PRIMARY CARE RESEARCH PRIORITIES IDENTIFIED AND SHARED WITH STAKEHOLDERS

Primary Care Research Through Practice-based Research Networks (PBRNs)

The majority of research funding supports research of 1 specific disease, organ system, cellular or chemical process, and is not related to issues surrounding the total needs of a real life patient in primary care. Not only does the majority of health care take place in the primary care setting, this setting is the key interface between the patient and the primary care provider. The importance of what happens in that space is crucial to improving care, improving outcomes, reducing errors, and realizing meaningful patient-centered outcomes research. NAPCRG sees an unmet need in strong funding support for research that is conducted with and by primary care practices and their patients—essentially what PBRNs do.

Practice Transformation

Very little is known about important topics such as how primary care services are best organized, how new technologies impact care, how to maximize and prioritize care, how to introduce and disseminate new discoveries so they work in real life, and how patients can best decide how and when to seek care. We know from our members and our patients that the need is great to understand what works for patients and practices. Part of this transformation includes the establishment of and reliance on interprofessional teams for training and patient care. More research into best practices related to this integration is needed in both the training and practice arenas. Transforming primary care practices to be effective medical homes for our patients should be a key priority—and one that can only be accomplished with studies in the primary care environment.

Patient Quality and Safety in Non-Hospital Settings

We are all aware of the research related to the many improvements in patient care in hospital settings, and the continued work in this area. Our patients tell us that one of the key areas that is problematic for them is in the non-hospital setting. For example, the communication between specialist and patient and primary care provider is an area that needs work to understand how to improve. Improved methods for engaging patients in the management of their health conditions is a key area that needs further study. Patient-centered outcomes research informs the evidence needed for guidelines that we can trust, but the voice of patients in the development of clinical practice guidelines remains a promise unfulfilled.

Multimorbidity Research

More attention and research needs to be directed to the “real-life” patient; the one who doesn’t have diabetes alone, for example, but also has cardiovascular disease, as well as renal disease. In 2000, an estimated 60 million Americans had multiple chronic conditions. By 2020, an estimated 81 million people will have multiple chronic conditions. In addition, care for people with chronic conditions is expected to consume 80% of the resources of publicly funded health insurance programs by 2020. When private and public expenditures are combined, 51% of total expenditures are for those with multiple chronic conditions.¹ More research funding and attention needs to be directed at multimorbidity research.

Mental and Behavioral Health Provision in Communities and Primary Care Practices

Research addressing best practices for integrated mental and behavioral health provision in communities and primary care practices, and ways to increase the uptake of these models in primary care practices is needed. As a 2011 Robert Wood Johnson policy brief states, “Comorbidity between mental and medical conditions is the rule rather than the exception. In the 2003 National Comorbidity Survey Replication (NCS-R), more than 68% of adults with a mental disorder had at least 1 medical condition, and 29% of those with a medical disorder had a comorbid mental health condition. Moreover, models that integrate care to treat people with mental health and medical comorbidities have proven effective, but despite their effectiveness, these models are not in widespread use.”² More research is needed to identify best practices regarding integrated behavioral and mental health care in primary care, as well as identify barriers to adoption of these best practices into primary care practices and communities.

Training Future Investigators

One piece critical to the successful engagement and development of primary care research is the constraint of not having an adequate cadre of well-trained researchers. We believe there is a need to deliberately promote this training.

NAPCRG’s hope is that by sharing these priorities, funding agencies will take them into consideration when determining where funding dollars will be allocated over the coming years.