Practice-Based Research Network
Practice-Based Research Network in Primary Care: a lacking story and learning points from an empirical model on Crete.
Authors:
Lionis CD1,2, Duijker G1,2, Angelaki A2, Tsiligianni IG1 , Anastasiou FS1, Prokopiadou DP1, Antonopoulou MD1, Bertsias A2, Chliveros K1, Dimitrakopoulos SA1, Galanakis C1,Galenianos Myron1, Klouva E1,Komninos G1, KoutisA1,2, Kounalakis DK1, Ladoukaki E1, Lintovoi E1, Makri KV1, Papadakaki M2, Papamastorakis E1, Petraki CS1,Psaroudaki C2, Saridaki A2, Stefanaki IN1, Symvoulakis EK1, Tsakountakis NA1, Vasilaki A1, Vasilaki E2, Vasilopoulos TK1, Vardavas CI1,2, Vittorakis C1
1Cretan Practice-based Research Network in Primary Care
2Clinic of Social and Family Medicine, School of Medicine, University of Crete
Background: Practice Based Research Networks (PBRNs) are valuable entities which are well established in countries such as the UK, New Zealand, Australia and the US. They facilitate research in primary care and provide community-based health care with the main aim to translate research findings into clinical practice. However, in certain European countries, including Greece, such networks are established with great difficulty. In a time where evidence-based primary care is a high priority and there are many unanswered questions relevant to the development of PBRNs particularly within countries with limited resources and under financial crisis.
Research questions: Is it possible to establish PBRNs in countries with limited resources and in areas where Academic General Medicine is underdeveloped? In which ways can PBRNs be organized and to what extent is the involvement of an academic department a necessity? Is it possible for a primary care physician to participate in such a research network? What is the role of the academic general practice in this network and what type of feasible methodologies and inexpensiveorganizational and contextual efforts should be developed and elaborated on?
Methods: In Greece, the Cretan Practice-Based Research Network (CPBRN) was established in July 2006 in collaboration with the Clinic of Social and Family Medicine, School of Medicine, University of Crete and consistsof 20 rural primary care practices. Rural experiences of the CPBRN -under the coordination of an academic department- have been utilized to address the above questions. To that purpose a "Stepwise Model", tested in rural Crete (Lionis et al., 2009) has been applied as an ongoing theoretical and empirical framework to guide the CPBRN. This network was built on three stages: 1) the selection of the participating qualified GPs mainly recruitedfromthe alumni of the University of Crete and GPs who completed their residency at the University Hospital, 2) the development and identification of research capacity,mainlyan electronic patient records system, 3) the development of clinical databases for morbidity monitoring.
Results: Until now 20 GPs have joined the CPBRN and among them 14 are serving rural areas and urban areas. 6 out of them 13were former medical or PhD students or residents of the University Hospital of Heraklion. Three clinical databases for monitoring and reporting herpes zoster (HZ), anaemia, community acquired pneumonia (CAP) and dementia have been developed. Morbidity from HZ andanaemiahave already reported in biomedical journals (BMC FamPract 2011, Asia Pac Fam Med 2012) and international conferences. Furthermore, the development of clinical databases for the monitoring of vaccination coverage among rural and high risk patients, uninsured patients and immigrants is in process. Regardless of the epidemiological interest that the existing databases have, certain findings of high clinical relevance within the implemented surveys have translated into actions for both primary care practitioners and policy makers. For example, the study of HZ in rural areas reported an incidence of 1.4/1000 patients per annum as well as highlighting a lower association of stress with post herpetic neuralgia in comparison with HZ. The funding for implementing practice-based research within this network was not a significant issue as financial support was sufficient through competitive collaborative European and national research programmes and sponsorships. The major noted issue was found to be the time restriction of the participating GPs, especially during the current period of financial crisis (Tsiligianni, et al, 2013).
Conclusions: The development of a PBRN is feasible in a country with limited resources especially in rural areas where morbidity recording and reporting is frequently lacking. Its discussion within the wide EGPRN-EURIPA audience could lead to a broad European dialoguethrough which the development of a PBRN could be facilitated leading to research in primary care and general practice, a beneficialfactor for both physicians and patients.
INTRODUCING THE CLINIC OF SOCIAL AND FAMILY MEDICINE
The Clinic of Social and Family Medicine (CSFM) is an independent division of the Department of Social Medicine, one of the ten Departments of the Faculty of Medicine, University of Crete. It is located in the Voutes Campus of the University of Crete, in Heraklion Crete. Founded in 1984 by Professor Michael Fioretos, to meet the needs of the local population and to promote research into general practice/family medicine and primary health care, the CSFM offers teaching and research opportunities to both undergraduate and postgraduate students. The Clinic is headed by Professor Christos Lionis and consists of a vibrant team of health professionals and scientists, working to deliver high quality teaching and research in the field of general practice/family medicine and primary health care. The CSFM operates an outpatient unit of the University hospital, as well as a university division within an academic setting, and is the only one of its kind in Greece.
The CSFM coordinates a Practice-based General Practice Research Network in collaboration with selected Health Centers and Rural Practices on the island of Crete. The network focuses on monitoring selected chronic conditions, while being involved in a number of research protocols in the area of General and Family Medicine, and Primary Health Care. The CSFM plays a key role in developing and delivering primary health care services, particularly to people residing in rural and remote areas with limited access to health care services. In 2009, a University Primary Care Unit was established in the urban area of Heraklion with the collaboration of the Municipality of Heraklion. The unit aimed at delivering health care to economically deprived individuals. In addition, the clinic functions as training site for 6th year medical students, during their Clinical Practice in PHC course, as well as for General Practice residents.
The Clinic has established collaborative arrangements with a number of universities and research institutes in Europe and the United States of America in order to develop multicenter studies and research protocols and to encourage staff and student exchange opportunities. The CSFM believes in the benefits of cross national and multidisciplinary collaborations, and the development of methods for reforming clinical practice in primary health care, which is reflected in a number of research programs funded by the European Union.
Practice Based Research Network in Primary Care
The Clinic of Social and Family Medicine (CSFM) has developed its research activities in close collaboration with GPs serving primary health care centres or individual practices on the island of Crete. A previous lack of networking and integration within the Greek setting, inspired the creation of a General Practice based research network to facilitate research and enhance capacity. The Cretan Practice Based Research Network (PBRN) under the current name: “G. Lamprakis”, was established in July 2006 by the CSFM and a number of Primary Care Practices served by GPs with a specific interest in research in primary care and general practice. Upon its establishment, the PBRN was endorsed by the 7th Health Region of Crete and it currently consists of 18 GPs working in Primary Health Care (PHC) settings. Of these practitioners, 15 work within the public healthcare system, two operate from private practices in Chania, and one is based at the primary care unit of Heraklion. The latter is a joint project between the Medical Faculty and the Municipality of Heraklion, developed to provide health care services to individuals who are financially deprived.
The Practice-Based Research Network is the first network in Greece to bring together University research activities and Primary Health Care Practice, introducing an innovative way to promote General Practice across the Country. It is also the first network to embrace both public and private GP practices. The network contributes to research activity, doctors' training, and quality of care in primary health care and general medicine on Crete. Its overall goal is to provide a quality service to meet the health needs of the local population.PBRN members meet monthly and are involved in writing, submitting and implementing studies in collaboration with CSFM.
PBRN objectives include:
1. The systematic amelioration of healthcare services provided by network members
2. Development of disease prevention programs
3. Focus on primary health care and rehabilitation
PBRN is also involved in the following:
1. Development of a database on selected common diseases and clinical contribution in primary health care
2.Design and implementation of cross-sectional studies that address the burden and epidemiology of chronic illness in the local population
3. Participation in national and European collaborative research programs diabetes (EUCCLID study)
4. Participation in dissertations of MSc and PhD students who conduct their studies under CSFM supervision
Nursing Working Group
The Nursing Working Group in Primary Care operates under the auspices of the Clinic of Social and Family Medicine (CSFM) of the Medical Faculty of the University of Crete. Its aim is to develop and disseminate knowledge and experience in Primary Health Care (PHC) nursing throughout the 7th Health Region of Crete.
This aim will be achieved:
1. by providing up-to-date, evidence-based nursing knowledge
2. by putting to use the possibilities of electronic communication and adopting an inter-disciplinary approach
3. by participating in research or educational projects to secure funding for particular actions.
The above principles are highlighted in the following selected areas of focus:
1. Integrated nursing care in the community
2. Evidence-based primary nursing care
3. Continuing education and training needs of nurses in PHC (Health Centres, Peripheral Practices, City Practices, Day Clinics, etc.)
4. Infrastructure – equipment – tools in Primary Care
5. Determination of the role, field of practice and minimum set of knowledge/skills/competencies for PHC nurses
6. Contribution of PHC nurses in health promotion and health education
7. Health services research in PHC nursing
8. Qualitative methodology in PHC
The Nursing Working Group in Primary Care is coordinated by Dr. Ada Markaki
(contact information: This email address is being protected from spambots. You need JavaScript enabled to view it. )
CLINIC OF SOCIAL AND FAMILY MEDICINE
Welcome to the Clinic of Social and Family Medicine (CSFM), which is an independent division of the Department of Social Medicine, one of the ten Departments of the Faculty of Medicine, University of Crete. It is located at the Faculty of Medicine in the Campus of the University of Crete, in Voutes Residential area in Heraklion Crete.
Founded in 1984 by Professor Michael Fioretos, to meet the needs of the local population and to promote research into general practice/family medicine and primary health care, the CSFM offers teaching and research opportunities to both undergraduate and postgraduate students.
The Clinic is headed by Professor Christos Lionis, and consists of a vibrant team of individuals, working to deliver high quality teaching and research in the field of general practice/family medicine and primary health care. The CSFM operates an outpatient unit of the University hospital, as well as a university division within an academic setting, and is the only one of its kind in Greece.