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Research ArticleMethodology From PBRNS

Opportunities, Challenges, and Lessons of International Research in Practice-Based Research Networks: The Case of an International Study of Acute Otitis Media

Larry A. Green, George E. Fryer, Paul Froom, Larry Culpepper and Jack Froom
The Annals of Family Medicine September 2004, 2 (5) 429-433; DOI: https://doi.org/10.1370/afm.224
Larry A. Green
MD
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George E. Fryer Jr
PhD
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Paul Froom
MD
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Larry Culpepper
MD
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Jack Froom
MD
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    Figure 1.

    Pain resolution for children with acute otitis media.

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    Figure 2.

    Fever resolution for children with acute otitis media.

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    Table 1.

    Practical Lessons in International Primary Care Research

    Approaches to protecting human subjects participating in research differ among countries, requiring additional time and effort for compliance
    Data collection and data entry processes based in clinical practice vary among countries, and what works in one country will not necessarily work in another, making pilot testing even more important
    Data transmission services transporting data in various formats from one country to another are not under the control of investigators and may not be stable throughout a study
    Duties and tariffs on necessary equipment may be an additional expense
    The value of national currencies fluctuates, sometimes widely, possibly leading to excessive or inadequate funding
    Incapacitation of an investigator in any collaborating country can disable an international investigation and not be overcome readily
    Already complex administrative tasks associated with research are even more complicated when different systems in other countries are used, and these tasks require expert management in every participating country
    There are direct costs associated with collaboration, and these expenses are essential, likely larger in international research, and should be included in grant budgets
    Strong, personal relationships among investigators can create new understanding and overcome much adversity
    Things take longer in international research

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    A study of acute otitis media (middle ear infection) in children was undertaken in the Netherlands, the United Kingdom, and North America (the United States and Canada) in the mid-1990s. Participating countries used different approaches to treating this condition: antibiotics were rarely used in the Netherlands but were used for 5 to 7 days in the United Kingdom, and for 10 days in North America. In spite of these differences in treatment, patients recovered in about the same amount of time. The study contributed to current approaches that encourage limited use of antibiotics in treating middle ear infection. Researchers also learned important lessons about the challenges of conducting international practice-based research, including the need for administrative skill and strong, trusting relationships among researchers.

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The Annals of Family Medicine: 2 (5)
The Annals of Family Medicine: 2 (5)
Vol. 2, Issue 5
1 Sep 2004
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Opportunities, Challenges, and Lessons of International Research in Practice-Based Research Networks: The Case of an International Study of Acute Otitis Media
Larry A. Green, George E. Fryer, Paul Froom, Larry Culpepper, Jack Froom
The Annals of Family Medicine Sep 2004, 2 (5) 429-433; DOI: 10.1370/afm.224

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Opportunities, Challenges, and Lessons of International Research in Practice-Based Research Networks: The Case of an International Study of Acute Otitis Media
Larry A. Green, George E. Fryer, Paul Froom, Larry Culpepper, Jack Froom
The Annals of Family Medicine Sep 2004, 2 (5) 429-433; DOI: 10.1370/afm.224
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