It is a good time to be a primary care researcher in Canada. There has been unprecedented recent investment in Primary Care research in Canada. The Canadian Institutes for Health Research (CIHR) funded 12 Community Based Primary Health Care Teams for 5 years starting in 2013. In addition the Strategy for Patient Oriented Research, (also funded by CIHR) is launching a pan-Canadian network focused on primary and integrated care. These big ticket investments are long overdue and very welcome. They have stimulated lots of excitement in the research community and will, through the inclusion of trainee funding in each grant, generate long term benefits for PC research.
The background to these initiatives is that primary care research in Canada has lagged behind other countries with similar socio-demographic picture. We have relatively few productive Practice Based Research Networks (PBRNs) and few funded research positions at academic institutions. It seems like a small community of the same players who are working in this area. This was demonstrated by the fact that there were so many people who were co-investigators on more than 3 of the 12 Team grants. Not only are faculty positions limited but training opportunities are even more limited with only one primary care PhD program and limited Masters programs offered. This means that our researchers usually get their research training in interdisciplinary programs, which has both advantages and disadvantages.
One of the features of the infusion of funding has been the requirement for partnerships with system planners and a focus on system outcomes. The CIHR has required a sound knowledge translation (KT) plan with all proposals, for a while now, but the focus has shifted to more applied research. Once again this has some good and some questionable consequences. Because we do not have a primary care institute at CIHR, the strategic investments in primary care have come predominantly from the Institute of Health Services and Policy Research and the Institute of Population Health Research. Many health policy pundits look to the primary care sector to “solve” the system problems such as emergency room overcrowding and overuse;, high rates of institutionalization of fragile seniors, and acute care bed shortages. While it is unlikely that family physicians will address these issues in isolation, it is clear that the discipline has much to contribute.
The College of Family Physicians of Canada has recently developed a Blueprint for Research Success through its Section of Researchers (SOR). As the dominant primary care workforce in Canada the 30,000 family physicians are on the front line for primary care service delivery. As such we need to provide the evidence that will drive the evolution of primary care in Canada. The Blueprint calls for all family docs to be “engaged with research”. This recognizes the continuum from being a research user (practicing evidence based medicine) on one end, to devoting the majority of one’s time to research on the other end. In between are a variety of roles that contribute to primary care research while maintaining a focus on patient care, teaching, or administration. Through capacity building, advocacy, and building external relations the plan looks to engage academic faculties of medicine, research funders, as well as family physicians and other stakeholders in the growth of family medicine research in Canada.
This ambitious plan is being implemented in an environment of fiscal restraint across most universities and increasing application pressure on funding agencies resulting in decreasing success rates. Despite this it seems to me that that primary care research in Canada is an awakening giant just beginning to stir.This blog is part of a series on global primary care research that CMAJBlogs is publishing in the lead-up to the NAPCRG Annual Meeting 2014