Transcript Role of academic primary care and research networks in Europe

Learning from international
networks in Europe
Igor Švab, MD, PhD, Danica Rotar Pavlic, MD, PhD
CONTENT
 The context
 Importance of primary care and family
medicine
 Wonca Europe and its networks
 Achievements
 Challenges
THE CONTEXT
EUROPEAN REALITY
 Diversity of cultures
 Diversity of religions
 Diversity of economies
 Diversity of pollitical systems
 Diversity of health care
systems
 Diversity of policies
 Diversity of practices
CRISIS OF ACADEMIC MEDICINE
 Academic medicine will have to put more effort into
relating to its stakeholders.
 Academic medicine will need to be ever broader in its
thinking and skill set, combining with and learning
from other disciplines
Clark, J. Five futures for academic medicine: the ICRAM scenarios. BMJ,
2005: 331:101-104
CRISIS OF RESEARCH
 Biomedical research isolates single diseases or
disease processes
 Disease is studied in highly selected patients
 Most medical research is designed to evaluate single
interventions
 Biomedical research tends to prefer “hard” outcomes,
such as death or change in measurable physical
indicators
Nutting PA. Practice-based research networks: Building the infrastructure of
Primary Care Research. J Fam Pract, 1996; 42:199-203
WHAT DOES AN OUTSIDER
HAVE TO OFFER?
 Answers to some
important questions that
can not be solved by
others
 Introducing new ideas
and concepts
 New methodologies and
approaches
ARE PRIMARY CARE
AND FAMILY MEDICINE
IMPORTANT?
If primary care has anything at all to do with
improving health, then its contribution will be
measurable. If not, it will be accepted as the
homeopathy of modern medicine.
Horton R. Is primary-care resarch a lost cause? Lancet 2003, 361: 977
EPIDEMIOLOGY & EDUCATION
HEALTH OUTCOMES
 The strength of a country’s primary care system is
associated with improved population health
outcomes
 Health systems with a strong primary care orientation
tend to be more equitable and accessible
 Using primary care physicians reduces costs and
increases patient satisfaction with no adverse
effects on patient outcomes
SUMMARY OF EVIDENCE
CONCLUSION AND A GOAL
Starfield B. Quality management in primary care –
an European approach. Berlin, 2005
INTERNATIONAL
ORGANISATIONS
WONCA EUROPE
 Organisation of national
colleges and network
organisations
 Established in 1995
What is a network
 Based in primary care or involving primary care
practitioners
 Involves facilitation of meetings and other collective
activities by primary care practitioners
 Supports the development of skills
 Functions through informal flexible and nonhierarchical support
Fleming DM. The role of research networks in primary care. EJGP1998; 4: 96-99.
Types of research networks
 Networks providing epidemiological data
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Sentinel networks
Morbidity surveys
Diagnostic validation
 Networks concerned with the process of care
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Quality assurance
Focused networks
Clinical trials
Interventions
International research networks
 EGPRN, NAPCRG
 Clinically based networks
 Epidemiology
 Research project groups
 QA projects
Conclusion
Practice based research networks are research
laboratories as essential to advancing the scientific
understanding of medical care as bench laboratories
are to advancing knowledge in the basic sciences…..
What these laboratories need now is broader
recognition of their viability, importance, & impact, &
acceptance that they merit sustained funding as a
continuing infrastructure.
Green LA, Dovey SM. Practice based primary care research
networks. BMJ 2001; 322:567-8.
Recommendations (Kingston 2003)

Systematic display of achievements

Sentinel practice systems

A clearinghouse

National research institutes and departments of family medicine
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Practice-based research networks
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Family medicine research journals, conferences, and Web sites.
Representation of family medicine research journals in databases.

Funding of international collaborative research in family medicine.

International ethical guidelines.

Specific needs and implications for developing countries.
Van Weel C, Rosser W. Improving Health Care Globally: A Critical Review of the Necessity of Family
Medicine Research and Recommendations to Build Research Capacity Ann Fam Med 2004; 2 (suppl2): S
5-16.
NETWORK ORGANISATIONS OF
WONCA
 EGPRN
 Euract
 Equip
 Euripa
 Europrev
 Vasco da Gama movement
 Special interest groups
EGPRN: the research network
 Established in 1974
 Regular meetings twice
a year
 Research courses
 Aimed at development
of young researchers
EURACT: the teaching network
 Founding member
 Established in 1974 as
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the Leeuwenhorst
group
New Leeuwenhorst
group
EURACT
Courses
Teaching materials
Teaching policy
documents
EQUIP: the quality network
 Quality of care
 Open conferences
 Many research policies
 Collaboration with other
agencies, interested in
quality (e.g.
Bertelsmann
foundation)
EURIPA
 Rural doctors
 Regular conferences
 Policy papers
EUROPREV
 Prevention
 Research papers
 Policy documents
 Regular meetings
VASCO DA GAMA MOVEMENT
 Young doctors
 Started in 2004
 Interested in teaching
and training
 Strong links with
EURACT
OTHER ORGANISATIONS IN
COLLABORATION
 Usually based around a clinical topic
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Primary care gastroenterology
Primary care cardiology
 European forum for primary care
 Occupational medicine
ORGANISATIONS WITH SIMILAR
GOALS
 UEMO
 WHO
 European forum for primary care
EUROPEAN JOURNAL OF
GENERAL PRACTICE
 Indexed in Medline
 Official journal of
Wonca Europe
 Taylor and Francis
publishing
ACHIEVEMENTS
ACHIEVEMENTS
 Wonca definition 2002
 Teaching agenda
 Journal
 Succesful conferences
 Managerial successes


Budget
Registration as a legal body
THE DEFINITION
 General practice/family
medicine is an academic and
scientific discipline with its
own educational content,
research, evidence base and
clinical activity, and a clinical
specialty orientated to
primary care
CHARACTERISTICS
a. First contact for all health problems
b. Coordination of care and advocacy of the patient
c. Person centred approach
d. Doctor-patient relationship
e. Longitudinal continuity
f. Decision making, which takes into account prevalence of disease in
community
g. Simultaneous management of acute and chronic problems
h. Dealing with diseases in early and undifferentiated stages
i. Promotion of health and wellbeing
j. Addressing health issues that are relevant to the community
k. Taking into account bio-psycho-social and existential dimensions of the
disease
COMPETENCES
1. To manage complaints in primary care
2. To be person centred in delivering care
3. To apply specific problem solving skills
4. To use comprehensive approach
5. To be orientated towards community
6. To use holistic modelling
EURACT teaching agenda
 A key element in
curriculum design
 Developed by EURACT
 Based on the definition
 Available in full text
through the EURACT
website
EUROPEAN JOURNAL OF
GENERAL PRACTICE
 Official journal of
Wonca Europe
 Taylor and Francis
publishing
 4 issues every year
 Indexed in Medline
Conferences
 A place to exchange
experiences and to
enjoy
 Rising numbers of
participants
 Towards a more uniform
programme
CHALLENGES
Do we need international cooperation?
 The needs of the individual doctor
 The needs of academics
 The needs of colleges
 The needs of pharmaceutical industry?
 The needs of patients
USUAL COMPLAINTS
 Injustice: we are not properly recognised, we
can not publish or get research funds due to
injust criteria, we can not reach decision
makers
 Stupidity of others: Nobody understands us,
our discipline is complex and difficult
The 4 traditional beliefs
 Describing the discipline in its complexity is
important
 Family medicine is different from other
disciplines
 Defining boundaries around the discipline is
important
 We must protect ourselves
Is describing the complexity of the
discipline important?
 Models are useful and have made us realise the
importance of the discipline.
 But they have generally not been translated in a
language that users would understand.
 Promotion of the discipline among users was often
lacking.
Are we so different?
 This argument was often used to give us a worse
position towards other disciplines.
 Family medicine is one of the many disciplines in
medicine.
 It deserves equal rights in terms of training, research
funding, publishing, participation and policy
decisions.
Is defining boundaries so
important?
 Defining boundaries is difficult and sometimes
problematic in a multidisciplinary system.
 The cooperation between the disciplines is more
important than the division among them.
 There is a lot other disciplines in medicine can learn
from us.
Must we protect ourselves?
 Family medicine is important because of its impact on
health.
 We must think about users, because they are our
strongest allies.
 Blaming others will do little to win the hearts and
minds of sceptics.
WE SHOULD ALSO
 Advertise our discipline
 Cooperate with other disciplines
 Work more with patients
 Stop complaining
WHAT NEXT?
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Research agenda
Dialogue with policymakers
Innovative approaches to conferences
Other meetings (e.g. Portugal 2008)
Cooperation with clinical specialists
Patients’ perspective
Marketing
Cooperation with other regions of Wonca
Long term goals, strategies etc.