Innovations in primary care research

Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

The concept of the “Salon” is based on the tradition of European intellectual gatherings that led to the great literary, artistic and political movements of our time. At a recent meeting of primary care researchers in Colorado Springs, Frank deGruy gathered a group of colleagues in this way together to create discussion, debate and perhaps generate ideas. Such gatherings might take place with any group and in any context - in a department, region or nationally. On this occasion, Frank attracted a group of about twenty delegates of the NAPCRG meeting from various international and professional backgrounds and I was fortunate enough to be included. For such a group to work, there are a few basic ground rules about respecting others’ opinions, but otherwise the objective is to produce free flowing discussion, seeded by a topic suggestion and a few leading statements. Food and drink help create a relaxed and comfortable setting. There were no prepared presentations and no pre-set deliverables. Everyone has an equal voice, with chairs placed in a circle, and the aim is for very light touch leadership. Frank, and Linda Niebauer, explain the concept here.

Although we might think there is a large primary care research community, the number of academic department of primary care world-wide is remarkably small; while each department may have a number of research projects at any one time, there are a limited number that conclude in any given year. It’s partly the numbers of departments, the funding and the infrastructure but, it is also immensely difficult to undertake trials in primary care. There is no research tradition and little financial support, for recruiting practices that involve aspects of service delivery, which makes conducting trials in primary care difficult. Accessing patients who are mobile, and working, studying, living in the community, and busy with their daily lives is complex. Undertaking interventions and follow up, often at considerable distance from a central hub, creates even more complications. And, most primary care interventions take time and require long term follow up. It’s difficult to explain to specialist colleagues the complexity of undertaking a trial in primary care.  I invited Martin Fortin to explain some of the problems, which he does in the following video, first in French and then in English.

Academic mobility is flourishing. Sharing ideas across countries and continents helps to catalyse intellectual development and useful collaboration. But, there are immense challenges for academics who uproot their families, abandon a familiar research and clinical environment and move to a different country. I caught up with Martin and Diana Dawes who moved from the UK to Canada, first to Montreal and then, just as far away again, to Vancouver, and to Tim Stokes, who also moved from the UK, but to the other side of the world in New Zealand.

I recently came across a great idea from the College of Family Physicians of Canada which, in 2015, produced a booklet recognising the top twenty pioneers of family medicine research. I think we don’t recognise our family medicine colleagues' achievements sufficiently. Many academic leaders make enormous contributions to health and wellbeing but, as individuals and as a profession, primary care docs tend to avoid the limelight. A few attain wider international recognition in their lifetimes but in most cases, we only applaud their achievement in their obituary! I know nothing of the discussions that preceded publication of the booklet, and I am sure it was difficult to choose who to include. But, on a wider scale, it’s not the individuals identified alone, but it’s the act of recognition that is important. I asked David White, current President of the College of Family Physicians of Canada, about it…

I also chatted to David about the challenges currently facing family doctors in Canada and his thoughts on the future. As an academic journal CMAJ tends to focus on research and education but, in the following video, David reflects on the much wider role of family doctors and the value of their work. He recognises the immense achievement of his colleagues and doesn’t shy away from the difficulties. It’s usually those doctors working in academic centres that we see publishing in CMAJ but, like David, we recognise that most of the clinical work is undertaken by highly motivated family doctors often working in difficult conditions and sometime with little support in isolated and rural communities.

Perhaps sometimes we focus too much on physicians and the medical research agenda. The High Plains Research Network in Colorado is fully integrated into the community and, while medicine has a place, health belongs to the community. Medicine can provide knowledge and advocacy but health relates to people, their families and the networks within which they live. We sometimes forget, in our modern electronically-connected world, that the community was the first social network. It is helpful to be reminded. In conversation, Sergio Sanchez and JC Carrik from the High Plains Research Network joined Denise Campbell- Scherer in reflecting on the immense success of their community network, the importance of community engagement, and on the fundamentals of knowledge translation.

It can sometimes be difficult for journals, restricted by the accepted forms of research communication, to provide a platform for dissemination. Research questions and answers might not fit the traditional formula. I discussed this with Maret Felzien and she emphasised the rigor of their research methods within the High Plains Research Network and expanded on some initiatives that may be suitable for randomised controlled trials.

It not that journals don’t value non-traditional research methods, it’s just that often those methods don’t quite fit within the strict and limited guidelines for research communication. Other media have pushed out beyond the restrictions of the written word and it is almost inevitable that this will overtake scholarly publication. Journals are still wedded to very traditional methods and perhaps we need to think more widely about how we can do it- experiment and innovate.

 

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