Grant Russell is a primary care clinician and health services researcher, as well as Head of School of Primary Health Care, Director of the Southern Academic Primary Care Research Unit (SAPCRU) and Professor of General Practice Research at Monash University in Australia. He spent 6 years working in Ontario, Canada
A CMAJ editorial once, famously, described Canada as being the ‘country of perpetual pilot projects’. “Pilotomania” is nowhere better seen than in Canada’s long running experimentation with models of delivering primary care. Given that experiments need some sort of professional interpretation, in 2007 the Canadian Health Services Research Foundation (as it was then) commissioned our team at the University of Ottawa (where I was working at the time) to review Canada’s primary care research capacity. Our report: Mapping the future of primary health care research in Canada, allowed us to unpack what turned out to be a fragile enterprise.
We were particularly struck by the challenges facing the primary care research workforce. Many researchers were isolated, especially those working outside nursing schools or Departments of Family Medicine. While islands of innovation existed, there was little sense of a sustainable system for primary care research and development.
I moved back to Australia a couple of years after Mapping the Future was published. This series of CMAJ blogs on research capacity has stimulated me to reflect on what’s happened in the 7 years since the release of Mapping the Future. After a little help from my old boss, Bill Hogg of the University of Ottawa, I've summarised in the table below my sense of Canada’s progress against the recommendations in the report. And, just for the sake of the exercise, my take on where we are in Australia.
There’s no doubt that both countries have invested in the coordination of primary care health services research : A pan- Canadian Coordinating Center for the CIHR: Primary and Integrated Health Care Innovation is on the horizon. Australia’s Australian Primary Health Care Research Institute (APHCRI) has tried to build links between researchers and policy makers and has worked with PHCRIS in its role as a clearing house and a point of reference in primary care research for over a decade. Both countries have funded substantial team grants: CIHR’s Community Based Primary Health Care initiative supports over a dozen new 5 year team grants, and APHCRI has invested in 3 year Centres of Research excellence in health services research.
While networks are critical, and team grants treasured, I have a strong feeling that if we were to duplicate our methods in either of our countries again, little would have really changed, especially for those outside of the umbrella of the team grants. We’d find passionate advocacy about the importance of primary care in the health system, but minimal organized attempts to build an early and mid career workforce. The advocates would be many of the same leaders. The only difference? They’d be the best part of a decade closer to retirement.
The network investments are a way to level the playing field that has been owned for so long by the biomedical industries of the Academic Health Sciences Centres and large medical schools. But without explicit, meaningful and durable support for people – particularly PhD scholars, post docs and clinician researchers - Alan Katz’s “awakening giant just beginning to stir”, could just go back to sleep again.
Policy recommended by the Mapping the Future report
|Canada 2014||Australia 2014|
|A national coordinating body for primary health care research||The CIHR plans a competition for a pan- Canadian Coordinating Center for its research network in Primary and Integrated health care Innovation that will be in operation in the spring of 2015||Nil.|
|National Coordinating Body helps in the development of a national PHC research strategy,||Recent establishment of the Canadian Health Services and Policy Research Alliance (CHSPRA) offers some direction here.||Nil (although APHCRI has a strategic approach to PHC research support)|
|Run an annual national PHC research conference||Nil specific to PHC research – however the NAPCRG meeting has a large Canadian content||PHCRIS conference held each year. Has a strong health services research focus|
|Administer funding for the coordination of the nation’s PBRNs.||The CIHR is funding provincial and territorial research networks as part of its network of networks in Primary and Integrated health care Innovation||Discussions commencing to support a national PBRN program.|
|A national inventory of active PHC researchers and PHC projects.||Nil organized. The Canadian Primary Health Care Research and Innovation Network does this is a small way||Core PHCRIS activity|
|Operating grants directed at critical PHC questions||Sporadic support for specific primary care initiatives.||APHCRI funds research on varied policy related questions in occasional small funding rounds|
|Team grants to allow experienced researchers to collaborate to address strategically important PHC issues.||The Community-based Primary Health Care (CBPHC) Signature Initiative.||APHCRI Centres of Excellence|
|A coordinated program to foster sustainable careers for PHC researchers.||Nil||Nil|
|PhD research scholarships for PHC clinicians and future research scientists||Nil directed to primary care researchers. Some within the CBPHC initiative||Some in Centres of Research Excellence|
|A program of post doctoral awards for research scientists involved in PHC research.||Nil||Nil|
|The expansion of clinician scientist award opportunities for PHC clinician investigators||Nil||Nil|
|Support for PHC research chairs||One explicit PHC research chair.||Nil|
|Encourage national and provincial agencies to tailor knowledge translation and exchange activities to the specific needs of PHC clinicians and policy makers,||Active work on knowledge transfer and exchange through CIHR’s IHSPR.||APHCRI has made this a major part of their activities.|
|to encourage universities to appropriately recognize KTE activities.||Nil||Minimal to non existent|
|Continuation of strategies to improve the quality and accessibility of Canadian PHC and health services research performance data.||CIHI has done a little bit in this area. The CIHR SPOR methods centers are supposed to do this more generally. Except in Quebec the SPOR Methods centers seem to be specialist oriented.||Some GIS data is available, and limited data through the Medicare Locals|
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