Family Practice Research Networks: Experiences from 3 Countries

,

Original Research

Family Practice Research Networks: Experiences from 3 Countries

J Fam Pract. 2000 October;49(10):938-943

By

Chris Van Weel, MD, PhD

Access to data about the clinical problems, patients, and processes that characterise family practice is essential for the development of this specialty. Practice-based research networks (PBRNs) play an increasing role in obtaining these data.

We compared 3 PBRNs: one in Wisconsin in the United States, one in Wessex in the United Kingdom, and one in Nijmegen in the Netherlands. We organized our data into 4 key areas for review: the mission of the network, its contribution to the evidence base of family medicine, the management of the network, and the financing of the network infrastructure.

Extending the evidence base of family practice is the overriding objective of these networks, and their main focus is on common morbidities. They provide access to unselected patient populations, but there are differences in their size.

There are aspects of PBRNs that are common in countries with different health care systems, despite the fact that local circumstances—the research mission or the characteristics of the health care system under which they operate—determine their form and structure. Networks develop over time and their focus and activities may evolve. Financial support for these networks continues to be a problem.

References

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In many countries the structure of health care is under review, and strengthening the delivery of primary health care is a common concern.^1,2 Primary care implies medical care in the context of the individual’s psychosocial and family structure—the “contextual complexity” of medical care³—and this primary care orientation⁴ improves cost-effectiveness.⁵ The medical discipline most directly involved in developing primary care is family practice; in Europe and the United Kingdom it is also referred to as general practice. We will use the term family practice, since these terms are used interchangeably in the international literature.³

For the continued development of the discipline of family practice, it is essential to evaluate the needs of patients and the effectiveness of primary care, and to develop evidence to guide practice. To achieve this, routine patient care in the community has to be subjected to systematic research. Practice-based research networks (PBRNs) provide the primary care disciplines with the research laboratories needed to promote scientifically rigorous collection of data. These laboratories reflect the social setting of practice and the personal relations between physicians and patients over time. They provide the opportunities to study unselected health problems, the effect of continuity of care, individual disease prevention strategies, care of families, and the implications of providing care with respect to individual and sociocultural norms and values.^6,7

This personal dimension of family practice can cause tension with the need for research to be representative of and applicable to family practice in general. This is a limitation of single-practice research. Thus, researchers usually aim for a representative mix of family practices in primary care research. Involving more practices also opens the possibility of recruiting larger numbers of patients and physicians. The networking of practices for research is a way of investing in the research culture of family medicine and creating favorable conditions to collect data, test interventions, and study the outcomes of care. PBRNs have become an important element in family practice and have been increasing in number and scope.^8-10 Their development can benefit from a better understanding of their strengths and weaknesses. In particular, the sharing of different experiences can help identify some key aspects of network operations.

Methods

The 1998 Wisconsin Research Network Conference provided an opportunity for the authors to study PBRN experiences. Network experiences from the United Kingdom and the Netherlands were presented, and this resulted in a comparison of 3 networks in 3 countries: the Wisconsin Research Network (United States), the Wessex Primary Care Research Network (England),¹¹ and the Nijmegen Family Practice Academic Network (the Netherlands).^12-14 Although this is an arbitrary selection of networks, each has a record of family practice research and operates in its prevailing health care setting and within its national culture of clinical research. This suggested that the comparisons would yield insights that are relevant for family practice research networks in general.

In the presentations and discussions various aspects of PBRN structure and operation were addressed. We condensed these into 4 key areas: (1) the missions of the networks; (2) the contribution of the networks to the evidence base of family medicine;^11-31 (3) the management of the networks, relationship to members, and data collection; and (4) the financing of the network infrastructure and studies.

Results

Information about the 3 networks is summarized in the Tables: In Table 1 the key characteristics are outlined, and in Table 2 the results of 5 characteristic studies are listed, including funding source and main publications. The Wisconsin network lists more than 700 members, including 467 family physicians in 207 practices (approximately one third of the family physicians in the state), who cover a population of more than 900,000. The network also includes specialists, nurses, and researchers. The Wessex network covers a patient population of more than 1.7 million people and involves 234 family physicians in 125 practices, as well as practice nurses, dentists, pharmacists, and optometrists. The Nijmegen network is based on a stable group of 10 practices with 25 family physicians. It covers a population of 45,000 that reflects the composition of the Dutch population in age and social class. Each network has a direct link to academic family medicine.

Missions of the Networks

The goal of all 3 networks is to increase the evidence base of primary care. However, there are important differences in the way this mission is put into operation. The Nijmegen network collects patient-related data on an ongoing basis. Since 1971 it has collected all presented morbidity, and since 1986 it has accumulated a core set of process and outcome data from patients with hypertension and heart disease, diabetes mellitus, asthma, and chronic obstructive pulmonary disease. Thus, a database of long-term individual morbidity and outcome of care has been built that forms the index for further clinical research. Data collection and associated research are centrally structured, and all practices and physicians are fully committed to the data collection.