Tiago Villanueva: Learning about European general practice research in Krakow, Poland

Tiago_VillanuevaLast week I left the 30ºC heat of Lisbon for the almost sub-zero temperatures of Krakow, and made premature use of my winter gear. But the cold was not enough to deter me from attending one of my favourite conferences, the biannual meeting of the European general practice research network, which gathers dozens of people interested and involved in primary care research.

Adam Windak, the pioneer of the family medicine movement in Poland, gave an impressive presentation about the history and state of family medicine and primary care research in Poland. He said that after many years of calling for more inclusion of primary care in the medical school curriculum, there are currently departments of family medicine in all universities in Poland, with a minimum of 105 teaching hours during basic medical education. Regrettably, only half of the heads of the departments of family medicine are practising GP’s, and for some reason, many of the others are nephrologists. Nevertheless, there are over 200 PhD theses and four post-doc theses completed by GP’s in Poland (and three others in progress).

While Greece may currently have the highest debt burden in Europe, for some reason it also seems to be the champion of outpatient antibiotic use, according to Samuel Coenen, a researcher from the University of Antwerp. His presentation provided food for thought as to what we’re doing in terms of antibiotic prescription in Europe. According to data that he showed from observational studies included in the GRACE project (Genomics to combat resistance against antibiotics in community acquired lower respiratory tract infections in Europe), the variations in clinical presentation do not justify the staggering degree of variation in terms of the quality and quantity of antibiotic prescribing between institutions in 14 different European cities. For example, the rate of prescribing was 20% in Barcelona and 80% in Bratislava, but Coenen stressed that these results are not representative of each country, but rather of the individual primary care centres.

Current knowledge about the long term complications of infectious diseases like giardiasis is limited, particularly in settings of high human development. Knutt-Arne Wensaas explained how a cohort study he and his team at the University of Bergen carried out after a large community outbreak of giardiasis in Bergen in 2004 found out that patients infected with Giardia lamblia had an increased risk of developing irritable bowel syndrome and chronic fatigue.

Another presentation focused on the lack of full understanding regarding the exact sexual practices which lead to the transmission of hepatitis C virus (HCV) infection among HIV infected men who have sex with men. Camilla Antonneau, a medical student at the University of Antwerp, wondered whether GP’s had enough awareness about the risk factors for sexually transmission of HCV, and thus carried out an online survey to all Flemish GP’s involved in vocational training at the four universities in Flanders, to which 187 GP’s responded. Several studies have shown that rough sexual techniques, ulcerative sexually transmitted infections, use of recreational drugs, and inconsistent condom use are significant risk factors. She found out that 26.2% of GP’s reported seeing few or no patients with sexual transmitted infections, so it’s likely that this is an overlooked issue.

Now, imagine you could predict a diabetic patient’s level of response to oral anti-diabetic drugs or predict the patient’s susceptibility for developing coronary artery disease or diabetic retinopathy. Paul van Royen, from the University of Antwerp, presented the TRANSFORm project. It has cost seven million euros and was partially funded by the European Commission. It could pave the way to potentially providing answers to those questions through the use of large scale research data. The idea is to create a “learning healthcare system” by combining phenotypical data, obtained through sources in hospital and primary care research databases (in this case, about type 2 diabetes complications), with genomic data like genomic markers obtained through sources such as biobanks and specific research databases. This will require both the understanding and the ability to connect various data sources, and van Royen admitted that the European Commission found the project overly ambitious. But who said European primary care research shouldn’t be ambitious?

Tiago Villanueva is a GP based in Portugal and former BMJ Clegg scholar and editor, student BMJ. He personally paid for all the travel and accommodation expenses incurred during his stay in Poland.