Primary Care Research For Patients, Families and Communities

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Primary Care ResearchFor Patients, Families and
Communities

• William R. Phillips, MD, MPH
• University of Washington, Seattle, USA
• Workshop on
• National Research Agenda for Primary Care
• Dead Sea, Israel, 2005

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Generalist View

• The Family Doctor needs science as much as the
  specialist. Caring for patients is even more
  challenging than studying organs and treating
  diseases. Because of our past emphasis on lab
  research, we still know too little about too much
  that is too important to too many.

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Place of Primary Care
Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM.
The ecology of medical care revisited. N Eng J
Med 20013442021-2025.
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COPCCommunity Oriented Primary Care
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Future of PC Research

• Scientific Community IOM
• Government NIH
• Profession FFM
• Specialty Society AAFP
• Health Systems MCO

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IOM Crossing the Quality Chasm A New Health
System for the 21st Century

• Safe
• Effective
• Patient-Centered
• Timely
• Efficient
• Equitable

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IOM Priorities for Clinical Research

• Process of care
• Chronic disease and syndrome management,
  especially the relationship of co-morbidities to
  outcomes
• Outcomes of non-commercial interventions, such as
  comparative studies, lifestyle and behavioral
  modifications, and non-patentable drugs
• Racial, gender and socioeconomic disparities in
  health care outcomes and utilization
• Clinical research infrastructure (PBRNs)
• Healthcare systems interconnectivity

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NIH Roadmap

• Accelerating Medical Discovery
• to Improve Health
• New Pathways to Discovery
• Research Teams of the Future
• Re-engineering the Clinical Research Enterprise

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Re-engineering the Clinical Research Enterprise

• Clinical Research Networks
• Clinical Research Policy Analysis and
  Coordination
• Clinical Research Workforce Training
• Dynamic Assessment of Patient-Reported Chronic
  Disease Outcomes
• Translational Research

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Re-engineering the Clinical Research Enterprise
At the core of this vision is the need to
develop new partnerships of research with
organized patient communities, community-based
health care providers, and academic researchers.
This also includes the need to build better
integrated networks of academic centers linked to
a qualified body of community-based health care
providers who care for sufficiently large groups
of patients interested in working with
researchers to quickly develop, test, and deliver
new interventions. http//nihroadmap.nih.gov/ove
rview.asp
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Re-Engineering Clinical Research
NIH Translational Research
Bench
Bedside
Public
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Primary Care Research
Bench
Bedside
Beyond
Patient Family Community Population
Office School Workplace Long-term Care
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Investing in our Future

• If we want improved health care better
  outcomes, more satisfied patients, reduced costs
  we will have to invest in the scientific basis
  of primary care.

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Future of Family Medicine

• 1. New Model of Family Medicine
• 2. Electronic Health Records
• 3. Family Medicine Education
• 4. Lifelong Learning
• 5. Enhancing the Science of Family Medicine
• 6. Quality of Care
• 7. Role of Family Medicine in Academic Health
  Centers
• 8. Promoting A Sufficient Family Medicine
  Workforce
• 9. Communications
• 10. Leadership and Advocacy
• http//www.annfammed.org/cgi/content/full/2/suppl_
  1/s3SEC16

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Future of Family Medicine

• Advancing Research Supporting
• the Integrated Care of the Whole Person
• Enhancing the Science of Family Medicine
• http//www.annfammed.org/cgi/content/full/2/suppl_
  1/s3SEC16

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Mission The Annals of Family Medicine is
dedicated to advancing knowledge essential to
understanding and improving health and primary
care. The Annals supports a learning community of
those who generate and use information about
health and generalist health care.
www.AnnFamMed.org
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Annals Theme Issues

• 11 Co-morbidity
• 12 Health care disparities
• 13 Continuity of care
• 14 Cervical cancer screening
• 21 Multimethod research
• 22 Clinical community research
• 23 Nested data
• 24 Office systems change - QI - Patient safety
• 25 Patient-clinician relationship
• 26 Patient perspective
• Annals of Family Medicine. Volumes 1-2, 2003-4.

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Annals Content

• Chronic Illness 30
• Prevention 17
• Womens Health 11
• Practice Management 8
• Research Development 8
• Child Health 7
• Elderly Health 7
• Family/Community 7
• Acute Illness 5 Total
• POEMs or TRIPs 4 110 articles
• Annals of Family Medicine. Volumes 1-2, 2003-4.

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Annals PC Core Values

• 72 addressed core values in PC
• Continuity of care
• Comprehensive care
• Access to care
• Coordination of care
• Compassionate care
• Personalized care
• Context of care

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AAFP Task Force

• Plan to enhance FM/PC Research
• 7.7 million
• Establish Research Centers
• Train Investigators
• Stimulate PBRNs
• Stimulate PC-MCO research
• Advocate for support

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AAFP National Network
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PBRNs TRIP

• TRIP
• Translating Research Into Practice
• Put research into practice.
• Put practice into research.

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Advancing PC Research

• Invest in laboratories
• Build teams.
• Develop tools.
• Support infrastructure.
• Earn academic credibility.
• Include PC in research establishment.
• Address important questions.
• Do hard work well.

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Develop PC Investigators

• Training
• Mentorship
• Early career support
• Publication outlets
• Critical mass
• Buy clinical time
• Build pipeline
• Time, Money, Rewards

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Managed Care PC Research

• Group Health - Washington
• Kaiser - CA 9 states
• Health Partners - Minnesota
• Harvard Pilgrim Community Health Plan

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Community Service Research

• CDN - Clinical Directors Network
• Community Health Centers
• Migrant Heath Centers
• IHS - Indian Health Service - USPHS

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Strategies for MCO Success

• Long-term support from sponsor organization
• Permanent professional staff
• Data systems (not just existing data)
• Primary care physician-scientists
• Combine PC-HServices-Biomed research
• Link research, care systems, QI, education
• Build programs of research
• Compete for outside funds

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Bringing it All Home

• Family Medicine research is the essential link in
  the chain that brings medical science from the
  bench to the bedside and beyond into our homes
  and our communities.