Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He recently attended the 2016 Primary Health Care Research Conference (PHCRIS) in Canberra, Australia
Grant Russell, newly elected for a second term as President of the Australasia Association of Academic Primary Care (AAAPC) was upbeat in his introduction to the second day of the meeting. He reminded us how the Canadian academic, Martin Bass, had warned against learned helplessness and he pointed out that primary care has much more influence than we give ourselves credit for.
Claire Jackson, one of Australia’s leading primary care researchers was introduced at her plenary lecture as “an eternal optimist”. True to form, she told us that there has never been a more exciting time to be in primary care research. She listed the national primary health care strategy, the primary care framework, and the 31 primary health networks. While there have been numerous health care reforms, each one has primary care at its centre and there is growing government awareness of the need to address complex chronic illness in community. But, researchers are going to have to change- there will not be bundles of money with a stamp that says primary care research- there is a need to think differently and creatively. She described how her own centre of research excellence, under pressure from stakeholders, adopted different research methods and priorities. They introduced the value co-creation concept from the business literature - it’s about serving communities and making a difference in real world. She described three examples from her own work: a practice improvement tool, building capacity diabetic retinopathy screening and, governance across primary and secondary care. She emphasised the need to think ahead, anticipate the new big research questions, to look beyond the traditional model of publish or perish, and to seek new partners to help design and grow primary care research. She also described how her own personal philosophy had changed, evolving from Victor Hugo’s “Greater than the tread of mighty armies is an idea whose time has come,” to embrace TS Elliot’s “Only those who risk going too far can possibly find out how far one can go.”
Claire also made a challenging comment during the discussion, saying that the traditional way we fund and do research is broken. She said we need new ways of doing research, new performance indicators, new KPI and we need to be relevant. And, it's up to senior researchers and heads of department to give leadership. You can hear more in the video below.
John Furler, who gave the distinguished paper lecture was described in his introduction as “one of the quiet achievers”. If academic presentation is an art form, this was a masterpiece. John’s research was about overcoming clinical inertia in type 2 diabetes care and he described a body of research extending from the qualitative background, theoretical basis, pilot studies, and ultimately a randomised controlled trial. While strict glycemic control may be controversial, I was interested in John’s point about how achieving glycemic targets early may influence metabolic memory. Their work was based on normalisation process theory- which deals with how we can embed complex interventions into everyday practice. Another important component of success was the clinical autonomy of practice nurse and trust by their GP. There was also considerable variation in way the intervention was implemented but, as John reminded us, standardisation can be the enemy of effectiveness. There is a short interview with John about his work in the video.
Cancer has become a long term condition so, how do we manage care and how does our model of care fit current practice? Mark Harris, in his qualitative study explored the views of patients, oncologists and general practitioners. Primary care is often overlooked and, with existing models, patients may continue to attend hospital for many years even when they no longer need the oncology team. But, it’s not just as simple as transferring all these patients to primary care. While there was support for a model of increasing GP involvement, patients valued both the ongoing involvement and reassurance from specialists and the continuity of care offered by GPs. But, for the success of future developments we need shared information systems and interoperability.
Tim Stokes, originally from the UK but now a professor of general practice in Dunedin in New Zealand, spoke about multimorbidity. I loved his description of the difficulties faced by GPs in the consultation - government requirements and patients’ needs each require 20 minutes of your 15 minute appointment. Clearly patients with mulimorbidity don’t fit our current model.
One of the highlights for me was helping facilitate the early career networking lunch. I joined a group of dynamic creative researchers from different professional and geographical backgrounds looking at the key issues they faced. Lydia Twining, a Canadian now based in Adelaide (and also winner of a poster prize) coordinated our group’s views and you can hear her summary on the video above.
Drawing it all together at the end of the conference, Erica Kneipp, Assistant Secretary with responsibility for Health and Medical Research at the Commonwealth Department of Health, also reflected that it is a good time for primary care research. She applauded the work presented by so many young researchers but wondered where the middle career researchers were. Tony Hobbs, Principal Advisor at the Commonwealth Department of Health, encouraged us to harness the huge volume of information available on our practice desktops and emphasised the point made by Claire Jackson, that data are King.
Richard Reed, incoming Director of PHCRIS spoke about disruptive innovation. Primary Care research is being disrupted but, whatever emerges, it’s no longer enough just to think of good ideas and then seek funding- we need to embrace co-creation and work with partners including consumers to come up with research questions that are relevant and important. Ellen McIntyre, outgoing Director of PHCRIS concluded the conference with a final message to the primary care community, “Look after yourselves and value each other.”