The state of primary care research in Canada and the United States has much in common. The development of this important body of knowledge is still in an emergent phase in both nations and while different strategies have been implemented to catalyze growth in research capacity, most are still in their infancy.
It has been well demonstrated that a health care system founded on primary care is associated with improved health outcomes for a nation’s population and enhanced cost-effectiveness. Research is vitally important to strengthen primary care through the generation of evidence-based medicine that informs both clinical practice and the organization of service delivery. Research conducted in the biomedical sciences and in the tertiary care setting—the predominant form in both countries—is often inappropriate to the needs of primary care clinicians, resulting in challenges to the dissemination and uptake of research knowledge.
Primary care clinicians themselves are best placed to generate relevant knowledge and ensure its translation into everyday practice because of their awareness of the needs of the communities they serve and the important research questions that need to be answered. Despite this opportunity, primary care has had a weak culture of formal inquiry, with poorly developed infrastructure and low levels of active participation in research. This has resulted in far fewer publications relative to other medical disciplines.
However, there are encouraging initiatives that have begun in Canada and the United States to enhance the profile of research within primary care. In the United States, one finds strategic government programs to promote primary care inquiry, while within Canada progress has been more fragmented.
One element common to both countries is the establishment of practice-based research networks (PBRNs). These networks recognize that primary care practices are the natural laboratories for primary care research and typically comprise a number of community-based practices that are linked with academic institutions. In this way, high-quality research can develop within a collaborative framework that includes academic and community based researchers.
US federal support for these networks is mainly through the Agency for Healthcare Research and Quality. Between 2000 and 2004, more than $8 million was awarded to 45 research networks comprising more than 10,000 primary care clinicians caring for more than 10 million Americans. These networks have done important basic descriptive work on the nature of primary care practice and patterns of medical errors and have also examined strategies for preventive service delivery and chronic disease management in a variety of settings and patient populations.
In Canada, despite an $800 million Primary Health Care Transition Fund established in 2000 to support primary care reform, little funding has been dedicated to developing primary care research infrastructure. The vast majority of this funding has been dedicated to clinical program implementation, often without the necessary research in place to underpin the programs. A number of PBRNs exist in Canada, particularly in Alberta, Ontario, and Nova Scotia, but are dependent on funding from local sources or are indirectly supported through research operating grants from agencies such as the Canadian Institutes of Health Research and Health Canada. Notable studies have been completed in the areas of cancer screening, management of hypertension, and diabetes education. What is clearly needed in both Canada and the United States is a strategic commitment at a national level to fund the infrastructure needed to support primary care research networks. There is still much to learn about improving the delivery of primary care services, including the impact of redesign at micro and macro levels. More effective and efficient systems of primary care will pay enormous dividends in improved population health and lower health care costs. NAPCRG is partnering with primary care organizations in both the United States and Canada to ensure that these arguments are heard and acted upon.
- © 2006 Annals of Family Medicine, Inc.