North American Primary Care Research Research Articles

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...

Fiftieth anniversary of NAPCRG: Canadian contributions and personal reflections.

# {#article-title-2} The North American Primary Care Research Group (NAPCRG, pronounced Nap-crag) is celebrating its 50th anniversary in 2022. The occasion provides an opportunity to reflect on the Canadian perspective of this binational (Canadian and American) organization and the contributions

The North American Primary Care Research Group strong at 50 years: the past, present, and future of primary care research.

The North American Primary Care Research Group strong at 50 years: the past, present, and future of primary care research.

My Experiences with the North American Primary Care Research Group: A Reflection from an Emerging Primary Care Researcher.

As an early career medical educator and a relatively new member of the North American Primary Care Research Group, and as an emerging researcher, author would like to share his experiences with NAPCRG using the 5 Ws to mark the organization's 50th Anniversary.

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.

North American Primary Care Research Group Position Statement on the Definition of Behavioral and Social Sciences Research, from NAPCRG

Within the National Institutes of Health, the Office of Behavioral and Social Sciences Research (OBSSR) coordinates behavioral and social sciences research (BSSR) efforts across institutes. As part of its authorizing legislation, Congress asked OBSSR to “develop a standard definition of the field

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.

An analysis of qualitative and mixed methods abstracts from Japanese, UK and US primary care conferences

BackgroundAs research in family medicine covers varied topics, multiple methodologies such as qualitative research (QR) and mixed methods research (MMR) are crucial. However, we do not know about the difference in the proportion of QR or MMR between Japan, the UK and the US. This knowledge is needed to shape future research within countries with developing primary care such as Japan and other Asian countries. This study aims to describe the use of QR and MMR in Japanese primary care and compare this to the UK and US; then to make informed recommendations for primary care research.MethodsA repeated cross-sectional study (2012–2016) based on the abstracts submitted to the annual conferences of the Japanese Primary Care Association in Japan, the Royal College of General Practitioners in the UK, and the North American Primary Care Research Group in the US and other North American countries. The proportions of QR/MMR among all the posters and paper presentations for each of these three conferences were assessed. Also examined were trends and types of qualitative techniques for all three countries and participants/settings for Japan.ResultsThere were 1080 abstracts for Japan, 575 for UK and 3614 for US conferences. QR/MMR proportions were 7.5%, 15.1% and 28.1%, respectively. Japan’s proportion was lower than that of UK and US (p < 0.001). The proportion was increasing over time for the UK (p = 0.02). Steps for coding and analyses was most popular for Japan, thematic analysis for the UK and grounded theory for the US. Primary care doctors and hospitals were the commonest contexts for Japan.ConclusionsQR and MMR were not as popular in primary care in Japan compared to the UK and the US, whereas their use was increasing in the UK. Approaches, participants and settings may differ among these countries. Education and promotion of QR/MMR and multi-disciplinary collaborations need to be recommended in Japan with developing primary care.

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 …

Strategies for Increasing the Role of Family Medicine in Mexican Health Care Reform.

There is little or no role for primary care and family medicine in current health reforms in Mexico. However, robust evidence shows that primary care helps prevent morbidity and mortality and increases health equity. Mexico has participated in several international meetings sponsored by the World Organization of National Colleges, Academies and Academic Associations and the North American Primary Care Research Group that are aimed at increased understanding of national health systems and the need to strengthen primary care for improved health outcomes. From 1 of these meetings the Cancún Manifesto emerged, with a strategic plan to increase the stature and impact of the Mexican College of Family Physicians (COLMEXAC) in strengthening primary care in Mexico. We aim to describe this strategic plan and discuss its early implementation, and for this account to serve as a possible formula for other countries. The 5 specific strategies discussed are 1) the need for consensus on the leading role of the Mexican family physician in the national health system; 2) health ecology research; 3) to improve the perception of patients about the benefits of primary care and family medicine; 4) to organize meetings of health providers, users, and other stakeholders; and 5) to promote the professionalization of COLMEXAC as a legal entity.

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.

The North American Primary Care Research Group's Patient and Clinician Engagement Program (PaCE): Demystifying patient engagement through a dyad model.

Community engagement in research is essential for translating the best evidence into community and clinical practice to improve the health and well-being of the population. North American Primary Care Research Group's Patient and Clinician Engagement Program (PaCE) program aims to develop a robust community of patients and primary care providers with knowledge and understanding of the unique features of patient-centred outcomes research related to primary care in order to advocate for and engage in research. PaCE employs a 'dyad' model in which a patient and a primary care provider collaborate to learn about and engage in primary care, primary care research, grant review, proposal development and advocacy. A series of educational trainings held in conjunction with national primary care conferences, international webinars and local symposia make up the foundation of the PaCE curriculum. To date, 186 participants have completed the full-day, interactive PaCE training, and more than 250 people have participated in PaCE webinars and/or symposia. A 6-month follow-up sent to PaCE participants evaluates engagement activities following training.

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

Tokenism in patient engagement.

Patient engagement throughout research is a way to generate more relevant patient-important research questions, methods and results with the ultimate aim of facilitating translation of research into practice. Tokenism is defined as the practice of making perfunctory or symbolic efforts to engage communities or patients. We wanted to explore how tokenism might influence engaging patients in research to help researchers work towards more genuine engagement. The Community Clinician Advisory Group and Patient and Clinician Engagement program held a workshop at the 2015 North American Primary Care Research Group meeting titled 'How Do We Move beyond Tokenism in Patient Engagement?' Patients, clinicians and academic researchers contributed examples of genuine and token engagement characteristics based on personal experience and knowledge. Data were iteratively collated and categorized into domains and items. Examples of genuine and token engagement were categorized into three domains: Methods/Structure of engagement, Intent and Relationship building. Members with experience in patient-engaged research projects felt that longitudinal engagement was a key element to effectively translating research into local community and practice. The group (i) highly valued genuine intent and relationship building as elements to combat tokenism; (ii) noted that early genuine attempts at engagement may superficially resemble tokenism as researchers build enduring and trusting relationships with patient/community partners and (iii) emphasized the importance of seeking and utilizing patient experiences throughout research. These observations may contribute to more formal methods to help researchers (and reviewers) evaluate where engagement processes sit along the 'genuine-token' continuum.

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.

New Zealand needs a Practice Based Research Network.

Practice Based Research Networks (PBRNs) are groups of general practices collaborating to produce research. Contemporary New Zealand health information technology systems are ideal for electronic data extraction for PBRN research. Stakeholders have a valuable, but typically underutilised, part to play in research. Development of an e-participation platform will facilitate stakeholder engagement. New Zealand is in a unique position to create an innovative, low cost, stakeholder-engaged PBRN. This type of PBRN would offer unparalleled research opportunities, and would strengthen New Zealand's general practice research capacity. The more research information we have based on our New Zealand population, the more appropriate care we can provide. Establishing a stakeholder-engaged PBRN in New Zealand will promote and support transformational change within our health system.

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.

Guidance for researchers developing and conducting clinical trials in practice-based research networks (PBRNs).

There is increased interest nationally in multicenter clinical trials to answer questions about clinical effectiveness, comparative effectiveness, and safety in real-world community settings. Primary care practice-based research networks (PBRNs), comprising community- and/or academically affiliated practices committed to improving medical care for a range of health problems, offer ideal settings for these trials, especially pragmatic clinical trials. However, many researchers are not familiar with working with PBRNs. Experts in practice-based research identified solutions to challenges that researchers and PBRN personnel experience when collaborating on clinical trials in PBRNs. These were organized as frequently asked questions in a draft document presented at a 2013 Agency for Health care Research and Quality PBRN conference workshop, revised based on participant feedback, then shared with additional experts from the DARTNet Institute, Clinical Translational Science Award PBRN, and North American Primary Care Research Group PBRN workgroups for further input and modification. The "Toolkit for Developing and Conducting Multi-site Clinical Trials in Practice-Based Research Networks" offers guidance in the areas of recruiting and engaging practices, budgeting, project management, and communication, as well as templates and examples of tools important in developing and conducting clinical trials. Ensuring the successful development and conduct of clinical trials in PBRNs requires a highly collaborative approach between academic research and PBRN teams.