Research Initiatives
Research in Family Medicine – The Wonca Research Committee
Information
Research in Family Medicine
The Brisbane Initiative
The International Federation of Primary Care Research Networks - IFPCRN
COOP/Wonca Charts
Wonca Collaborating Centres
Documentation, position papers and projects
Wonca Kingston Research Conference 2003 Preliminary Report
Survey of National Primary Care Research Institutes
Plan for making research an integral part of every family practice
Understanding Networks: The Functions of Research Policy Networks
Educational opportunities for practice based researchers
The need for research in primary care to solve global health problems
External links to otherWonca Research
Resources and Networks
International
Federation of Primary Care Research Networks (IFPCRN) documents(External
link)
The International
Federation of Primary Care Networks (IFPCRN) (External link)
The European General
Practice Research Network (EGPRN) – the Wonca
Europe Research Network (External link)
Research in Family Medicine
Summary of the research forum discussion, Wonca
World Conference 2001.
Introduction
The Durban workshop reviewed the status of research in family medicine around the world. Participants represented a large variety of countries and regions, some having a background in academic research while others were very much in the phase of developing an interest in it. This made it perhaps the most representative discussion on research in Wonca.
The main themes
From the discussions three issues became clear:
There is a substantial research need in family medicine, as research is an essential prerequisite in developing evidence-based practice. This research field includes a substantial part of illness and disease presenting to health services. The large majority is only encountered in primary care, and the more common, the less researched. But the research need is not restricted to the clinical content: behavioural aspects (changing lifestyle and patient empowerment), multidisciplinary cooperation and teamwork, and the effectiveness of the structure of health care should also be taken into consideration. This reflects a universal need and is not restricted to, for example, developing countries.
An important aspect of the development of primary care and family medicine is the implementation of effective models and strategies of care. When effective care is available, the principle of family medicine is that it should be practised 'everywhere', without restriction. Implementation research is for that reason important, but it is by no means the only type of research. To pursue evidence-based family medicine the full scope of research must be applied, from efficacy and effectiveness studies to the assessment of cost-effectiveness, efficiency and implementation. Again this reflects a universal need.
There are, however, marked differences in the development of research in the various Wonca regions. In particular research in Europe, North America and Asia Pacific have developed, yet the greatest needs are in Africa, South Asia and Latin America. From this, it can be concluded that Wonca already possesses substantial expertise that it can recruit for research development.
From this follows that the points raised during the meeting can be summarised under three headings:
The specific role Wonca must play in the development of family medicine research.
Unmet research needs that will have to be developed for family medicine.
Important research needs can be catered for from the Wonca organisation and/or its membership.
The role of Wonca in developing family medicine research
Wonca is the only body that can lead the development of family medicine research on a world level. For that reason Wonca should play an advocacy role, promoting and voicing the fundamental need of research in the development of family medicine, and specifying the need. From that position, Wonca can lobby for:
- funding of family medicine research on a national and international level;
- the inclusion, in regional, national, and university research programmes, of family medicine research;
- the development of research training programmes and the professional development of family physicians/researchers.
Part of the advocacy role is the regular monitoring of the state-of-affairs of family medicine research around the world.
As a world body Wonca provides a network for researchers to present, discuss and exchange experience. This enables the transfer of expertise and the development of a common 'state-of-the-art'. Although much of these activities concentrate around the increasing number of international Wonca conferences, Wonca should be a permanent clearing house of research tools, skills and expertise.
Important research needs can be met from Wonca
The Wonca structure is able to cater for a number of issues that can be most helpful in supporting family medicine researchers elsewhere. An important task here would be to streamline this potential of Wonca and to enable even better use.
Accessibility of expertise is seen as a problem, which does lead to unnecessary repetition or the undesired re-inventing of the wheel. In particular this refers to:
- Conferences and fora: A scholarship programme could support promising researchers and future leaders in this field to take part.
- Expertise: Experts from a multidisciplinary background are available as advisors and mentors. Through an inventory Wonca could support this by providing the information better (Wonca website).
- Publication of research: There are a number of peer reviewed journals for family medicine and primary care, but the research community can make better use of these facilities. This requires a better interplay between editors, reviewers and the family medicine research community at large. Specific meetings within Wonca conferences can support this process.
- Translation of available material is an important way of supporting regional and local developments.
- Collaboration between centres and countries within Wonca, in order to supply experience and expertise from where this is available to where it is needed.
Currently there is a development in a number of countries to bring family practices and family physicians together in practice-based research networks. These networks combine expertise, collaboration and role modelling for others. As part of the Wonca research initiative, an international forum of practice-based research networks was founded: the International Federation of Primary Care Research Networks - IFPCRN. The initiative can be accessed via the IFPCRN Listserver on Wonca's website.
The contact is Dr John W Beasley jbeasley@fammed.wisc.edu
Universal unmet needs in family medicine research
For the promotion
of family medicine research it was seen as essential that the networking
pays tribute to the fact that strongest support usually comes from those
working under comparable conditions. This is the main reason of success of
regional networks. In advocating the importance of family medicine
research, it should be clarified what makes research into family medicine
relevant research. For funding, it should be stressed that research is an
integral part of family medicine and primary care development. Linking to programmes of WHO, the World
Bank and other global bodies were seen important. This lead to the need of Wonca to pursue:
- A research agenda that specifies the domains of research, the
implications for teaching/training of researchers and manpower development.
- Regional structures of Wonca that includes a
research networking structure.
- Links with other international organisations.
- Exploration of possible funding sources (for example from the
pharmaceutical industry) to support mechanisms to assist international
research training.
Professor
Chris van Weel c.vanweel@hsv.kun.nl
(On behalf of the research forum participants)
The Brisbane Initiative
Pursuing advanced research training and the establishment of a future
research leadership for primary care.
In 2002 a
group of experts met in Brisbane
to review strategies of advanced research training for primary care. The
meeting was an initiative of the Department of General Practice and Primary
Care, University of Queensland Australia, the Netherlands School of
Primary Care Research (CaRe) and the Scottish School of Primary Care (SSPC). It
also involved the Department of General Practice, Oxford
University UK
and the Department of Family Medicine, University of Wisconsin US.
All of these groups were involved in the training and supervision of
primary care researchers and responsible for a substantial primary care
research output. A common concern was the recruitment -and especially the
retention - of the most talented researchers for primary care. Research in
primary care is becoming well established, as is its practice and care for
patients. A key characteristic of primary care is its focus on the needs of
the particular local community that it serves, and as a consequence primary
care research has not benefited as much from the international expertise,
international exchange and collaboration as other areas of health care and
medicine have.
The Brisbane meeting
confirmed the potential of international co-operation and did lead to the
founding of the Brisbane International Initiative (BII). In April 2003 the
group met again at a meeting hosted by the Scottish
School of Primary Care in Dundee,
where the European General Practice Research Workshop (EGPRW), the
Department of General Practice of the University
of Göttingen
Germany, and the
Department of General Practice and Primary Care of the University of Ghent
Belgium
joined the group.
This
second meeting allowed the group to focus more clearly on the aims and
objectives of the BII. The aims of the BI are to build a future research
leadership and to structure career paths in order to retain the greatest
talents for primary care research. This requires spotting talented
researchers, training in advanced research skills, ,
supervision during 'hands-on' research activities, and the introduction to
the primary care research community.
This requires a set of activities over time, tailored to individual needs,
including formal courses, international exchange visits and mentoring,
resulting in sustained networking and research collaboration to :
· develop strategies for the building of future leaders of primary care
research.
· explore the value of advanced research courses, international exchange
visits, mentoring and collaboration in primary care research.
· share this experience with others involved in
primary care research.
These
activities were well aligned with the outcome of the recent Wonca Kingston Invitational Conference of research in
family medicine, held in March 2003. That is, in addition to building an
overall research capacity for family medicine around the world as that
conference set-out to do, there is the additional need to develop a
leadership of future researchers. Evidence-Based Practice (EBP) in the
primary case setting, Practice-Based Research Networks (PBRN) and
multidisciplinary research methodology (in particular qualitative and
participatory research) generic primary care research needs identified at
the Kingston conference present excellent opportunities on which to focus
the advanced courses, exchanges, mentoring and collaboration.
The target
group for the programme was defined as:
- talented students to be recruited for a research track: undergraduate
medical or other health care students
- promising junior researchers to be groomed for a research career: PhD
students
- researchers with an established track record in research to be retained
for a senior career: post docs.
Challenges
and restrictions were identified in both clinical and research settings.
There is a need to bring primary care clinicians into the leadership of
primary care research. The combination of clinical work with research is a
challenge throughout health care, but a feature of primary care is the
personal involvement of the family physician or other primary care
practitioner in his/her practice. As a consequence, primary care clinicians
can only be involved in international exchanges and visits, when these
involve limited periods of time. For that reason the group will focus on programmes with short periods of visits.
A second
point is the multidisciplinary nature of primary care research. Although
many of the current activities are related to family physicians, the BII is
committed to a multi disciplinary and multiprofessional
approach to the advancement of primary care research. This requires further
discussions before it is progressed, but for the time being, the family
medicine directed experiences will be focussed on
initially prior to a more generic application of the initiative to primary
care researchers at large.
As
activities for the coming period the BII is piloting a number of exchange
visits for promising undergraduate students, PhD students and post docs. In
particular the costs and benefits of short visits will be critically
reviewed. Other activties include the collation
of courses taught at postgraduate level that are suitable for, and would
benefit from, being undertaken by a multi-national group of students and
the occasional provision of short courses for post-doctoral researchers. At
the same time the BII is most interested to share its work with others
involved in the building of primary care research capacity. The BII is
currently preparing workshops in the context of a number of primary care conferences
and is eager to be contacted by like-minded groups.
The Brisbane Initiative:
Professor Chris Del Mar, Professor Paul Glasziou, Department of General Practice and Primary
Care, University of Queensland
Australia.
Professor
André Knottnerus, Professor Geert
Jan Dinant, Professor Chris van Weel (chairman BI), Netherlands School of Primary
Care Research (CaRe)
Dr. Sally Wyke, Dr. Lucy McCloughan,
Professor Frank Sullivan, Scottish
School of Primary
Care (SSPC)
Professor
David Mant, Department of General Practice, Oxford University, UK.
Dr. John
Beasley, Department of Family Medicine, University of Wisconsin, US.
Professor
Frank Dobbs, European General Practice Research Network (EGPRN)
Professor
Michael M. Kochen, Department of General
Practice, University of Göttingen, Germany.
Professor
Jan De Maeseneer, Department of General Practice
and Primary Care, University of
Ghent, Belgium
IFPCRN
International Federation of Primary Care Research Networks
Organized under Wonca, the World Organization of
Family Doctors
The International Federation of Primary Care Research Networks (IFPCRN) was
organized under the Wonca Task Force on Research
at the May 2001 meeting in Durban,
South Africa.
Nineteen individuals from seven countries participated. Chris van Weel offered, on behalf of the Wonca
Task Force on Research, to sponsor the listserver
and website for the new IFPCRN.
The
mission of the IFPCRN is to will support research for primary health care
for the benefit of patients by:
* the mutual support of research networks
* the exchange of ideas and methodologies
* advocacy for the quality of research in primary care
* capacity building
* policy and advocacy initiatives
* doing collaborative research
John
Beasley from the US
was selected as interim chair and Helen Smith (Chair of the UK FPCRN) as
interim co-chair. Francisco Gomez Clavelina from Mexico
has volunteered as editor of the newsletter and the website.
Membership
from individuals as well as from networks is being solicited at this time.
At a small, informal meeting of some IFPCRN members at the 2001 NAPCRG
meeting in Halifax some preliminary criteria for international projects
were established:
* an energetic and committed PI and support by clinicians in various
countries
* the question to be answered is of importance and interest to local
clinicians
* clear evidence of why an international approach is needed to answer the
question
The IFPCRN
members at the Halifax meeting also added to
the list of potential projects first articulated in Durban and identified several potential
PI's. The list of potential projects now includes:
* Impact of HIV/AIDS in primary care
* A day in the life of a family doctor
* How the stigma of mental illness impacts care
* Study of publication bias and impact of having a euro-centric literature
* Management of smoking
* Access to EBM and other information sources in different countries and
different areas
* Definition of alcohol abuse in different countries
* Contrasting care pathways (e.g. diabetes, maternity care)
* Patient expectations of care for (e.g.) pregnancy
* Perceived quality of life in different countries
* Role of FP/GP's in immunization programs.
Membership
in the IFPCRN is being developed rapidly, and now includes representatives
of networks or planned networks in 13 countries (Australia,
Austria, Canada, Kenya,
Korea, Mexico, Malaysia,
Netherlands, Pakistan, Peoples
Republic of China , South Africa,
UK, USA).
The two
most promising initial studies among the areas listed above are: a study of
what family doctors do when confronted with patients with HIV/AIDS, and a
study of the barriers to immunizations and how family doctors can better
assist with immunizing populations.
To meet
our goals of the mutual support of research networks and the exchange of
ideas and methodologies, the IFPCRN has established a listserver
through Wonca's Global Family Doctor and a
website.
This is
an external link to the IFPCRN website: http://www.ifpcrn.org/
To contact
the IFPCRN, please email John Beasley at jbeasley@fammed.wisc.edu
COOP/Wonca
Charts
The copyright of the COOP/Wonca charts rests with the
Department of Family and Community Medicine, DartmouthMedicalSchool, and Wonca. The Charts may be used for research and clinical
care. This excludes the right to distribute, reproduce or share the charts
in any form for commercial purposes.
When using
the charts in research, the researchers are invited to acknowledge the
origin of the charts and refer in publications to:
a. Nelson E, J Wasson, J Kirk, A Keller, D Clark, A Dittrich,
A Stewart, M Zubkoff. Assessment of function in
routine clinical practice: description of the COOP Chart method and
preliminary findings. J Chron Dis
1987; 40 (suppl 1): 55S-63S.
b. Scholten JHG, C van Weel. Functional status assessment in family practice:
the Dartmouth COOP Functional Health Assessment Chars/WONCA. Meditekst, Lelystad, 1992.
c. Weel C van, C König-Zahn, FWMM Touw - Otten, NP van Duijn, B. Meyboom - de Jong. Measuring
functional health status with the COOP/Wonca
Charts. Northern Centre for Health Care Research, University
of Groningen, The Netherlands,
1995.
Translation
of the charts is allowed under the above conditions, and should be done as
recommended in the publication Measuring functional health status with the
COOP/WONCA Charts - A manual in section 7: Criteria for crosscultural
use, 'Translation process and field testing' and 'Translation procedure of
the COOP/Wonca charts'.
Measuring functional health status with the COOP/Wonca Charts: A manual where there is more information about the COOP/Wonca Charts.
Introduction and Contents
Section One - Functional status measurement
Section Two - Description of the COOP/WONCA-charts, officially the Darmouth Coop Functional Health Assesment Charts/wonca
Section Three - Study populations, descriptive data
Section Four - Validity
Section Five - Reliability
Section Six - Responsiveness to change
Section Seven - Criteria for crosscultural use
Section Eight - Conclusions
References
Permission for use of the COOP/WONCA charts
Wonca Collaborating Centres
The aim of
establishing Wonca Collaborating Centres is to encourage research and development in
General Practice/Family Medicine by assisting, coordinating and making use
of the activities of existing institutions. This is seen as a more
practical approach to advancing Wonca's agenda to
develop General Practice/Family Medicine than establishing, under its own
auspices, international research and development institutions.
Current
Wonca Collaborating Centres
Family
Medicine Research Centre (FMRC), University
of Sydney, Australia
The work
of the FMRC centers on health services research and development in General
Practice/Family Medicine. The Centre has considerable expertise and
experience in the entire research process from the formulation of study questions,
to study design, grant applications, development of protocols, study
logistics, project management, data collection and classification,
statistical and analytical techniques, report writing and publishing.
The Centre
has undertaken major development work related to Wonca's
International Classification of Primary Care (ICPC) and is the distributor
of ICPC and an extended vocabulary, ICPC 2 Plus, in the Asia Pacific
Region. The two senior researchers in the FMRC are members of the Wonca International Classification Committee, Professor
Helena Britt and Dr Graeme Miller.
Further
information is available on the FMRC website.
This
is an external link to the FMRC website: http://www.fmrc.org.au/
Wonca Kingston Research Conference 2003 Preliminary Report
The World
Organization of Family Doctors 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".
To view
the report, click
here.
Survey of National Primary Care Research Institutes
In 2004 the Wonca Research
Working Committee commissioned a survey of National Primary Care Research
Institutes, which was carried out by Bob Phillips and Jackie McGee of the Robert Graham Center,
and completed in 2006.
To view the document,click
here.
The plan for making research an integral part of every family practice
The Wonca Research Working Group met in Florence on August 26th
and 27th 2006 and endorsed the idea that every family physician should have
the generation of new knowledge about family practice as an integral part
of their own practice. The accompanying set of slides and bibliography
provide a background rational for this plan.
To view the slides as a
PowerPoint presentation, click here.
To see the research bibliography, click here.
The Wonca Working Group on Research hopes to
promote this idea over the next 3 to 5 years, and hopes to recruit
volunteers to promote the idea in many countries around the world.
If you are interested, please email the Wonca
Working Group on research at rosserw@HDH.KARI.NET
Understanding Networks: The Functions of Research Policy Networks
by
Enrique Mendizabal
Working
Paper 271 - Overseas Development Institute, London
UK,
June 2006.
This is an informative research resource on the Overseas Development
Institute website.
To view it in PDF format, click here.
Educational opportunities for those interested in gaining research skills for Family Practice Research
Created by the Wonca Working
Group on Research
This important document arose from a proposal by the Wonca Working Group on Research for a web-based
clearing house for all courses involving research methods and training that
are currently available. The clearing house has two 'layers'. The first
layer is a list of countries with a list of courses available in each
country under the country name. Clicking on any course listed brings up
either the information Wonca has collected on
each course, or directly connects to a website of the sponsoring
organization, or both. It therefore provides both an overview of what is
available and then any detailed information that someone might require.
More detailed information is on a second page, accessible from the first.
To
view part one of the document, click
here.
To
view part two of the document, click
here.
The need for research in primary care to solve global health problems
A position
paper The need for research in primary care to
solve global health problems from The Network - Towards Unity For
Health, click here.
This
is an informative research resource off the Wonca
website.
To view the document, click here.
Please report any broken links to jksoler@synapse.net.mt
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