Research ArticleOriginal Research

A National Survey of Primary Care Practice-Based Research Networks

William M. Tierney, Caitlin C. Oppenheimer, Brenda L. Hudson, Jennifer Benz, Amy Finn, John M. Hickner, David Lanier and Daniel S. Gaylin
The Annals of Family Medicine May 2007, 5 (3) 242-250; DOI: https://doi.org/10.1370/afm.699

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Location of primary care practice-based research network administrative offices.

    PBRN = practice-based research network.

    Note: Practice locations are limited to cities, so multiple PBRN offices or practices in a single city are indicated by a single dot.

Tables

  • Table 1.

    Practice-Based Research Network (PBRN) Characteristics (N=86)

    CharacteristicNo. (%)
    PhD=doctoral degree.
    Single-specialty PBRNs (n = 33)
        Family medicine20 (61)
        Pediatric10 (30)
        Family nurse-practitioner2 (6)
        General internal medicine1 (3)
        Obstetrics, gynecology, and midwifery1 (3)
    Multispecialty PBRNs (n = 53): specialty of PBRN physicians
        Family medicine51 (96)
        Pediatric38 (72)
        General internal medicine38 (72)
        Other specialties (PhDs, dentists, specialized medicine)21 (40)
        Family nurse-practitioner7 (13)
    Affiliation
        University65 (76)
        Nonprofit organization9 (10)
        Professional organization6 (7)
        Other, none, or not stated6 (7)
    Support from affiliated organization (of 83 with an affiliation)
        Direct8 (10)
        Indirect12 (14)
        Both39 (47)
        Neither direct nor indirect19 (23)
        Not stated5 (6)
    Funding for PBRN studies (multiple responses allowed)
        Federal funding agency, project-specific72 (84)
        Home institution (eg, university, or nonprofit or professional organization)64 (74)
        Foundation, project-specific48 (56)
        Professional organization21 (24)
        Philanthropic15 (17)
        Other unspecified source of funds8 (9)
    Source of research ideas (n = 85 reporting)
        PBRN leaders and clinicians (bottom-up)12 (14)
        Outside investigators (top-down)23 (27)
        Both PBRN leaders/clinicians and outside investigators50 (59)
    General research theme (multiple responses allowed)
        Methodology: Interventional studies25 (29)
        Methodology: observational studies23 (27)
        Specific population: age14 (16)
        Specific population: ethnicity14 (16)
        Specific population: urban/rural12 (14)
        Specific population: race11 (13)
        No general theme25 (29)
    Health condition or treatment focus (multiple responses allowed)
        Preventive medicine48 (56)
        Diabetes41 (48)
        Cardiovascular risk factors29 (34)
        Mental health26 (30)
        Heart disease21 (24)
        Cancer21 (24)
        Lung disease16 (19)
        Substance abuse10 (12)
        No condition or treatment focus10 (12)
  • Table 2.

    Demographic Characteristics of PBRN Patients’ Compared With National Benchmarks

    CharacteristicPBRN Patients* %National Figures† %Persons Seeking Health Care‡ %
    PBRN = practice-based research network; NA = not available.
    * Mean value among 60 PBRNs reporting patient data.
    † Data from July 1, 2002, published in Table NA-EST2002-ASRO-02. National Population Estimates – Characteristics Source: Population Division, US Census Bureau. Release Date: June 18, 2003.
    ‡ Blackwell DL, Tonthat L. Summary health statistics for the U.S. population: National Health Interview Survey, 1999. Table 20. National Center for Health Statistics. Vital Health Stat. 2003;10:211.
    Sex (female)575160
    Age
        1–18 y3426NA
        19–59 y4861NA
        ≥60 y1816NA
    Race
        White648185
        African American231310
        Native American211
        Asian/Pacific Islander542
        Other race612
        Hispanic ethnicity181314
    Health insurance
        Private457175
        State or federal421418
        No insurance13147
  • Table 3.

    Characteristics of Research Governance and Studies Reported by Primary Care PBRNs

    CharacteristicPBRNs No. (%)
    PBRN = practice-based research network; IRB = institutional review board.
    All practices covered by IRB (n = 84 reporting)
        No14 (17)
        Yes – single IRB28 (33)
        Yes – multiple IRBs39 (46)
        Unsure3 (4)
    No. of separate IRBs covering the practices (n=23 reporting)
        1–513 (57)
        6–205 (22)
        20+1 (4)
        Unsure4 (17)
    Single source for human subjects certification (n=43 reporting)
        Yes25 (58)
        No14 (33)
        Unknown4 (9)
    PBRNs with research experience (n = 85 reporting)
        Active study now, never in past4 (5)
        Active study now and at least 1 prior study45 (53)
        At least 1 prior study, but none now21 (25)
        Neither an active study nor prior study12 (14)
    No. of studies completed (n = 56 reporting)
        No studies completed15 (27)
        1–3 studies completed17 (30)
        4–7 studies completed17 (30)
        >7 studies completed11 (20)
    No. of subjects in largest study (n = 46 reporting recruiting patients into a study)
        1–1008 (17)
        101–50016 (35)
        501–1,0002 (4)
        >1,00020 (43)
    Persons who recruited subjects in past research (n = 85 reporting) (multiple responses allowed)
        Clinician40 (47)
        Study’s research assistant37 (44)
        Practice’s research assistant35 (41)
        Practice nurse24 (28)
        Practice clerk11 (13)
        Other13 (15)
  • Table 4.

    Ten Examples of Active Practice-Based Research Network (PBRN) Research at the Time of the Survey

    Project TypeProject TitleDescriptionName of PBRN
    Health services researchHow community pediatricians use electronic technologyA survey of community pediatricians in a practice-based research network using a self-administered form to describe how they use electronic technology for work-related tasks, level of competence for specific technology-related activities, and interest in learning these skillsWashington University Pediatric/Adolescent Research Consortium
    Clinical researchChild self-reporting asthma symptomsAsking the question, “When is it appropriate for children to report for themselves?” this study aims to assess the acceptability, feasibility, and psychometric quality of administering asthma-related quality-of-life questionnaires to childrenCincinnati Pediatric Research Group
    Clinical researchPediatricians recognition of maternal depressive symptomsA project examining the factors that influence pediatricians’ recognition of depressive symptoms in mothers with young children. It aims to develop and pilot an intervention that addresses barriers to recognition in the pediatric primary care setting and improve pediatrician’s ability to recognize and refer mothers with depressive symptomsRainbow Research Network
    Health services researchDefining patient visits studyA study to learn about patients and problems seen in “typical practice” and to allow for a comparison of data with national survey data and an assessment of the extent to which study practices represent the nation’s pediatric practicesPediatric Research in Office Settings
    Prevention researchHow patients decide on prostate cancer screeningEvaluation of shared decision making around prostate cancer screening to determine the effect of viewing a Web page or mailed brochure on prostate cancer screening on the decision-making process between a patient and physicianVirginia Ambulatory Care Outcomes Research Network
    Prevention researchMultilevel approaches to colon cancer screeningAn exploratory study designed to investigate the effectiveness of strategies to increase colorectal cancer screening in rural family practices. The primary outcome is the rate of adherence with the US Multi-Society Task Force on Colorectal CancerArkansas Research Collaborative
    Prevention researchImproving colorectal cancer (CRC) screening in primary careA study to characterize CRC screening practices across a variety of primary care clinics of a practice-based research network. It will provide information about the relationship between practice characteristics and CRC screening delivery and short-term outcomesOklahoma Physicians Resource/Research Network
    Prevention researchOsteoporosis studyA study designed to determine whether chart reminders or patient education information for osteoporosis screening improved discussion and treatment of low bone density in older women. Preliminary analysis shows that chart reminders, but not patient education, improved osteoporosis discussion and screeningIowa Research Network
    Health services researchCardiovascular risk education and social supportElaborate on a 3-year study of a practice-based intervention designed to harness the power of social support to improve adherence to prescribed treatments among diabetic patients with the ultimate goal of reducing their risk of heart attack and strokeKentucky Ambulatory Network
    Health services researchPractice improvement projectA study to assess the rates of influenza immunization in asthma patients within the primary care practices to (1) identify the organizational and patient barriers to influenza immunization of asthma patients, (2) randomize patients to dissemination of the research findings, and (3) tailor interventions to improve immunization of asthma patientsDuke Primary Care Research Consortium
  • Table 5.

    Self-Assessed Strengths and Weaknesses of PBRNs (n = 83 reporting)

    PBRNs Listing Characteristic
    CharacteristicAs a Strength No. (%)As a Weakness No. (%)
    PBRN=practice-based research network.
    Community involvement33 (40)23 (28)
    Research experience29 (35)15 (18)
    Data collection17 (20)7 (8)
    Research administration15 (18)6 (7)
    Information technology13 (16)25 (30)
    Research design13 (16)6 (7)
    Survey research11 (13)4 (5)
    Data analysis10 (12)5 (6)
    Ability to secure funding10 (12)54 (65)
    Writing journal articles6 (7)11 (13)

Additional Files

  • Supplemental Appendix

    Supplemental Appendix. Practice-Based Research Networks (PBRNs) Participating in This Survey

    Files in this Data Supplement:

  • The Article in Brief

    A National Survey of Primary Care Practice-Based Research Networks

    William M. Tierney, MD , and colleagues

    Background Practice-based research networks (PBRNs) are groups of medical practices that take part in research projects. Their research is set in the doctor�s office and examines questions about primary health care. This study surveyed PBRNs in the United States to learn more about them.

    What This Study Found The survey included 86 PBRNs representing 4 primary care specialties (family medicine, pediatrics, general internal medicine, and family nurse-practitioners), 1,871 medical practices, almost 13,000 doctors, and more than 14 million patients. Three-quarters of the PBRNs are affiliated with a university. Most PBRNs in the study get research ideas from their members and from outside researchers. Eight-five PBRNs focus their clinical research on diabetes, risk of cardiovascular disease, mental health, and preventing illness and disease. PBRNs serve a diverse patient population and most have difficulty getting funding.

    Implications

    • PBRNs are gaining momentum and recognition both nationally and internationally, and are increasingly involved in clinical and public health issues.
    • To meet their full potential, PBRNs need to continue to grow and mature.
    • Effective communication is needed between funding agencies, researchers, PBRN administrators, and PBRN participants. PBRNs must be aware of the research interests and needs of funding agencies, and funding agencies should use PBRNs to explore questions about high-quality, cost-effective primary care.
    • PBRNs should also collaborate and share experiences among themselves.
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Get Permissions

Jump to section

Related Articles

Cited By...

More in this TOC Section

Similar Articles

Subjects