ViewpointThe state of primary-care research
Section snippets
Primary care needs an evidence base
Research in primary care is essential because: (1) clinical and preventive care must be underpinned by research evidence; (2) the bulk of such care in most countries, especially poorer countries, is delivered in primary care; and (3) evidence to underpin this care (for example, the diagnosis and appropriate management of headache, vomiting, rashes, diarrhoea, fever, joint pains, chest pain, abdominal pain, cough, breathlessness, vaginal bleeding—the list is long and ranges across all specialist
Primary-care research should focus on clinical practice
The Lancet editorial suggested that the focus of primary-care research should be the family. This is a serious misunderstanding. The main function of primary-care research is to inform clinical practice in primary care. A government review in the UK characterised the research need in terms of four “evidence gaps”—about the effectiveness of interventions delivered mainly in primary care, the applicability of hospital-based research to primary care, the implementation of best evidence in
Primary-care research can affect clinical practice
These governmental decisions to support and develop primary-care research were affected by the observation that high-quality research that influences clinical practice can be done successfully in primary care. This is particularly clear in relation to the management of conditions seen only in primary care. For example, publication of the results of the first primary-care-based treatment trial of otitis media in children over 20 years ago10 revolutionised the clinical management of this disease
Achieving high quality primary-care research
Achievement of excellence in clinical research depends above all on recruitment of the most able and committed people to the discipline. In many countries, primary care is still perceived as second class,30 and the academic career structure in primary care is often notable for its financial and career insecurity. This problem will not be easily overcome without government intervention at a national level to address barriers to recruitment and retention, and this will not be a short-term fix.
Achieving integration with clinical care
High-quality applied clinical research requires integration of research into clinical services. Primary care is certainly not unique in this requirement—the freedom with which clinicians of all disciplines can make evidence-free clinical judgments contrasts starkly with the barriers to undertaking research to supply the evidence.31 For example, we can contribute to the global problem of antibiotic resistance by prescribing antibiotics for common viral infections without accountability or
Conclusion
Primary-care research is not a lost cause. It is an important cause. Effective prevention in primary care avoids serious diseases. No disease can be cured unless someone, usually in primary care, first recognises it. No long-term treatment works unless it is administered effectively, again often in primary care. All these clinical activities need the leadership, reflection, and underpinning evidence that primary-care research provides. The strength of primary-care research in any country is
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