How different is research in GP and does it make a difference ?

3. How different is research in GP and does it make a difference ? Prof.J.Degryse Md PhD K.U.Leuven Профессор Йан Дегрис Conference Sint-Petersburg Russia May 26-27th 2014

4. Introduction • Is primary-care research a lost cause ?(The Lancet 361, 2003 editorial) • The state of primary-care research (Mant et al The Lancet 364, 2004) • The need for research in primary care(De Maeseneer et al The Lancet 362 2003)

5. Two main issues • The purpose of research in GP • Is primary care researchdifferentfromotherbiomedicalresearch ?

6. 1.The purpose of primary care research • Primary care needs an evidence base • Primary care research focusus on clinical practice • The main function is to inform clinical practice in primary care. • Primary care research can influence clinical practice effectively A few examples:

7. Fig 1 Odds ratios of various outcomes among children with acute otitis media who were treated with antibiotics or placebo Del Mar, C. B et al. BMJ 1997;314:1526

9. «The strength of primary-care research in any country isprobably a good indicator of the strength and quality of primary care in that country. » Douglas JD. Lancet 2003 Or vice-versa ?

10. 2. Is research in GP different ? • NO: « There is only ONE kind of research: good research » • YES: « It is different and it makes a difference »

11. Yes ! Primary Care research is different: • The huge variety of methods that are used. (Methodology) • The very large domain of interest. (Domain and focus) • An interest for the outcome for a particular individual (the individual patient as focus of research) • As much interested in health and health promotion as in diseases and their therapies(focus on mechanisms of health conservation)

12. Primary Care Research can also make a difference • It’s dilligence to generate scientific knowledge and better understanding of « every day life-problems and complaints ». • It’s purpose to produce results that can trigger better quality of care for chronic diseases i.e. better understanding as well as better management of patients wilth multiple disabilties resulting from thos diseases. • It’s ambition to integrate scientific reflection in to clinical practice.

16. NO ! Is research in primary care different? • A rigourous scientific methodology should be used. (Methodology) • A clear and detailed focus should be formulated. (Domain and focus) • As combination of psychometric and traditonal biomedical aproches should be used (the individual patient as focus of research) • Not the research topic matters but the correct methodology . (Domain and focus) • Results should also be published in high impact journals(Publish or perish ! )

17. Part 2: Three strategic examples Recruiting teaching practices to participate in a punctual research.(example: respiratory research) Building a network of sentinel practices(example: the INTEGO network) Investing in large scale observational cohort studies. (example: the BELFRAIL study)

18. Averroës , a primary care research network « L'aveugle se détourne de la fosse où le clairvoyant se laisse tomber. »[ Averroès ] Averroës Averroes was a defender of Aristotelian philosophy against Ash'ari theologians led by Al-Ghazali. Although highly regarded as a legal scholar of the Maliki school of Islamic law, Averroes' philosophical ideas were considered controversial in Muslim circles.Averroes had a greater impact on Western European circles and he has been described as the "founding father of secular thought in Western Europe

19. Why such a research network ? • To promote and implement relevant clinical research « on site ». • To sensitize clinciens for clinical research. • To bring “added value” to the daily work of family physicians. • To create a group of motivated experienced and competent clinicians that can collect data and provide reliable and relevant input.

20. Some outcomes: • DIDASO I, • DIDASCO II • SPIROSTOP • Chronic Cough in children

21. Differential diagnosis • What is the diagnostic accuracy for asthma and COPD of subsequent diagnostic steps in a population older than 40 years with probable obstructive airway disease?

22. Spirometry and smoking cessation ? • Smokers with documented airflow obstruction have higher odds for smoking cessation (Bednarek, Thorax 2006) • •If randomized allocation to spirometry or not there is no significant difference in smoking cessation rate (Buffels J, Degryse J Respir Med 2006)

23. “The BFC80+ was designed to acquire a better understanding of the epidemiologyand pathophysiology of chronic diseases in the very elderly and to study the dynamic interaction between health, frailty and disability in a multi-system approach”. . . .

25. Intego: a continuous registration network. Since 1994 220.000 patients 86 GPs-55 practices 1.500.000 patient-years Diagnoses, prescribed drugs, laboratory results, background All contacts Thesaurus (+ ICPC/iCD10

26. Incidence of asthma & COPD according to age & sex

27. Myocardialinfarction & COPD : time trends Smoking?

28. Table 8: Top 20 most frequent new diagnoses, 2007-2009 28

29. More specific analyses:

30. Continuousmorbidityregistration: requirements • (One) structured software packagewith a thesaurus enabling coding of the maininformation in background • Denominator • Central database (will soon become a big one) • GPsselectedon the basis of the goodquality of theirregistration (rare) • Smallgroup of researchers centrally

31. To summarize • Yes research in primary care has a great future ! • Yes it can make a difference ! Спасибо!