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 CD^1,2,  Duijker G^1,2,  Angelaki A², Tsiligianni IG¹ , Anastasiou FS¹, Prokopiadou DP¹, Antonopoulou MD¹,  Bertsias A², Chliveros K¹, Dimitrakopoulos SA¹,  Galanakis C¹,Galenianos Myron¹, Klouva E¹,Komninos G¹, KoutisA^1,2,  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 CI^1,2, 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.