Is primary care research important and relevant to GPs?

[The KKS examiner course as a qualification measure for GP practices to participate in clinical research: A qualitative study with participants from the SaxoForN research practice network]

BACKGROUND

With the aim of increasingly integrating research into outpatient care and ensuring its quality, the Dresden/Frankfurt am Main General Practice Research Network (SaxoForN, information at www.saxoforn.de) has been qualifying GP practice teams for research in outpatient care since the beginning of 2021. SaxoForN offers four qualification modules for this purpose, including the course for members of the investigator group in accordance with the German Medicines Act (AMG, investigator course) in order to be trained for participation in clinical trials and to be introduced to the principles of good clinical practice (GCP) so that they can work together on research projects. This course is implemented in SaxoForN through cooperation with the Coordination Centre for Clinical Studies Dresden (KKS-Dresden) (KKS examiner course). An evaluation was to be conducted to examine how well the qualification concept works for general practitioners (GPs) and medical assistants (MFAs) in the research practice network and how they perceive the KKS examiner course.

METHODS

The evaluation of the PPS examiner course for GP practice teams was planned for September 2021 using a qualitative design. The research interests focused on the participants' subjective experiences and opinions. Due to the potential vagueness and complexity of the remembered course experiences, a qualitative study design was chosen to enable a differentiated and explorative analysis of these impressions. For the survey, telephone-based, guided interviews with 11 narrative-generating, open questions were agreed upon by a team of several researchers being familiar with qualitative methods from the social and health care sciences. The interviews were analyzed using Mayring's qualitative content analysis. The methodology was documented according to the COREQ checklist.

RESULTS

A total of eight participants of the KKS examiner course were interviewed in October 2021 (n = 8, interview duration 15-20 min). The focus was on three central topics: (1) the quality of the content of the PPS examiner course, (2) the framework conditions in terms of time management and implementation, and (3) the suitability of the course for clinical trials and GP practices. In particular, the organization and interactive design of the KKS examiner courses were rated positively. However, the need for improvement was identified with regard to the accuracy of the training for GP practice teams: above all, the participants felt that the adaptation to the GP setting through instructions for the concrete implementation of studies in GP practices was lacking.

CONCLUSION

The integration of the KKS examiner course into the SaxoForN research practice network has worked well to cover the necessary GCP basics in the outpatient setting. However, there is a need for further development in the practical implementation of the qualification content. In the future, this need is to be met through intensive collaboration between SaxoForN and the KKS as well as accompanying workshops with tools for implementation in GP practices.

Implementing and evaluating the comprehensive integration of physical activity into a major health system: study design and protocol

INTRODUCTION

The healthcare sector has great potential for promoting physical activity (PA) for chronic disease prevention, treatment and management; however, multiple adoption and implementation barriers exist, ranging from practice integration to information flow. In 2016, Exercise is Medicine Greenville (EIMG), a comprehensive clinic-to-community approach that involves PA assessment, recommendation and/or prescription and provider-based referral of patients to community-based PA programmes, was launched by Prisma Health in Greenville, South Carolina, USA. Since inception, variability has emerged in adoption and implementation, impacting patient reach, referral rates and engagement in the community-based PA programmes, highlighting the need for closer evaluation and refinement of strategies to maximise programme impact.

METHODS AND ANALYSIS

This pragmatic study will examine the adoption, implementation and reach of EIMG. 20 Prisma Health primary care clinics will be invited to adopt EIMG. In Phase I, adopting clinics will receive a standardised EIMG instructional video followed by EIMG activation, allowing providers to refer eligible patients to a 12-week evidence-informed PA programme offered at local community facilities. In Phase II, adopting clinics will receive a more in-depth EIMG onboard training. At adopting clinics, referral rates of eligible patients will be tracked over both phases (each lasting 4 months). A mixed-methods approach will explore factors related to EIMG adoption, achieving optimal implementation and reach, and patient enrolment in the PA programmes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will inform the assessment of implementation outcomes, while the integrated Promoting Action on Research Implementation in Health Services framework will be used to explore contextual factors influencing patient-level and clinic-level outcomes.

ETHICS AND DISSEMINATION

We received ethical approval to conduct this study from the Prisma Health IRB Committee A (#1963762). The results of this study have the potential to significantly enhance clinical practice and improve health outcomes related to integrating a clinic-to-community PA model in health systems to connect patients with community-based PA resources. Information gained from this study will lead to the refinement of a generalisable approach to inform future implementation strategies on optimising and scaling up the integration of comprehensive PA models in US health systems and be disseminated through conference presentations, publication in peer-reviewed journals and direct work with health systems.

TRIAL REGISTRATION NUMBER

NCT06073041.

Relationship between research activity and the performance of English general practices: cross-sectional and longitudinal analyses

BACKGROUND

Research activity usually improves outcomes by being translated into practice; however, there is developing evidence that research activity itself may improve the overall performance of healthcare organisations. Evidence that these relationships represent a causal impact of research activity is, however, less clear. Additionally, the bulk of the existing evidence relates to hospital settings, and it is not known if those relationships would also be found in general practice, where most patient contacts occur.

AIM

To test 1) whether there are significant relationships between research activity in general practice and organisational performance; and 2) whether those relationships are plausibly causal.

DESIGN AND SETTING

National data were analysed between 2008 and 2019, using cross-sectional and longitudinal analyses on general practices in England.

METHOD

Cross-sectional, panel, and instrumental variable analyses were employed to explore relationships between research activity (including measures from the National Institute for Health and Care Research Clinical Research Network and the Royal College of General Practitioners) and practice performance (including clinical quality of care, patient-reported experience of care, prescribing quality, and hospital admissions).

RESULTS

In cross-sectional analyses, different measures of research activity were positively associated with several measures of practice performance, but most consistently with clinical quality of care and accident and emergency attendances. The associations were generally modest in magnitude; however, longitudinal analyses did not support a reliable causal relationship.

CONCLUSION

Similar to findings from hospital settings, research activity in general practice is associated with practice performance. There is less evidence that research is causing those improvements, although this may reflect the limited level of research activity in most practices. No negative impacts were identified, suggesting that research activity is a potential marker of quality and something that high-quality practices can deliver alongside their core responsibilities.

Evidence-Based Medicine as Perceived by Healthcare Professionals: A Cross-Sectional Study in the United Arab Emirates

BACKGROUND

To investigate evidence-based medicine (EBM) use by physicians and pharmacists in the United Arab Emirates (UAE).

METHOD

A cross-sectional study using a validated questionnaire. Results: Overall, 70.7% of physicians and 35.3% of pharmacists had positive attitude toward EBM. Physicians with 10-15 years of professional experience scored highest on EBM implementation; no statistical association was found (p = 0.099). Younger pharmacists aged 25-35 years were more interested in implementing EBM compared to older pharmacists (p = 0.011). Physicians in Al Ain performed better than those in other cities (p < 0.0001), and pharmacists in Abu Dhabi implemented EBM better than others (p = 0.014).

CONCLUSION

Age and years of experience could influence implementing EBM.

Appraisal of National Institute for Health and Care Research activity in primary care in England: cross-sectional study

BACKGROUND

The National Institute for Health and Care Research (NIHR) was set up to enhance clinical and health research activity in a variety of National Health Service (NHS) healthcare settings, including primary care.

OBJECTIVE

To appraise how overall General Practitioner (GP) practice performance, location, and staffing levels may interact with NIHR Portfolio activity in primary care in England.

METHODS

Cross-sectional summary of GP practice research activity and practice descriptors; complete data from 6,171 GP practices was collated from NIHR (using data for 2013-2023 for Portfolio studies), Public Health England, Care Quality Commission, and NHS Digital sources, respectively.

RESULTS

In primary care, 1 million patients have been recruited into NIHR Portfolio studies in the last decade. The top 10% of practices-measured by different studies recruited to-contributed over 50% of that accrual. When the top decile of GP practices is compared to the 20% least active GP practices, research activity is significantly and individually linked with larger GP practices. Furthermore, it is significantly yet modestly associated with GP practice performance (positive patient feedback, Care Quality Commission rating), lower locality deprivation levels, and lower patient to GP ratios.

CONCLUSIONS

Research activity in GP practices is-as seen previously with hospitals-significantly linked with better GP practice performance and patient feedback. Practice list size and staffing levels in particular interact with the aforementioned. This should be taken into account when determining strategies to increase patient and GP practice participation in NIHR Portfolio research studies.

Describing the Breadth and Scope of Keck Medical Student Primary Care Research Projects

Introduction

Primary care research is an important field of study within medicine, but little research has characterized medical students' projects on this topic. Second-year medical students at the Keck School of Medicine (KSOM) of University of Southern California are required to complete a research project on a topic of their choice. This study seeks to describe the scope of primary care medical student research conducted by KSOM medical students and specifically Primary Care Program (PCP) pipeline students. The PCP consists of students with a vested interest in primary care, and who we hypothesize are more likely to complete a primary care project.

Methods

To assess students' primary care (PC) research output, we reviewed and sorted 1,408 KSOM abstracts between 2014 and 2020 into PC or non-PC. PC projects were then recategorized into more specific PC topics. χ² analysis determined significance at P<.05.

Results

We reviewed abstracts from 1,408 KSOM medical students (n=122 PCP; 1,286 non-PCP). Results revealed that the number of PC research projects conducted by 122 PCP students (67.2%, n=82) was statistically significantly higher than by 1,286 non-PCP students (14.7%, n=189, P<.00001). The most common PC research topics (n= 271) were education (patient/medical, n=71, 26%), health diversity/disparities (n=60, 22%), mental health/psychiatry/behavioral science (n=58, 21%), and community medicine (n=48, 18%).

Conclusions

Our study describes the breadth and scope of Keck medical student PC research. Supporting PC research efforts by medical students may increase the proportion of students conducting PC research, students choosing PC careers, and faculty producing PC scholarship.

Complex skills are required for new primary health care researchers: a training program responds

BACKGROUND

Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research.

MAIN BODY

In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges.

CONCLUSION

We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.

La mujer en la investigación en la sociedad científica. Una aproximación mediante un análisis de producción científica en la semFYC

Objetivo: conocer el grado de feminización de la autoría de los estudios y proyectos de investigación presentados en las reuniones científicas nacionales de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC). Métodos: se realizó un estudio descriptivo transversal mediante el análisis de las bases de datos de las comunicaciones de investigación presentadas en los congresos nacionales de la semFYC entre los años 2007 y 2021, así como de los proyectos presentados para las becas de investigación para tesis doctorales. Se recogieron las variables de género, comunidad autónoma, universidad, año de celebración del congreso y áreas temáticas estudiadas. Resultados: se analizaron 6.057 comunicaciones de investigación, siendo el 66,7% (IC 95%: 65,5-67,8) presentadas por una mujer con primera autora. Las comunidades a las que corresponden el mayor porcentaje de comunicaciones de autoría femenina fueron Cataluña (42%), Andalucía (19%), Madrid (8%), Comunidad Valenciana (5%) y Murcia (5%). Aragón es la que presenta mayor ratio de mujeres/hombres (72%), seguida de Cataluña (69%) y Andalucía (69%). Se analizaron 273 proyectos de tesis doctorales, siendo una investigadora principal en el 72% (IC 95%: 66,7-77,7), y procedente de Cataluña (23,9%), Andalucía (18,9%). Las universidades más representadas son la Autónoma de Barcelona (12,5%), Zaragoza (6,4%) y Valladolid (5,5%), estas dos últimas con la mayor ratio de feminización (100%, 48%, respectivamente). Conclusiones: la investigación presentada en los eventos de la semFYC está feminizada, siendo reflejo de la feminización de la medicina de familia, y manteniéndose a lo largo del tiempo. Las comunidades autónomas (CC. AA.) con estructuras específicas de investigación para la Atención Primaria (AP) son también las que más contribuyen a dicha feminización. Palabras clave: género, Atención Primaria, investigación, feminización de la medicina.

La mujer en la investigación en la sociedad científica. Una aproximación mediante un análisis de producción científica en la semFYC

Objetivo: conocer el grado de feminización de la autoría de los estudios y proyectos de investigación presentados en las reuniones científicas nacionales de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC). Métodos: se realizó un estudio descriptivo transversal mediante el análisis de las bases de datos de las comunicaciones de investigación presentadas en los congresos nacionales de la semFYC entre los años 2007 y 2021, así como de los proyectos presentados para las becas de investigación para tesis doctorales. Se recogieron las variables de género, comunidad autónoma, universidad, año de celebración del congreso y áreas temáticas estudiadas. Resultados: se analizaron 6.057 comunicaciones de investigación, siendo el 66,7% (IC 95%: 65,5-67,8) presentadas por una mujer con primera autora. Las comunidades a las que corresponden el mayor porcentaje de comunicaciones de autoría femenina fueron Cataluña (42%), Andalucía (19%), Madrid (8%), Comunidad Valenciana (5%) y Murcia (5%). Aragón es la que presenta mayor ratio de mujeres/hombres (72%), seguida de Cataluña (69%) y Andalucía (69%). Se analizaron 273 proyectos de tesis doctorales, siendo una investigadora principal en el 72% (IC 95%: 66,7-77,7), y procedente de Cataluña (23,9%), Andalucía (18,9%). Las universidades más representadas son la Autónoma de Barcelona (12,5%), Zaragoza (6,4%) y Valladolid (5,5%), estas dos últimas con la mayor ratio de feminización (100%, 48%, respectivamente). Conclusiones: la investigación presentada en los eventos de la semFYC está feminizada, siendo reflejo de la feminización de la medicina de familia, y manteniéndose a lo largo del tiempo. Las comunidades autónomas (CC. AA.) con estructuras específicas de investigación para la Atención Primaria (AP) son también las que más contribuyen a dicha feminización. Palabras clave: género, Atención Primaria, investigación, feminización de la medicina.

Hepatic schistosomiasis, upper gastrointestinal bleeding, and health related quality of life measurements from the Albert Nile Basin

BACKGROUND

Health related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda.

METHODS AND MATERIALS

This was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded each participant's medical history, physical examination, laboratory tests results, ultrasound results, and endoscopy findings. We also recorded health related quality of life measurements using the EuroQoL 5-dimension instrument and derived disability weights from EQ-VAS and EQ-5D measurements. These were our dependent variables. Descriptive and inferential statistics were generated summarizing our findings.

RESULTS

We found 103 participants had a history of upper gastrointestinal bleeding and hepatosplenic schistosomiasis. Sixty percent were between the ages of 30-49 years, 59% were females, 74% were farmers, 92% had splenomegaly, 88% had varices at endoscopy, 22% were medical emergencies with acute variceal upper gastrointestinal bleeding, and 62% had anemia. Measures of the different dimensions of health from 101 participants with patient reported outcomes revealed 77 (76%) participants experienced problems in self-care, 89 (88%) participants reported anxiety or depression, and 89 (88%) participants experienced pain or discomfort. The median EQ-VAS derived disability weights and median EQ-5D index-derived disability weights were 0.3 and 0.34, respectively. Acute upper gastrointestinal bleeding, praziquantel drug treatment, and age by decade predicted higher EQ-VAS derived disability weights (p value < 0.05). Under weight (Body mass index ≤ 18.5), acute upper gastrointestinal bleeding, ascites, age by decade, female gender, and praziquantel drug treatment predicted higher EQ-5D index- derived disability weights (p value < 0.05).

CONCLUSION

Adult patients with upper gastrointestinal bleeding and hepatic schistosomiasis from this primary health facility experience poor health and considerable health loss. Several factors predicted increased health loss. These factors probably represent key areas of health intervention towards mitigating increased health loss in this population.