Primary health care research needs leadership, not pampering

Chris van WeelChris van Weel is Emeritus Professor of Family Medicine/General Practice
at Radboud University Nijmegen in The Netherlands; Professor of Primary Health Care Research at the Australian National University in Canberra, Australia; and Past President of WONCA

 

On a global scale, research in family medicine and primary health care appears to develop slowly and hesitantly, certainly in light of its contribution to education. This difficult state of affairs is mirrored in substantial international differences in research facilities: few countries can boast the visionary funding policies of Canada or Australia, or the inclusive research programming of universities in the Netherlands and the UK. The research grass often looks greener on the other side of a border, and this tends to trigger contemplation of what might have been – along with lamentations of deprived opportunities.

Yet, there IS a parallel primary health care research reality to enjoy. Italian family physicians have been able to publish their research in the highest impact journals, Brazilian universities are building their primary health care research performance. These are just two examples of what is possible when leadership replaces undue focus on being facilitated by third-party actions and structures. He who cares to look will find examples of a healthy research development in many places.

This is not to deny that success in research is an effort or a struggle, which, in all probability, it is in every field of study. The challenges for family medicine and primary health care are in building its capacity and applying its methods to an inherently diverse field of patient care. As in the care of patients, so in research: primary health care has to operate under local conditions – seize the opportunities that are there, cope with the constraints and barriers that are in the way. And advocate its case on this basis, by demonstrating its impact on the health of people.

When the local context is a core aspect of primary health care, studying local contexts should be the core of primary health care research. Ensuring methodology to diversify, tailor and adapt to local situations should be a key feature of international research collaboration. Much has been developed in this area: practice based networks, integrating data of health, demography and social and economic characteristics; participatory research to engage patients and populations; the use of mixed methods. These are rich achievements that deserve better recognition within the greater science community.

The mission of the field of primary care research is rightly ambitious: for every family a family doctor – family medicine and primary health care in every community around the world. Communities around the world differ, and may present essential differences in the context in which primary health care has to perform. This demands a research capacity that can study the effectiveness and value of primary health care in this local context – and provide evidence of how best it can be delivered under the prevailing conditions.

Of course this is complex, difficult and full of uncertainty – in research as much as in patient care. But that is exactly why the world needs primary health care. Therefore, on to NAPCRG and New York: stop whining, celebrate leadership.

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 2014NAPCRG 2014a-630

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