Research Capacity In Primary Care Research Articles

Research themes of family and community physicians in Brazil

Introduction: Research capacity in primary care varies worldwide, and bibliographic databases such as MEDLINE, Scopus and Web of Science do not index most primary care research coming from Latin America. Our objective was to investigate the research themes of family and community physicians in Brazil, and to correlate the articles’ research themes with their authors’ trajectories in postgraduate education. Methods: we compiled a national list of family and community physicians, retrieved their curricula from the Lattes Platform, compiled a list of journal articles, and obtained their keywords from LILACS and MEDLINE. Treating journal articles and their keywords as the two node types in a bipartite network, we derived research themes using the dual-projection algorithm, combining the Leiden algorithm with hierarchical clustering. Results: We found two research themes to be the largest, most developed, and most central ones: human health and primary care. Authors with a master’s or PhD in collective health (public health, epidemiology, and social sciences and humanities in health) were as likely as those with no postgraduate degree to publish articles on primary care. On the other hand, authors with a postgraduate degree in medicine were more likely to publish articles on human health. Conclusions: After discussing the findings in light of previous research and methodological aspects, we conclude there’s a relative divide between primary care and clinical research, and the highlight policy implications.

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...

Mixed-methods evaluation of family medicine research training and peer mentorship in Lesotho.

BackgroundStrengthening primary care research capacity is a priority globally. Family medicine training programmes in sub-Saharan Africa represent an important opportunity to build primary care research; however, they are often limited by insufficient research training and mentorship. Peers can be used to extend research mentorship capacity, but have not been evaluated in this context.AimThe aim of this study was to evaluate one family medicine training programme’s research capacity building efforts through a blended research curriculum and peer mentorship.SettingLesotho is a landlocked country within South Africa of approximately two million people. The Family Medicine Specialty Training Programme (FMSTP) is the only accredited postgraduate medical education programme in Lesotho.MethodsThis two-year mixed-methods evaluation used: (1) Likert-scale surveys measuring trainee research confidence, (2) written evaluations by trainees, peers, programme faculty and administrators and (3) in-depth, semi-structured interviews. Survey data were analysed using Friedman and sign tests. Interview and written data were analysed thematically via a mixed inductive-deductive approach using Cooke’s framework.ResultsFamily Medicine Specialty Training Programme trainees (n = 8) experienced moderate increases in research confidence that were statistically significant. Skill-building occurred primarily via experiential learning. Research was grounded in trainees’ clinical practice and locally relevant. A positive research culture was created, promising for sustainability. We identified infrastructure gaps, including funding and protected time. Peer research mentorship supported trainees’ motivation and provided a safe space for questions.ConclusionThe FMSTP research curriculum and peer mentorship programme were successful in positively impacting a number of Cooke’s research capacity domains. This evaluation identified improvements that are now being implemented.

Collaborative postgraduate training in family medicine and primary care: Reflections on my visit to South Africa.

This reflection describes my funded visit to South Africa to assist in primary care research capacity building as Chair, WONCA Working Party on Research (WP-R). The trip included time at the Universities of Walter Sisulu, Limpopo and Stellenbosch to mentor postgraduate students working on master’s and PhD theses. I held one-on-one and group sessions and ran interactive scientific writing workshops. I assisted with the establishment of a Stellenbosch University Family Physician Research Network of faculty academics and family physicians (FP) which will generate research questions from community stakeholders. I also ran a writing workshop at the Joint 5th WONCA Africa and 20th South African National Family Practitioners Conference in Pretoria attended by about 100 conference delegates, ranging from FP registrars to academics with PhDs and peer-reviewed publications. A WP-R panel presentation of international comparisons of primary care systems was also held at this conference, with the countries of Ghana, Malawi, Zimbabwe, Ethiopia and Nigeria presented. During my stay, I reflected on the differences between family medicine in South Africa and in my home country, New Zealand (NZ). In South Africa, there is high prevalence of HIV and tuberculosis, seldom seen in NZ. Donor-funded vertical programmes cause significant fragmentation of care. Family doctors generally work in district hospitals, providing consultancy support to nurse-led clinics. They have a laudable requirement to complete a Master’s in Medicine in conjunction with vocational training. Academic family medicine in South Africa is coming of age. I feel privileged to play a small part in its journey to maturity.

Building Primary Care Research Capacity in a College of Osteopathic Medicine.

Building Primary Care Research Capacity in a College of Osteopathic Medicine.

Reply to Drs. Endersby et al

The Alma Ata and Astana Declarations reaffirm the importance of high-quality primary healthcare (PHC), yet the capacity to undertake PHC research—a core element of high-quality PHC—in low-income and middle-income countries (LMIC) is limited. Our aim is to explore the current risks or barriers to primary care research capacity building, identify the ongoing tensions that need to be resolved and offer some solutions, focusing on emerging contexts. This paper arose from a workshop held at the 2019 North American Primary Care Research Group Annual Meeting addressing research capacity building in LMICs. Five case studies (three from Africa, one from South-East Asia and one from South America) illustrate tensions and solutions to strengthening PHC research around the world. Research must be conducted in local contexts and be responsive to the needs of patients, populations and practitioners in the community. The case studies exemplify that research capacity can be strengthened at the <i>micro</i> (practice), <i>meso</i> (institutional) and <i>macro</i> (national policy and international collaboration) levels. Clinicians may lack coverage to enable research time; however, practice-based research is precisely the most relevant for PHC. Increasing research capacity requires local skills, training, investment in infrastructure, and support of local academics and PHC service providers to select, host and manage locally needed research, as well as to disseminate findings to impact local practice and policy. Reliance on funding from high-income countries may limit projects of higher priority in LMIC, and ‘brain drain’ may reduce available research support; however, we provide recommendations on how to deal with these tensions.

Developing indicators for measuring Research Capacity Development in primary care organizations: a consensus approach using a nominal group technique

Research Capacity Development (RCD) in the National Health Service supports the production of evidence for decision-making in policy and practice. This study aimed to establish a level of consensus on a range of indicators to measure research capacity in primary care organizations. Indicators were developed in a two-stage process using workshops and modified nominal group technique. In 2005, workshops were used to generate possible indicators from a wide range of research active and research-interested people. A theoretical framework of six principles of RCD was used to explore and identify indicators. Data were thematically coded, and a 129-item, 9-point Likert scale questionnaire was developed. A purposive sample of nine experts in developing research capacity in primary care agreed to take part in a nominal group in April 2006. The questionnaire was circulated prior to the meeting, and analysis of the responses formed the basis for structured discussion. Participants were then asked to rescore the questionnaire. Only seven participants were able to take part in the discussion and rescore stages. Data were analysed in two ways: level of relevance attributed to each indicator as a measure of organizational RCD, represented by median responses (medians of 7-9 defined strong support, 4-6 indicated moderate support and 1-3 indicated weak support), and level of consensus reached by the group. Consensus was reached if 85% of the group rated an indicator within the same band. Eighty-nine (68%) indicators were ranked as strongly relevant, and for seventy-three of these indicators, a consensus was reached. The study was successful in generating a set of agreed indicators considered relevant for measuring RCD in primary care organizations. These will form the basis of a pilot tool kit to assist primary care organizations to develop research capacity. Further work will explore the applicability of the indicators in practice.

Learning From History: The Legacy of Title VII in Academic Family Medicine

The current renaissance of interest in primary care could benefit from reviewing the history of federal investment in academic family medicine. The authors review 30 years of experience with the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program, addressing three questions: (1) What Title VII grant programs were available to family medicine, and what were their goals? (2) How did Title VII change the discipline? and (3) What impact did Title VII family medicine programs have outside the discipline?Title VII grant programs evolved from broad support for the new discipline of family medicine to a sharper focus on specific national workforce objectives such as improving care for underserved and vulnerable populations and increasing diversity in the health professions. Grant programs were instrumental in establishing family medicine in nearly all medical schools and in supporting the educational underpinnings of the field. Title VII grants helped enhance the social capital of the discipline. Outside family medicine, Title VII fostered the development of innovative ambulatory education, institutional initiatives focusing on underserved and vulnerable populations, and primary care research capacity. Adverse effects include relative inattention to clinical and research missions in family medicine academic units and, institutionally, the development of medical education initiatives without core institutional support, which has put innovation and extension of education to communities at risk as grant funding has decreased. Reinvestment in academic family medicine can yield substantial benefits for family medicine and help reorient academic health centers. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Engaging family practitioners in research: are we getting it right?

The argument that health care for everyday conditions should be based on research conducted in primary care is widely accepted. To achieve this, governments in various countries have sought to develop academic family practice and support community-based research. These include initiatives to develop new researchers, as well as to encourage service practitioners to take part in studies initiated by academics or the pharmaceutical industry. In Australia, the Primary Health Care Research, Evaluation and Development strategy aims to strengthen primary care research capacity. 1 In the UK, the ‘Mant’ report in 1997 heralded increased funding 2 and more recently the establishment of a national Primary Care Research Network has raised expectations that adopting a systematic approach will improve the amount and quality of research conducted. 3 But how effective are initiatives like these at engaging people working in frontline primary care services? Two papers published in Family Practice this month cast light on this question. 4,5 Reporting from Germany, Hummers-Pradier et al. explored the views of GPs who had opted not to take part in a portfolio of research projects which drew on electronic health records to identify patients with particular conditions for further review. 4 Although some of the findings relate to the specific project and the particular situation in Germany, where primary care research is less developed 6 , the scepticism uncovered has lessons for researchers more widely. Some saw research as an alien process that might conflict with their responsibilities to give individual patients the best care. Some described researchers as out of touch and self-interested and said that they had little opportunity to influence the study design. Others voiced concerns that research focussed on clinical practice might threaten their independence. Several of these concerns have also been voiced by GPs in the UK, particularly with regard to recruitment of people with mental health problems. 7

Research activity, interest and skills in a health and social care setting, a snapshot of a primary care trust in northern England: implications for collaboration and capacity

International and UK National Health Service policy has focused attention on the need to develop research capacity in primary care, with the emphasis on collaboration between professional groups and across organizations including health and social care, and the academic context. The results of a survey of research activity, interest and skills in a health and social care community, in Northern England, are reported. The survey targeted primary care trust (PCT) staff, general practice staff and social services staff seconded to the PCT, and a response rate of 31% was achieved. Twelve per cent of respondents were involved in research, with research active professionals typically involved in between one and three projects. PCT staff reported a significantly higher level of research activity, research skills and research interest than general practice or social care staff. The holding of a master's degree was associated with a greater desire to lead or collaborate in research. All three groups expressed a preference for practice-based research training and other forms of research support were identified, including protected time, apprenticeship, mentoring and funding advice. The results of this survey have been valuable in terms of research governance, forming research strategy, and impact on capacity via training and support for the health and social care community within a newly formed research alliance between a district general hospital, a PCT and social services, including an academic advisory group. The paper concludes that a holistic approach to research capacity building should inform changing policy and research funding in the UK.

The 'Designated Research Team' approach to building research capacity in primary care

Trent Focus, a Research and Development Support Unit, have introduced the ‘Designated Research Team’ (DRT) approach to building research capacity. This approach funds protected time to develop research ideas and skills for a team with limited research experience. This paper uses the example of a successful team of podiatry researchers to illustrate the approach to, and outcomes of, a DRT. It draws on documentary analysis of meeting notes and annual reports, and team members’ views collected during a recorded reflective session of the team at the end of the funding period. The DRT were successful in achieving agreed outcomes, including completing the project, submitting and publishing in peer reviewed journals, and presenting at conferences. They were also able to attract further funding, and engage with international collaborations and research activity. The unique contribution of this paper is that it focuses on facilitating factors to building research capacity based on a practice example. These include: enabling protected time, effective managerial support, applied and timely research training at relevant levels to expertise, immediate access to supervision and mentorship, a critical mass of research expertise within the team, and an encouraging workplace environment. Importantly, research undertaken was seen as a means to improve practice and the status of the professional group. ‘Accessible’ academic support including outreach work and attitudes of the team members and supervisors towards teaching and learning were important. Process factors enabling success include the use of project management techniques, clear delegation of tasks, effective lines of communication and accountability, and high levels of social capital and commitment between team members. The paper highlights ways forward to using these facilitating factors to build further research capacity, and to use this approach to highlight other areas of research capacity outcome measures.

Barriers and opportunities to developing research capacity in primary care trusts: the views of staff attached to a primary care trust

In the UK, the Department of Health recognizes the importance of research activity to improve patient care, but the amount of research activity relating to primary care is scant. Few have considered managerial and organizational aspects relating to developing research capacity in primary care and none have examined this from the perspective of organizations responsible for managing primary care at a local level. Yet these organizations have a critical role in increasing the amount of appropriate health services research and developing a research culture. A qualitative analysis of focus group workshops was performed to identify issues associated with developing research capacity within a primary care trust (PCT) covering a single local authority borough in England. All staff attached to the PCT were invited to attend facilitator-led focus groups and asked to consider from an individual and organizational perspective: What will enable them to increase the use of and participation in research? What barriers exist? What opportunities exist or could exist to develop this in the PCT? Themes were identified using content analysis based on written records from the focus groups. Issues relating to developing research capacity were grouped into the following categories: What is research? Training; Resources; Managerial; and Organizational issues. Research was not seen as an integral component of the daily or routine work of most people in a health care organization. Managerial and organizational issues were a considerable barrier to developing research capacity. Lack of appreciation and support for research by managers and lack of structures to facilitate research within the organization prevented research capacity being developed. Primary care management organizations need to work with service managers to encourage the incorporation of research activity into the routine work of staff. Greater dialogue is needed between individuals, service managers and academics to ensure that appropriate research is carried out to support the organization in meeting its explicit objectives. More work is needed to understand the perceptions of research from a managers’ perspective and to develop constructive ways to gain their support for a research agenda.

Primary care research — what in the world is going on?

Primary care research has been described as a "lost cause", and, although this claim has been strongly refuted, general practitioners publish less research than their colleagues in surgery, medicine and public health. Despite a fivefold increase in Australian general practice research papers from the 1980s to the 1990s, fewer than half of these focused on clinical topics. Trying to establish a global figure for expenditure on general practice and primary care research is difficult, but data show that public expenditure for primary care research is minimal in Australia, New Zealand, the Netherlands and the United Kingdom--fewer than 1.50 dollars per capita in 2002-2003. Compared with hospital- and laboratory-based research, primary care receives significantly fewer resources, ranging from 3.2% of total public expenditure on health and medical research in the Netherlands to 6.8% in New Zealand. Government-led investment in interventions such as strengthening primary care departments and colleges and supporting primary care academics, establishing practice-based networks, fostering international initiatives for cross-national efforts, and engaging individual primary care practitioners in research projects, are all required to build research capacity in primary care.

Developing R&amp;D capacity in a primary care trust: use of the R&amp;D culture index

There has traditionally been a low level of engagement of primary care practitioners with research. In the UK, primary care trusts (PCTs) now have some responsibility for the encouragement of research and development in primary care. The aim of this study was to assess the current level of research activity and capacity for research within a PCT. A questionnaire, incorporating a recently developed and validated research and development culture index, was sent to all 572 health care professionals and staff under the auspices of North Tyneside Research PCT. Data analysis used nonparametric tests of association including chi-squared, Mann–Whitney U and Spearman's rank order correlation. There was a 50.3 per cent response rate to the questionnaire. Groups more likely to show an increased capacity for research included those with postgraduate qualifications and those in post for the least time. General practitioners were less likely than other professional groupings to declare personal skills or aptitude for research. The two most important factors thought to contribute towards the development of a culture of R&D were having access to people to support development and changes in professional practice and having access to training and development opportunities. The use of the R&D culture index enabled groups to be identified that may be more research interested and can therefore be targeted to increase research capacity. The R&D culture index could be used by other PCTs wishing to define and develop research capacity in primary care.

Practitioner research: An approach to developing research capacity in primary care

The development of research capacity is a priority in healthcare. However, little information is available on the outcomes of different approaches to capacity-building. This paper provides a description of the approach taken in a primary health care (PHC) project (Teamcare Valleys) to support the development of research skills by PHC practitioners. The 35 practitioners were all experienced nurses, midwives, health visitors, GPs, practice managers and health promotion specialists. Research capacity development was supported by colleagues with experience in a range of research approaches in PHC and social science research. A case study was designed to examine the impact of the capacity-building process on the development of research and other skills. Data were collected at the end of the three-year project and five years later to identify the development of research skills and their utilisation in subsequent posts. Evidence indicates that the practitioner researchers developed considerable skills in research and associated areas; for example, in methods of research dissemination. However, their subsequent utilisation of these skills resulted from their own motivation rather than from being a requirement of subsequent posts. It is concluded that development of practitioner research skills needs to be supported by a career strategy enabling clinical research careers in the NHS.

Report from University of Bristol

Professor Debbie Sharp was appointed to the foundation Chair of Primary Health Care at Bristol in 1994, initially as part of the Department of Public Health and Epidemiology. The subsequent creation of an autonomous Division of Primary Health Care, re-located within the Department of Clinical Medicine, has resulted in a signiŽcant upgrading of the academic standing of the discipline within the University. This has been achieved by increasing the ow of high quality research output from the Division and a much-enhanced contribution to the Medical School’s demanding teaching programme. The Division has been very successful in obtaining high quality external research grant funding and in obtaining research fellowships from a variety of different bodies. Primary Health Care has now achieved an enviable balance of senior:training and clinical:non-clinical staff. The Division’s research portfolio continues to show the breadth associated with a generalist area. However, activity is consolidating around several clear areas of expertise, each being developed under the auspices of one of the Division’s senior academic staff. Professor Debbie Sharp leads the focus on mental health in primary care, including projects examining aspects of post-natal depression, dementia, deliberate self-harm and depression:anxiety. Other current projects under her guidance include those researching emergency contraception, breast screening, cancer genetics, multiple sclerosis and childhood immunisation. Doctor Tom Fahey has recently been awarded the prestigious Žve-year NHS Primary Care Career Scientist award. His Želd of investigation includes decision-support, hypertension, cardiovascular disease in primary care and the treatment of acute respiratory infections. Doctor Fahey has also had great success in guiding the careers of junior research staff towards, for example, the achievement of national training fellowships. Doctor Chris Salisbury’s research interests include the organisation of primary care services, such as out-of-hours services, the development of a new health park and the establishment of walk-in centres. His research responsibilities also encompass care for children with life-threatening illnesses and schoolbased services for teenagers diagnosed with asthma. The strategy for the next Žve years is to further develop programmes of work which play to the strengths of the Division’s senior researchers alongside the ability to respond swiftly and appropriately to government initiatives. Therefore, the research portfolio will balance commissioned research and responsive funding. In line with government policy to expand the research capacity in primary care, the Division of Primary Health Care has been instrumental in developing a practice-based research network, GANG (Gloucestershire and Avon Network Group for primary care research). The primary care practitioners within the network receive education and training in research methods and participate in university initiated research. There is also a smaller group of sixteen practices with whom the Division has developed very close relationships in terms of being major collaborators with or, in some instances, co-principal investigators on major research projects. All these practices are essential players in the studies that require the participation of large populations. Health-related research is also in progress elsewhere within the University, notably in the Department of Social Medicine and the MRC Health Services Research Unit (HSRC). Several ongoing projects involve principal investigators from the HSR Division of Social Medicine. With regard to teaching, the Division remains a very active contributor to the new curriculum (introduced 1995) and now teaches across all Žve years of the curriculum. We have initiated clinical teaching in general practice in the Žrst term of Year 1 and built on this experience in each of the subsequent years. We also take overall responsibility for communication skills teaching throughout the curriculum. The Division of Primary Health Care is located in Canynge Hall on Whiteladies Road in Clifton, adjacent to the main university campus and facilities. Canynge Hall has its own library and excellent computer resources. Primary Health Care shares this