The World Organization of Family Doctors (Wonca) held an invitational research conference at Queens University, Kingston, Ontario, Canada. from March, 8 to 11, 2003. The meeting was organized and co-chaired by Professor Walter Rosser, M.D., of Kingston and Professor Chris Van Weel, M.D., of Nijmegen, the Netherlands, and the Chair of Wonca's Research Committee. Seventy-four experts from 36 countries, analyzed ways to improve health globally. The global research experts issued a preliminary summary report, entitled "Improving Health Globally: The Necessity of Family Medicine/General Practice Research". This summary report is excerpted below.

Wonca Research Experts Gather in front of the Gordon center at Queens University

Conference Chairs Chris van Weel and Walter Rosser entering for their first session

Background

There are deep concerns about the sustainability and effectiveness of health care systems around the world. Socio-economically disadvantaged communities with insufficient access to health care usually have the highest rates of common diseases with preventable morbidity and mortality as well as the greatest prevalence of health risks that are unaddressed. Quality primary care systems are essential to provide health care access to all and to minimize health risks in disadvantaged communities.

The roles and care provided by family physicians/general practitioners are essential for efficient functioning of all health care systems, and are important for integrating primary, secondary and tertiary care. Solutions to many health and health care problems can only be found through research in family medicine/general practice.

The Conference

Our goal is to promote research in family medicine / general practice, which will improve knowledge in the areas of:

• Understanding morbidity and health-risk patterns in communities with the objective of achieving the greatest improvement in health and wellness.
• Developing best practices to manage early signs and symptoms of diseases, and to deal with uncertainty and co-morbidity, patients' needs, demands and expectations - elements that contribute to the complexity of family medicine/general practice.
• Translating evidence-based clinical innovations into established practice routines;
• Enhancing access to primary care facilities in the prevailing health care system based upon need.
• Discovering the origins of disease, determinants of health care access and factors that enable health.
  

Additional research in any country addressing these areas would improve the health and wellness of their population.

Research Experts Reviewing Recommendations in Plenary Meeting

Kingston Conference Participants in Breakout Session

Conclusions

The conference reviewed the many challenges and opportunities in the development of family/general practice research and found a considerable number of documented models of success. It is essential that research be directed at the health problems with the highest impact on patients' health and wellness, and here family medicine/general practice is well positioned to contribute. This will vary between communities and emphasizes the importance of local sentinel systems to monitor morbidity and mortality in the community.

Models with an established value to drive research development, to transfer expertise, to build research capacity and to change the research culture include:

• Mentoring: Mentoring of aspiring researchers and research institutes by experienced researchers is valuable. Mentoring should include systematic support between institutes and countries.
  
• Practice-based research networks (PBRNs): PBRNs are practices united to examine the health problems of their patients and perform studies in the family/general practice setting. PBRNs facilitate the transfer of research findings into patient care and the generation of research questions from the actual problems encountered in practice. Universities and research institutes can facilitate the quality of their own research by extending their studies into the community by supporting and linking with PBRNs.
  
• Collaborative Research: Efforts should be made to build partnerships of researchers with communities.

These models of success have been well documented in the family medicine/general practice literature. However, these effective research models should be disseminated widely, as insufficient understanding remains of their potential in medico-political and scientific circles.

While strengthening family medicine/general practice research, care should be taken to guarantee adherence to ethical principles. This is especially important in research settings without an existing research tradition or without international research cooperation. This may be particularly issue in developing countries in which such a system of ethical guidance may not yet be in place. The need for research in developing countries is important and requires special attention.

The conference advised Wonca to be involved in the implementation process and to seek partnerships at an international (e.g., WHO, World Bank), regional (eg., through Wonca's Regional structure) and national level (eg, through national family/general practice colleges, universities, governments and research organizations and funding entities).

Research Recommendations

The recommendations presented in the preliminary report represent the consolidation of 9 papers and 48 small group sessions. The richness of the international input arising from this effort will be contained in the final report. The core recommendations of the conference are that Wonca should:

1. Adopt a policy that optimal health and health care for all depends on a robust research enterprise in family medicine/general practice. Advancing research in all countries is therefore a Wonca priority.

2. Develop a strategy to display research achievements in family/general practice to policy makers, health (insurance) authorities and academic leaders.

3. Seek the development in all its member countries of sentinel practices to provide surveillance reports on illness and diseases that have the greatest impact on patients' health and wellness in the community.

4. Organize a clearinghouse for research expertise, training and mentoring.

5. Organize an expert group to provide advice on the development of PBRNs around the world.

6. Organize international ethical standards for international research cooperation and develop an international ethical review process.

7. Address in any recommendations for family medicine/general practice research the specific needs and implications for developing countries.

Dr Aziz Tank Kahn, with Wonca President Michael Boland and Wonca CEO Alfred Loh looking on, presenting a plaque to the Conference CoChair, Professor Chris van Weel

Wonca acknowledges the support it received for this meeting from Health Canada, the Canadian International Development Agency, Queen's University, the American Academy of Family Physicians (AAFP), the College of Family Physicians of Canada (CFPC), the Dutch College of General Practitioners (NHG), the Royal Australian College of General Practitioners (RACGP), the Centre for Studies in Primary Care, Queens University Kingston, Canada and the Department of Family Medicine, University Medical Centre Nijmegen, the Netherlands.

Publication of the final report is foreseen by the end of 2003.

Professor Chris van Weel
Professor Walter W. Rosser