Improving Health Care Globally: A Critical Review of the Necessity of Family Medicine Research and Recommendations to Build Research Capacity

Abstract

An invitational conference led by the World Organization of Family Doctors (Wonca) involving selected delegates from 34 countries was held in Kingston, Ontario, Canada, March 8 to12, 2003. The conference theme was "Improving Health Globally: The Necessity of Family Medicine Research." Guiding conference discussions was the value that to improve health care worldwide, strong, evidencebased primary care is indispensable. Eight papers reviewed before the meeting formed the basic material from which the conference developed 9 recommendations. Wonca, as an international body of family medicine, was regarded as particularly suited to pursue these conference recommendations:1. Research achievements in family medicine should be displayed to policy makers, health (insurance) authorities, and academic leaders in a systematic way. 2. In all countries, sentinel practice systems should be developed to provide surveillance reports on illness and diseases that have the greatest impact on the population's health and wellness in the community. 3. A clearinghouse should be organized to provide a central repository of knowledge about family medicine research expertise, training, and mentoring. 4. National research institutes and university departments of family medicine with a research mission should be developed. 5. Practice-based research networks should be developed around the world. 6. Family medicine research journals, conferences, and Web sites should be strengthened to disseminate research fi ndings internationally, and their use coordinated. Improved representation of family medicine research journals in databases, such as Index Medicus, should be pursued. 7. Funding of international collaborative research in family medicine should be facilitated. 8. International ethical guidelines, with an international ethical review process, should be developed in particular for participatory (action) research, where researchers work in partnership with communities. 9. When implementing these recommendations, the specifi c needs and implications for developing countries should be addressed.The Wonca executive committee has reviewed these recommendations and the supporting rationale for each. They plan to follow the recommendations, but to do so will require the support and cooperation of many individuals, organizations, and national governments around the world. S6IMPROVING HEALTH CARE GLOBALLY health care system for most people-is important. Most people receive formal medical care in primary care, 2,3 and it is in that setting most episodes of illness are treated. Family medicine is a key discipline of primary care, and in many countries family physicians are the only physicians directly accessible to the public. 4 Clinical decisions made on fi rst encounters often determine whether health care resources are appropriately used. 2,[5][6][7] Strengthening the knowledge base in primary care will contribute to better medical care for all.Against this background an invitational conference was organized by the World Organization of...

Global Health and Primary Care Research

“…[22][23][24][25][26][27] There is increasing recognition that research not only about, but also within, primary health care is essential in all countries. 23,27,28 Research conducted in other settings and specialties has limited relevance because primary care (1) encounters health problems rarely managed in other sectors of health care; (2) manages clinical problems in an environment of low probability of major acute disease; and (3) involves the concurrent management of multiple problems. 29 -33 In Australia, The Netherlands, the United States, and the United Kingdom there is clear recognition of the need to conduct research relevant to primary care 34 -36 ; there is no reason to think that the need is any less in countries with fewer resources.…”

“…25,27,37,38 Primary care research is essential for gathering evidence to improve health outcomes and to enhance the field of primary health care.…”

“…For example, collaborations can facilitate exploration of the needs and perceptions of patients, the ways they access and use health care services, 26,27 and issues in patient safety. 67 The primary care research environment is enriched by researchers who have a wide range of professional skills and who are motivated and able to work with primary care researchers.…”

“…50 Primary-care research networks (PCRNs) offer the potential for the adoption of new findings. 27,44,53 Although these conditions are not easy to attain, especially in developing countries, the presence of at least a few will facilitate the development of primary care research. Worldwide, there has been some success, although limited.…”

Research Published in 2003 by U.S. Family Medicine Authors

“…1,2 Although family medicine benefits from the research of other clinical disciplines and from research in the basic and social sciences, its practitioners also need answers to clinical questions from studies involving family medicine's own patient populations and practice settings. [3][4][5][6] Similarly, innovations in the organization of family physicians' offices and in the training of future family physicians depend on data from family medicine's health services and education researchers.…”