The Genesis of the North American Primary Care Research Group

NAPCRG: The Beginning

During the 1960s and 1970s, many in the newly established primary care departments throughout North America recognized the need for an organization to expand academic primary care research while continuing to nurture the rich tradition of research in private practice. Gene Farley wrote that this was “a time of high hopes that the people could make changes in society [by reforming] the health care system to serve the needs of traditionally ignored populations.” Gene and others felt that “new knowledge was needed” to care adequately for those populations.

Gene led the establishment of the Family Medicine Program at the University of Rochester, NY, which from the beginning purposefully integrated service, demonstration, and research, and included practice and information systems. Gene recruited David Metcalfe in 1969. David, a member of the Royal College of General Practitioners (RCGP), was experienced in using age, sex, and morbidity indices that had been used in the United Kingdom since 1955.

Recognizing a void in the primary care movement in the United States, David appreciated the importance of roles undertaken by the STFM and the AAFP but saw a knowledge base was lacking. He advocated for generating an “innovative research capability” unique to primary care.

I had the good fortune of being recruited the Medical College of Virginia in 1969. Together with Fitzhugh Mayo and Kinloh Nelson, we established the Medical College of Virginia’s Department of Family Practice. My membership in the RCGP gave me a knowledge base similar to David’s, and I had years of practice-based research experience. Fitzhugh, a family physician in Virginia and an independent researcher in private practice, had undertaken clinical research in his own practice by recording and retrieving clinical data for his pioneering epidemiological studies. By 1972 the department had 3 training programs using problemoriented medical records that were linked to demographic and clinical data sets.

Fitzhugh believed that a unique organization was necessary to build an infrastructure in family medicine to facilitate research and education based on service.

These perceived needs and the jointly held convictions led to a seminar-workshop in April 1972 entitled Data Recording, Data Retrieval and Research in Primary Care. The conference, cosponsored by the Family Medicine Program of the University of Rochester and the Department of Family Practice of the Medical College of Virginia had 50 attendees from 28 family medicine programs in the United States and Canada. Participants concluded that an interactive group should be organized to stimulate research in community-based settings; they elected a steering committee consisting of Lou Filiatrault from the University of Minnesota, David Metcalfe, and myself. We were charged with defining suitable goals and a structure for the group. By May 1972 we distributed a position paper that defined goals; we solicited funding to support a second meeting in the fall of 1972 and annual meetings, which began in 1973.

In retrospect, our first meeting in 1972 responded to an overwhelming need for an office practice information system. Our original goals were written to meet that need. We have largely achieved our original goals, although a unified data recording and retrieval system never became established in North America. In NAPCRG, work on such systems continues today; however, I remain somewhat disappointed that we haven’t yet achieved our informatics goals in our own backyard. Nevertheless, I am hopeful that the work pursued by several groups in the United States will ultimately yield an important information system that will continue to push the frontiers of primary health care for the sake of research, education, and service.

Maurice Wood, MD