. This document emerged from that session and reflection and discussion regarding the original Policy Statement, the emerging PR literature, and our own experiences. The foundational principles articulated in the 1998 Policy Statement remain relevant to the current PR environment. Lessons learned since its publication include that the maturation of partnerships is facilitated by participatory processes that support increased community responsibility for research projects, and benefits generated through PR extend beyond research outcomes. Future directions that will move forward the field of PR in primary care include: (i) improve assessment of PR processes to better delineate the links between how PR teams work together and diverse PR outcomes, (ii) increase the number of models incorporating PR into translational research from project inception to dissemination, and (iii) increase application of PR approaches that support patient engagement in clinical settings to patient-provider relationship and practice change research. PR has markedly altered the manner in which primary care research is undertaken in partnership with communities and its principles and philosophies continue to offer means to assure that research results and processes improve the health of all communities.

Building research capacity in departments of family medicine: pearls from NAPCRG 2013.

One of the ongoing goals of the ADFM research committee is to assist chairs in building research capacity in family medicine departments. As a part of this effort, there were 3 separate events at the 2013 North American Primary Care Research Group (NAPCRG) annual meeting focusing on this issue. The first event was actually 9 events—“mini-consultations” given by chairs with research experience to those working to develop research within their departments. The second was a 90-minute session called “Secrets of My Research Success,” during which 3 experienced and successful family medicine researchers told their stories and answered questions from an engaged group of about 70 participants. Finally, approximately 17 Canadian and US family medicine chairs in attendance at NAPCRG conducted their customary NAPCRG joint meeting, and the focus was building research capacity. We (J.H., T.K.) had the privilege of attending all 3 sessions and would like to share the take-away lessons. These lessons are for both department chairs and aspiring researchers.

Infrastructure to support modern primary care: the NAPCRG debate update.

In December 2012, at the North American Primary Care Research Group (NAPCRG) conference in New Orleans (USA), associates of London Journal of Primary Care (LJPC) from London (UK) and Cleveland Ohio (USA) hosted a forum entitled ‘Local Health Communities for Integrated Care’. The forum was attended by senior practitioners/academics from different countries who debated the infrastructure needed to support collaboration at primary/community care level. They drew on lessons from West London's integrated care pilot1 and Cleveland's ‘Promoting Health across Boundaries’ initiative.2 Participants at the forum recognised international need for case studies of community-oriented integrated care (COIC), including primaryand community-care leadership of collaboration for integrated care, and continuous improvements of whole systems of care. In November 2013, at the NAPCRG conference in Ottawa (Canada), LJPC associates from Quebec (Canada) and London (UK) hosted a second forum to continue this conversation. In preparation for the Ottawa Forum, in October 2013 LJPC invited its readers to rank 11 aspects of integrated care in respect of their importance to research. Table 1 shows the results in order of most ‘votes’ overall (weighted formula). It also shows the first four (of 11) ‘votes’ of 61 respondents. Table 2 shows additional comments made by 30/61 respondents. Table 1 Priority aspects of integrated care to research Table 2 Additional comments made by 30 respondents about researching integrated care While ‘Patient Involvement’ and ‘Extended Multidisciplinary Primary Care Teams’ were perceived to be the most important aspects (and indeed 29/61 respondents gave them their first ‘vote’), the overall ranking pattern is more complicated. There is an argument for saying that all of these aspects are important, and their perceived importance may relate to their perceived neglect at present. Recognising the wide range of qualitative comments offered in Table 2, these initial results illustrate the range of research still needed to understand how the infrastructure of primary care can be developed, and, as discussions at the two conferences elaborated, more progress can be made in developing research that examines primary care in context.

Improvement of workflow and processes to ease and enrich meaningful use of health information technology.

The introduction of health information technology (HIT) can have unexpected and unintended patient safety and/or quality consequences. This highly desirable but complex intervention requires workflow changes in order to be effective. Workflow is often cited by providers as the number one ‘pain point’. Its redesign needs to be tailored to the organizational context, current workflow, HIT system being introduced, and the resources available. Primary care practices lack the required expertise and need external assistance. Unfortunately, the current methods of using esoteric charts or software are alien to health care workers and are, therefore, perceived to be barriers. Most importantly and ironically, these do not readily educate or enable staff to inculcate a common vision, ownership, and empowerment among all stakeholders. These attributes are necessary for creating highly reliable organizations. We present a tool that addresses US Accreditation Council for Graduate Medical (ACGME) competency requirements. Of the six competencies called for by the ACGME, the two that this tool particularly addresses are ‘system-based practice’ and ‘practice-based learning and continuing improvement’. This toolkit is founded on a systems engineering approach. It includes a motivational and orientation presentation, 128 magnetic pictorial and write-erase icons of 40 designs, dry-erase magnetic board, and five visual aids for reducing cognitive and emotive biases in staff. Pilot tests were carried out in practices in Western New York and Colorado, USA. In addition, the toolkit was presented at the 2011 North American Primary Care Research Group (NAPCRG) meeting and an Agency for Health Research and Quality (AHRQ) meeting in 2013 to solicit responses from attendees. It was also presented to the officers of the Office of the National Coordinator (ONC) for HIT. All qualitative feedback was extremely positive and enthusiastic. The respondents recommended that the toolkit be disseminated widely to improve staff education and training, leading to practice improvements.

NAPCRG 2012: reflections from across the pond

The 40th annual meeting of the North American Primary Care Research Group (NAPCRG) was held in New Orleans from 1–5 December 2012. As early-career family doctors from the UK we were keen to explore primary care research from around the world. With delegates from North America and Europe to the antipodes and Ethiopia, attending this conference far exceeded our expectations. The host city perfectly reflected the energy, diversity, and warmly receptive nature of the conference, which gave us a real feel for the enthusiasm to drive primary care forward in the US and Canada. We were impressed by the support shown by senior researchers to their junior colleagues, particularly during oral and poster presentations. The lack of pharmaceutical displays1 was welcome. The plenary sessions were inspirational. The opening plenary, ‘The Healing of America. A Global Quest for Better, Cheaper, and Fairer Health Care’ was given by former Washington Post journalist turned ‘healthcare expert’ TR Reid, who provided an engaging overview of healthcare systems around the world. It was fitting that he paid particular tribute to Lord Beveridge on the 70th anniversary of his landmark report. The design of a country’s healthcare system is a moral decision that requires clear commitment from the whole …

Publication of Research Presented at STFM and NAPCRG Conferences

Presentations of research are important in the dissemination of new knowledge, but they do not reach the same audience as research published in journals. The purpose of this study was to evaluate the proportion of presentations at recent major primary care research conferences that have become published. Oral and poster presentations for completed and work-in-progress projects from the 2007 and 2008 North American Primary Care Research Group (NAPCRG) and Society of Teachers of Family Medicine (STFM) annual conferences were included in the analysis. The first presenter for each presentation was searched on PubMed, and titles and abstracts for presentations were compared for content to titles and abstracts of potential matches found on PubMed. We analyzed the proportion of presentations that were published in peer-reviewed journals, mean time to publication, and the proportions of the type of journal in which the article appeared (family medicine vs other) were analyzed. There were 1,329 presentations included in the study. Overall, 34.4% of projects presented were also published. More oral presentations (42.9%) were published than were poster presentations (25.3%) (P <.001). Mean time to publication was 15.4 months. Oral presentations were published more quickly (13.7 months) than poster presentations (18.6 months) (P <.001). Published reports appeared in 192 different journals. Family medicine journals accounted for 36.5% of published. More than one-third of all presentations at STFM and NAPCRG conferences were published in journals indexed in PubMed. Time to publication was comparable to that of other specialties. Fewer than 2 of every 5 reports were published are in a family medicine journal, suggesting vast breadth in family medicine research. Family medicine academicians need to refocus efforts on transforming presentations into published articles in peer-reviewed journals for broader dissemination of research findings.

Essential requirements of information technology for primary care

Policy, economics and technology are driving primary care with unprecedented speed. Responding to this rapidly changing environment is essential for maintaining state-of-the-art care delivery. Although Health Information Technology (HIT) offers much promise to primary care, electronic health records (EHRs) have produced only modest improvements in quality. To understand how HIT could better meet the needs of primary care, the North American Primary Care Research Group (NAPCRG) gathered a select group of Family Medicine physicians from across North America and Europe with a broad range of informatics expertise. Over several months, the group discussed existing standards, classifications, modelling, communications, data structures, coding systems and how each of these enabled or hindered primary care delivery. During the discussions, a broad consensus emerged on HIT requirements essential to the primary care domain. This summary provides the author’s interpretation of the identified technical challenges in ontology, terminology, continuity and portability in terms more familiar to most Family Physicians. Although standardized EHR capabilities are described by Health Level Seven International [(www.hl7.org) a global standards development organization for health information], little is known about specific capabilities important to primary care. The committee characterized information services in terms of the capacity to support Family Medicine core values. Enhancement of continuing, comprehensive, compassionate and personal care provided an indication of responsiveness to primary care. The recommendations below reflect the most important challenges identified and provide a qualitative measure to discriminate HIT support for essential primary care services. The committee focussed on areas with known problems in order to guide providers, promote research and spur development by vendors.

GENERATING THE KNOWLEDGE NEEDED TO MAKE THE PATIENT-CENTERED MEDICAL HOME A REALITY: A COLLABORATIVE PROJECT OF THE PRIMARY CARE SPECIALTIES

GENERATING THE KNOWLEDGE NEEDED TO MAKE THE PATIENT-CENTERED MEDICAL HOME A REALITY: A COLLABORATIVE PROJECT OF THE PRIMARY CARE SPECIALTIES

MORE BELLS AND WHISTLES: INTRODUCING THE RECENTLY REVAMPED NAPCRG WEB SITE

The North American Primary Care Research Group (NAPCRG) is pleased to offer an enhanced Web site (<http://www.napcrg.org>) that is easy to navigate and packed with worthwhile information. The revamped Web site now includes pertinent information about NAPCRG as an organization, member services,

FAMILY MEDICINE RESIDENT AWARD FOR SCHOLARSHIP

The need for capacity building in family medicine research is well recognized. One strategy for accomplishing this goal is to mentor and recognize residents for their accomplishments in scholarly activities. The Association of Family Medicine Residency Directors (AFMRD), the North American Primary Care Research Group (NAPCRG), and the College of Family Physicians of Canada (CFPC) have developed the AFMRD / NAPCRG / CFPC Family Medicine Resident Award for Scholarship to both recognize resident scholarly activity and, by doing so, promote increased capacity building in family medicine research and scholarly activity. One award will be made by each family medicine residency program annually. The AFMRD / NAP-CRG / CFPC Boards have suggested that each program create a committee to review resident scholarly activity applications and make the award recommendation to the program director. AFMRD / NAPCRG / CFPC does not select the honorees; departments or programs will inform the organizations who should be honored from their program. AFMRD / NAPCRG / CFPC supply the certificate that will be presented to the resident receiving the award to the program. As developed by the participating organizations, the following restrictions apply: No resident may win the award more than once, only one award per program will be awarded annually, the scholarly activity for consideration must have been completed while the resident was in residency training, the nature of the scholarly activity and whether it “qualifies” is at the discretion of the program’s award committee, jointly-done scholarly activity between 2 or more residents may be eligible for a joint award (each resident will receive a certificate), and scholarly activity must be in large measure performed by the resident—this activity includes most, but not necessarily all, of the following: the inception of the idea, development of the project, gathering data, presenting the results, or writing a report or publication. The AFMRD / NAPCRG / CFPC Family Medicine Resident Award for Scholarship was first available last year to residency programs. Further information regarding deadlines for submission of nominees will be provided to program directors later this year.

DEFINITIONS OF COMMON TERMS RELEVANT TO PRIMARY CARE RESEARCH

The following definitions of terms commonly used by primary care researchers were developed by the Practice-Based Research Subcommittee of the North American Primary Care Research Group (NAPCRG) Committee on Advancing the Science of Family Medicine(CASFM) after reviewing available definitions,