Tiago Villanueva: What’s new in European primary care research?

Tiago_VillanuevaThe University of Antwerp, Belgium, recently hosted the 75th meeting of the European General Practice Research Network. Paul Van Royen, dean of the Faculty of Medicine and Health Sciences at the University of Antwerp spoke about the challenges for primary care research, namely innovation, transferability, interprofessionalism, social impact, and partnership. In terms of innovation, he stressed that primary care research needs increasingly to make use of the translational pipeline (including basic sciences), with a good example being the TRACE project. He added that it is also necessary to improve recruitment of patients to clinical trials, which would allow, for instance, to answer many questions about treatments for acute stroke in just 24 hours.

Even though the advantages of a strong primary care system are widely acknowledged, Peter Groenewegen, who heads the Netherlands Institute of Health Services Research (NIVEL), explained that there is less strong evidence concerning the effects of  strong primary care in Europe due to a number of reasons. Much of the research has been carried out within the US (for example, by the late Barbara Starfield), international comparative studies are usually made up of a group of many heterogenous countries, and most studies carried out have been mainly ecological and cross sectional.

He also described the primary care research agenda for years to come, which include themes such as internal organisation (team skill mix, task delegation, role of practice nurses), quality (diagnostic delay, disease management, care for patients with multimorbidity), support amongst the population as well as doctors (gate keeping, triage), external coordination (integration of primary care and public health, substitution from secondary care) and costs.

It’s always exciting to listen to internationally renowned academic primary care “heavyweights,” but there was also the opportunity to look at what budding young researchers are up to. Portuguese primary care physicians and researchers Liliana Laranjo and Ana Luísa Neves said that they want to carry out four focus groups with 10 adult patients in order to “explore the needs and perceptions of patients with high cardiovascular risk relating to education for risk reduction.” At the end of their study, they expect to gain a better understanding of the needs and perceptions of patients with high cardiovascular risk, which could allow the implementation of a patient centered approach regarding their education for risk reduction. Several members of the audience suggested to Ana Luísa and Liliana to start their study with semi-structured interviews rather than focus groups.

Furthermore, there were many medical students giving presentations at this meeting, which is quite unusual. Maike Buchmann, a medical student at the University of Gottingen, carried out narrative interviews with type 2 diabetic patients in order to understand how they experience living with diabetes and with the pressure to adopt healthy lifestyles. She found out that those patients often react to guidelines and professional advice by feeling pressured to give up normal life and life’s pleasures. The solution may lie in  carefully considering the patient’s experience when recommending treatment, which may end up reducing pressure on them or may even make patients look more positively on these lifestyle changes.

Even though the meeting was chiefly Eurocentric, there were also some inspiring presentations from GPs from outside Europe. Gálo Sanchez, president of the Ecuadorian society of family medicine, showed the results of his research on the obstetrical skills required for medical students and doctors to work in rural Ecuador. He explained that even though working for one year in rural areas is required in order to gain a licence to practice, most of the 39 final year medical students who took the clinical exam did not pass it and may thus not be adequately prepared/skilled to work in rural areas. These are worrying findings considering that the maternal mortality rate in Ecuador has increased substantially between 2007 and 2010.

Tiago Villanueva is a GP based in Portugal, former BMJ Clegg Scholar and editor of the studentBMJ. He is an epidemiology student on the international programme at the London School of Hygiene and Tropical Medicine and an individual member of the European General Practice Research Network. He paid the meeting fee and his own travel and accommodation expenses to/from Antwerp.