here - General Practice and Primary Health Care Academic Centre

Practice-Based ResearchNetwork Development inVictoria: The VicReN ExperienceMeredith Temple-Smith and Melinda Soós

Australia (Victoria)Over 20millionpeople residein AustraliaAlmost 5million residein Victoria

First contact medical care in the community

Challenges in primary care• Equity• Quality• Rural, Outer metro, SES, Indigenous• Difficulty managing workforce and funding distribution• Practitioner vocational recognition voluntary• Practice accreditation voluntary• Inability to enforce or mandate quality frameworks• Efficiency• Fee-For-Service• Levers to encourage teamwork, integration, quality care• Research culture• Little infrastructure or financial support

The ecology of medical careAdult population atrisk1000Adults reporting oneor more illnesses orinjuries per month750(Ref: White, 1961; Green 2001)Adultsconsulting aGP one ormore times amonth250951Adults admitted tohospital per monthReferredTertiary

Work inPractice?Lab basedresearchImportance of communitybased practitioners• Problems vs diseases• Rise of chronic diseaseCan we provide quality carewithout research inpractice?Effective inHumans?

EVIDENCE PRACTICE HEALTH DECISION-MAKINGSince the discovery of the basic tools of molecular biology in the1970s, clinical research output has gradually fallen behind that ofbasic sciences research.Why?Two ‘roadblocks’ between basic science and improvedpublic health:1. Between basic science and clinical trials2. Between clinical trials and…a. Health services researchb. Effectiveness / efficacy researchc. Outcomes researchd. Comparative research

Translation roadblocks on way toward improved public healthFundingSource: NIHand othersFunding Source:Whose responsibility?BasicScienceResearchTranslationalResearch &Clinical TrialsImplementationresearchImprovedpublichealthTRANSLATION INTO HUMANSTRANSLATION INTOCLINICAL PRACTICESource: Crowley et al 2004

A model…….• Researchusers, translators• Program Focus• Rigorous methods• Quality trainingServicePracticesAcademicUnits• Researchcollaborators• TeachersResearchPracticesResearchLedPractices• Prac-researcherwith PhD/MD

SUMMARY An excellent healthcare system must be underpinned byexcellent clinical research Excellent clinical research can only occur whenresearchers have rigorous skills, time and resources International recognition of the crisis in clinical research An exciting opportunity exists for us to facilitate researchin practice

PRIMARY HEALTH CARE: AUSTRALIAPrimary Health Care Research, Evaluation andDevelopment (PHC RED) Strategy since 2000 Evidence-based policy and practice A broad, well-trained active research workforce Attract new researchers into the primary health careresearch workforce Identify knowledge gaps Ensure that evidence is taken up in primary health carepolicy and practice

PHC RED STRATEGY4 major Strategy components:• The Australian Primary Health CareResearch Institute (APHCRI)• The Research Capacity BuildingInitiative (RCBI)• A program of training awards, andinvestigator-driven and prioritydrivenclinical research grants• The Primary Health Care Researchand Information Strategy (PHCRIS)

PHC RED STRATEGYKey Strategy objectives: To increase the pool of primary health careresearchers To up-skill researchers To support primary health care researchers To ensure the research is relevant to primaryhealth care needs and priorities To disseminate and facilitate the uptake ofevidence into policy and practice

WHAT IS A PRACTICE-BASED RESEARCHNETWORK?‘PBRNs are sustained collaborations between practitionersand academicians dedicated to developing relevantresearch questions, working together on study design andconduct, and translating new knowledge into practice.’Key features: Involve practitioners as well as academics Generate researchPearce et al, 2004 Generate research that is collaborative and ‘close topractice’ Are ongoing Object of producing research is to change practice

WHAT IS A PRACTICE-BASED RESEARCHNETWORK?Key features: Involve practitioners as well as academics Generate research Generate research that is collaborative and‘close to practice’ Are ongoing Object of producing research is to changepractice

WHAT IS A PRACTICE-BASED RESEARCHNETWORK?Key features: Involve practitioners as well as academics Generate research Generate research that is collaborative and‘close to practice’ Are ongoing Object of producing research is to changepractice

WHAT IS A PRACTICE-BASED RESEARCHNETWORK?Key features: Involve practitioners as well as academics Generate research Generate research that is collaborative and‘close to practice’ Are ongoing Object of producing research is to changepractice

WHAT IS A PRACTICE-BASED RESEARCHNETWORK?Key features: Involve practitioners as well as academics Generate research Generate research that is collaborative and‘close to practice’ Are ongoing Object of producing research is to changepractice

WHAT IS A PRACTICE-BASED RESEARCHNETWORK?Key features: Involve practitioners as well as academics Generate research Generate research that is collaborative and‘close to practice’ Are ongoing Object of producing research is to changepractice

WHY ARE PBRN IMPORTANT?For two reasons:a. Practice-based research is importantb. PBRN can help bridge the gap betweenevidence, clinical practice, and healthdecision-making

WHAT DO PBRN DO?Academicsprovide network memberswith opportunities to buildresearch capacityPHC staffprovide networkmembers with accessto a practice baseGenerate research* Contribute to the evidence base* Influence clinical practice* Influence health decision-makingImprove health andhealthcare delivery

PBRN: RESEARCH PRODUCTIVITY Basic research (research into methods) Clinical research (to inform clinical methods) Health services research (improve healthservice industry) Health systems research (improve healthsystems and policies) Educational research (improve education forPHC clinicians)

CONTRIBUTIONS TO THE EVIDENCE BASE VicReN (Melbourne, Australia) – trialling a new cognitivefunction tool for GPs to use, trials in partner violence andchild obesity Nijmegen PBRN (the Netherlands) - PHC interventioneffects on CHD, depression, childhood morbidity anddiabetes Wessex PBRN (UK) - hay fever, osteoporosis, asthmaand venepuncture Wisconsin PBRN (USA) – disease risk, alcoholism,asthma screening

PBRN HISTORY PBRN origins lie in health surveillance networks Practice-based research conducted since late1800s Most experience in the Netherlands, UK and US

PBRN HISTORYOpportunity knocks!Opportunity knocks!Opportunity knocks!Opportunity knocks!SEQRNOpportunity knocks!Spencer GulfPRACNETUniversity of NewcastlePHReNet-GPSARNetVicReNOpportunity knocks!

Established May 2007 A collaboration between thePrimary Care Research Unit andprimary care practices aroundVictoria Open to GPs, PNs,chiropractors, dentists,pharmacists, counsellors,practice managers…

PBRN CONSIDERATIONS Aim FundingGovernance Network leadership Taxonomy of networks Size and Staff Communication Monitoring and Evaluation Research Training and Productivity

Aim:“To spur the development of important and highquality primary care research in Victoria that isrelevant to clinical practice and through this toprimary care policy-making.”

FUNDINGVicReN is an initiative inknowledge exchange funded by: a University of Melbournespecial purposes grant – Facultyof Medicines, Dentistry andHealth Sciences the Research CapacityBuilding Initiative of the PrimaryHealth Care ResearchEvaluation and DevelopmentStrategy, the Department ofHealth and Ageing

VicReN: GOVERNANCEReference GroupHigh-level network guidancePractice CommitteeResearch capacity building andmembershipResearchersLead practices/practitioners(Foundation Members)&A larger group of primary health carepractices/practitionersSubscriber MembersMembers who receive information onlyReference GroupPractice CommitteeFMResearchersSubscriber Members

VicReN: LINKING MEMBERS Providing monthly e-bulletins Quarterly newsletters VicReN Coordinator organizes the network andfacilitates all contacts Practice Committee meetings Links members into the wider research community

VicReN: MONITORING & EVALUATIONBaseline data is essential Survey members: research capacityand practice content Academic measures: income,publications, higher degreequalifications, clinical guidelines andpractice Number of members: member activitylevels, non-project funding, levels ofawareness of the network and itsactivities

VicReN: MONITORING & EVALUATIONHow will VicReN’s achievements be measured?Regular monitoring of: research capacity and practice content its membership network activitiesSpecific evaluation time-points of: research training and research conduct member issues – needs analyses funding, publications, higher degree qualifications, policy

VicReN: BUILDING RESEARCH CAPACITY Aims to provide research skillstraining for members Developing research skillsmaterials Involves members in researchstudies Involves members in wideruniversity research events andprograms Links members into researchhigher degree opportunities

VicReN: BUILDING RESEARCH CAPACITYPrimary Health Care Research and Evaluation Strategy(PHC RED) Fellowships Each year the Department of General Practice hosts practitionerswho research a topicThe Department of General Practice offers the followingacademic courses: Postgraduate Certificate of Primary Care Nursing Postgraduate Diploma of Primary Care Nursing Masters by research PhD MD

VicReN-SUPPORTED STUDIES The detection and management ofdementia Shared-care RCT to address childobesity (HopSCOTCH) Telephone-assisted smoking cessationintervention (QUIT) Exercise and Type 2 diabetes study RCT to examine abuse and violence ofwomen (WEAVE) Acupuncture to treat knee pain study

THE VicReN MODEL Academic GP – researchproject development General practitioner adviserand practice nurse adviser – toprovide the general practiceperspective Forums between VicReNmembers and research projectteam members VicReN coordinator – providesconsultative services

THE VicReN MODEL – EXAMPLE HopSCOTCH Shared-care RCT to address childobesity (HopSCOTCH) Developed by a team of researchersat Royal Children’s Hospital (tertiarycare) Intervention to be delivered in partthrough general practice (primary care)

THE VicReN MODEL – EXAMPLE HopSCOTCH Professor Jane Gunn (academicgeneral practitioner) as a chiefinvestigator on the study Dr Cathy Hutton (generalpractitioner) as a GP adviser 2 Forums set up between the projectresearch staff and VicReN GPs Consultation services around GPrecruitment provided by the VicReNCoordinator

THE VicReN MODEL – EXAMPLE HopSCOTCH Forums Open invitation to all VicReN GPs toparticipate – the first 5 were selected Paid forum with dinner provided GPs met with the RCH project teamto discuss the current management ofobese children in general practice Helped design the intervention

VicReN: THE FUTURE A larger inclusive primary care network Regular research skills training Member input into research projectdevelopment Ability for members to approach VicReNwith research ideas: project consultancy Continuing access to university forums,seminars, and higher degree, fellow andfunding opportunities More numerous and improved links withstakeholders

PBRN: THE FUTURE International Federation of Primary Care ResearchNetworks (IFPCRN) World Organization of Family Doctors (Wonca) > 50 countries worldwide have PBRN Australia’s PBRN are growing Australian Health Minister Tony Abbott hasrecently called for a proposal on PBRN WHO recognize primary care research is essentialto close the 10/90 gap

COMMENTS? QUESTIONSMelinda SoósVicReN CoordinatorDepartment of GeneralPracticeThe University of Melbourne200 Berkeley Street, Carlton3053 Victoria(03) 8344 3392msoos@unimelb.edu.auwww.gp.unimelb.edu.au/vicren/

REFERENCESJournal ArticlesCrowley, W. et al. (2004). “Clinical Research in the United States at a Crossroads”. JAMA 291(9):1120-1126Lindbloom, E. et al. (2004). "Practice-Based Research Networks: The Laboratories of Primary CareResearch." Medical Care 42(4 (supplement)): III-45 - III-48Nutting, P. A. (1996). "Practice-based research networks: building the infrastructure of primary careresearch." J Fam Pract 42(2)Pearce, K. et al. (2004). "How and Why to Study the Practice Content of a Practice-Based ResearchNetwork." Ann Fam Med 2(5): 425-428Thomas, P. et al. (2006). "How primary care networks can help integrate academic and serviceinitiatives in primary care." Ann Fam Med 4(3)White, K. et al (1961). “The ecology of medical care.” N Engl J Med 265: 885-889Zwar, N. et al. (2006). "Supporting research in primary care: are practice-based research networks themissing link?" MJA 185(2): 110-113BooksCouchman W.& Dawson J. (1990) “Nursing and Healthcare Research.” Scutari Press, LondonHockey L. (1992) “Surviving the research process.” Deakin University