Development of Primary Care Research in North America, Europe, and Australia From 1974 to 2017

The analysis of Hajjar et al on the development of primary care research is welcome news: it adds to earlier analyses [1] in terms of time frame and numbers of countries. This stresses the point that there is a general, 'global' increase in primary care research publications and this increase is consistent over time. In the past decades NAPCRG and WONCA as international primary care organizations have stimulated research [2], and this paper confirms that these efforts have fallen on fertile soil. Primary care research is an increasing, lasting component of health research and that is in all probability the most important message to take from the paper.

Whether the actual numbers presented are an exact numerical representation of the actual publications is another, and probably less relevan matter. Two factors should be taken into account here:

1. The study of Hajjar et al was based on indexed, mainly English- language journals. This represents the scientific community and the paper emphasizes primary care's position. But at the same time primary care has to communicate its research to the field of primary care practice - through publications in English, where English is the local language, but for European scientists through publications in French, German, Danish, Dutch, Norwegian or Swedish, according to their national situation. And primary care publications in national, non-English, journals have not been included. Yet, for primary care from non-English speaking countries this represents a substantial part of their research output.

2. MeSH terms and key words guided the study of Hajjar et al. Allocation of MeSH terms and key words is open to individual choice of authors and editorial policy. And it is not clear if primary care researchers would always flag the primary care nature and setting of their papers. They may have other priorities and it is likely that the volume of primary care publications is larger than included in this paper.

And that triggers another question: how important is it to stress the primary care nature of research? This acknowledgement is part of an emancipation process, but the findings of Jajjar et al may signal that this emancipation has come to an end. In the Netherlands, for example, primary care research is more and more seen as a (core) part of applied health research [3], while applied health research is benefiting from the achievements of primary care in science: the potential of research to change practice and the methodology to facilitate translation - societal impact [4].

And that leads to the most relevant question the paper of Hajjar et al triggers: the impact of the growing volume of research in primary care on the health status and quality of health care for the populations in the countries studied. In the end the relevance of research and science is in its contribution to population health.

References:

1. Glanville J Kendrick T, McNally R, Campbell J, Hobbs FDR. Research output on primary care in Australia, Canada, Germany, the Netherlands, the United Kingdom, and the United States: bibliometric analysis. BMJ 2011;342:bmj.d1028

2. Weel C van, Rosser WW. Improving health care globally: A critical review of the necessity of family medicine research and recommendations to build research capacity. Ann Fam Med 2004:2:S5-S16.

3. The Netherlands School of Public Health and Care Research (CaRe)http://www.researchschoolcare.nl/ (accessed March 11, 2019)

4. Royal Netherlands Academy of Arts and Sciences. The societal impact of applied health research. Towards a quality assessment system. 2002. https://knaw.nl/en/news/publications/thesocietal-impact-of-applied- health-research (accessed March 11, 2019)

Competing interests: None declared