| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
|
|
|
|||||||
|
|||||||||
TRACK to:
|
|
Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Spectrum of PBRN Research
Future challenges for PBRNs
|
|
|||
|
William M. Tierney, Indianapolis, IN, USA Chancellor's Professor of Medicine, Indiana University School of Medicine, Caitlin C. Oppenheimer, Brenda L. Hudson, Jennifer Benz, Amy Finn, John M. Hickner, David Lanier, Daniel S. Gaylin
Send response to journal:
|
I agree completely with Dr. Thomas' assertion that PBRNs should be performing a broad spectrum of research projects with multiple methods and multidisciplinary investigators. The examples we gave were limited to a small number of currently active projects, but the AHRQ PBRN Resource Center [1] has compiled a list of more than 500 articles published by U.S. primary care PBRNS that focus broadly on health, health care, health care delivery, outcomes, etc. A specific example of the research Dr. Thomas calls for is the recently completed Robert Wood Johnson Foundation's Prescription for Health Initiative [2] which was a series of multimethod interventions aimed at improving the healthy behaviors of primary care patients. My own PBRN [3,4] has published more than 300 articles in peer- reviewed journals that employ a wide palette of multidisciplinary investigators, methods, foci, and outcomes. However, as Dr. Thomas states and our article documents, most PBRNs in the U.S. are young and just now discovering their strengths, mission, interests, and research directions. NIH's promulgation of Clinical and Translational Sciences Institutes [5] across U.S. academic medical centers will enhance and speed the development - and hopefully use - of PBRNs to facilitate more research relevant to primary care practices (and the communities they serve) while moving research more generally out of academic medical centers and into the communities. We hope that Dr. Thomas' vision is realized by this next generation of PBRNs so they leverage the NIH support to go beyond just moving the same old clinical research into the community but transform research to better serve the needs of those communities. 1. PBRN Resource Center. Available at: http://www.pbrnrc.iupui.edu/. Accessed June 23, 2007. 2. Prescription for Health. Available at: http://www.prescriptionforhealth.org. Accessed June 23, 2007. 3. Tierney WM, Miller ME, Hui SL, McDonald CJ. Practice randomization and clinical research: The Indiana experience. Med Care 1991; 29:JS57 JS64. 4. Kho AN, Zafar A, Tierney WM. Electronic data collection in practice-based research networks: Lessons learned from a successful implementation. J Am Board Fam Med 2007; 20:196-203. 5. Clinical and Translational Sciences Awards. Available at: http://www.ncrr.nih.gov/clinical_research_resources/clinical_and_translational_science_awards/. Accessed June 23, 2007. Competing interests: None declared |
|||
|
|
|||
|
Paul R Thomas, London UK general practitioner
Send response to journal:
|
This is a very accomplished paper. Clear, illuminative, a nice read. But there was something about the last line that made me read the paper again and again. Something was niggling me about the assertion that ‘…PBRNs will be necessary…to fulfil the NIH and AHRQ vision of putting research into practice and practice into research’. I found a clue to my concern in Table 4, that gave ten examples of PBRN research. They are all medical. ‘Clinical research’ focuses on the familiar medical topics of asthma and maternal depression - so where is research into complex and relational issues such as co-morbidities, family dynamics and continuity of care? ‘Prevention screening’ focuses on prostate cancer, colon cancer and osteoporosis, making the ‘prevention’ category so tight that there is no room for ‘health promotion’ that helps people to do things for themselves, rather than having things done to them. Even ‘health services research’ has the narrow focus of defining patient visits, cardiovascular risk education, and improving practice performance at influenza immunisation. Where are the social sciences? Where is research into organisations and systems? Where are multi- disciplinary, multi-method projects? Where are complex interventions? To be fair these are young networks, this is not a full list of their projects, and better understanding of the detail even of these projects might reveal my concern to be groundless. But my overall impression is that American PBRNs use familiar methods of bench science to count familiar medical things. This static and narrow approach is not good enough if we want to claim insight into a complex and constantly moving world, and into health rather than disease. The clock is ticking fast. The very survival of whole person, community-oriented primary health care is under threat. Mechanistic, simplistic management of discrete diseases is favoured. PBRNs must examine more than familiar medicine and use more than familiar laboratory research approaches if they are to say something new and valuable about ‘research into practice and practice into research’. Competing interests: None declared |
|||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
TRACK: