Issue 38 / 2 October 2012

A NATIONAL practice-based research network is “long overdue” for Australian primary health care research and would enable huge savings in time and money, according to a leading GP.

Professor Mark Nelson, chair of the University of Tasmania’s discipline of general practice, authored an editorial in this week’s MJA commenting on two primary health care trials, which showed disappointing results. (1)

Published in the same issue of the MJA, one trial involved the care of patients with chronic obstructive pulmonary disease (COPD) and the other examined vascular risk factor management in general practice. (2, 3)

Professor Nelson said while the results of both trials were “essentially negative”, they showed the importance of translational research and that multicentre clinical trials could be conducted in general practice.

Professor Dimity Pond, professor of general practice at the University of Newcastle, told MJA InSight that a practice-based research network was “absolutely vital”. She said having a national network of GPs who have been educated in the basics of research would enable primary care research projects to run more smoothly, be more time effective and provide valid data.

Professor Pond said an important first step in establishing a network came last month, when the Australian Primary Health Care Research Institute (APHCRI) called for expressions of interest in a $50 000 per annum 2-year scheme to establish a national support service for a national practice-based research network. (4)

Professor Pond, who is also president of the Australian Association for Academic Primary Care, which intends to apply for the grant, said the level of funding proposed was not sufficient to fund a network, but it was a good start.

Professor Mark Harris, executive director of the University of NSW’s Research Centre for Primary Health Care and Equity and lead author of the study on vascular risk factor management in general practice, also agreed with the call to establish a national network.

He said APHCRI’s proposed national support service may be key in drawing together the many smaller research networks established under the Primary Health Care Research, Evaluation and Development Strategy’s research capacity-building phase, which came to a close last year.

Professor Nick Zwar, professor of general practice at the University of NSW and lead author of the COPD trial, said a national practice-based research network would prevent researchers from “reinventing the wheel” for every new trial.

“Each time we do a study in Australia … we more or less start again with recruiting practices and finding patients to take part in trials in general practice”, Professor Zwar said. The US, the UK and Canada all had networks of practices that took part in studies on an ongoing basis.

“There’s [expertise] in these practices which enables and supports them to take part on a more regular basis and builds their capacity to understand and use research”, Professor Zwar said.

Professor Harris said it was only through primary care research that the challenges of translating research conducted overseas or in hospital settings into general practice became evident.

He said his trial’s finding — that assessing and offering brief advice was on its own not effective in dealing with difficult problems such as diet and obesity — provided insight into how programs could be redesigned.

“We actually need to provide a more intensive system of care that includes referral to other providers, programs and services and follow-up”, he said.

In his editorial, Professor Nelson said the COPD trial showed that general practice needed “more rigorous and less presumptive diagnostic classification of COPD (ie, more widespread use of spirometry)”.

The two MJA studies involved 74 practices throughout NSW and pilot projects were conducted through established smaller research networks.

Professor Harris said to conduct studies any larger than these without a national practice-based network would be extremely difficult and expensive.

– Nicole Mackee

1. MJA 2012; 197: 263-264
2. MJA 2012; 197: 394-398
3. MJA 2012; 197: 387-393
4. Australian Primary Health Care Research Institute: Funding opportunity: Practice Based Research Networks; 2012: 17 September

Posted 2 October 2012

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