Building research capacity

- a pragmatic approach

Tom Brett

and

Diane Arnold-Reed

The General Practice and Primary Health Care Research Unit

School of Medicine, Fremantle University of Notre Dame Australia

Director: Prof Tom Brett R&D Co-ordinator: A/Prof Diane Arnold-Reed Research Support Officer: TBA Statistics Advisor: Prof Max Bulsara (Institute for Health Research)

Research Officers: Project specific Medicine Honours Students

General Practice Research Network (GPs, PNs, Nurse Practitioners, Allied Health)

Medicare Locals

2006-2011: Commonwealth Department of Health and

Ageing, Primary Health Care Research, Evaluation and

Development (PHCRED) Strategy (Phase II)

WA PHCRED

University of WA

Combined Universities Centre for

Rural Health

University of Notre

Dame

Participate

(independently or

collaboratively) in

research which will

inform practice

Identify research

projects that will

engage general

practice interests

Develop a group of

general practices

capable of

undertaking clinically

relevant research (ie

research practices)

Encourage GPs and

other health

professionals to have

“hands on” roles in

research projects

Support

undergraduate

student interest in

primary care

research

Foster broader

consumer

involvement in

primary care

research

Encourage primary

health care

research interest

partnerships with

other areas

Provide core

academic support

for primary care

researchers

RESEARCH UNDERTAKEN

•Fremantle Primary Prevention Study-Risk factor modification studies for cardiovascular

disease

•The role of practice nurses

•Consumer participation in primary care research

•Prevalence of chlamydia in young men

•Patients’ perceptions of barriers to discussing and testing for sexually transmitted infections

(STIs) in general practice.

•Knowledge and attitudes to prostate cancer

•Tracking outcomes of prostate cancer patients through primary and tertiary presentations

using WA data linkage

•An analysis of the extent of multimorbidity and disease burden in patients attending two

Western Australian general practices

•Multimorbidity in drug-addicted patients enrolled in a community based methadone program

delivered through general practice

•Multimorbidity in a mobile street clinic

•GP Registrar work intentions study

•GP 45+ retirement intention study

•General practice as potential career aspiration for graduate entry medical students

•Capacity census of General Practices in Western Australia

• Effects of a Combined Group Exercise and Counselling Program on Selected Physiological

and Psychological Parameters in Breast and Prostate Cancer Survivors

PROJECTS UNDERTAKEN Improving access and reducing inequity Better management of chronic conditions

Increasing the focus on prevention Improving quality, safety, performance and accountability

BUILDING RESEARCH CAPACITY

University of Western Australia

Medicare Locals (Fremantle, Armadale/Bentley, PECML)

Consumer involvement in research

State Health

WA Hospitals

Other overseas Universities/collaborations

Institute for Health Research (IHR) UNDA

Publications/Conference presentations

SoM Fremantle and Sydney

EXAMPLES OF RESEARCH IN PRACTICE

Fremantle Primary Prevention study

Patients presenting to GPs

Initial screening

Not within age range for study

Prior cardiovascular event

Incapable of giving informed

consent

Transient visitor

Physical inability

Eligible participants n=1200

Informed consent

Demographics, baseline measures of risk

Group 1 n=3X200

Consultation and data collection

3 months

6 months

9 months

Opportunistic

follow-up

12 month final data collection

Group 2 n=3X200

Actual participant flow

Patients presenting to GPs

November 2006-July 2008

Initial screening (n=1230)

Exclude n=30 No baseline data collection

Eligible participants n=1200

Informed consent

Demographics, baseline measures of risk

Intensive n=3X200

Consultation and data collection

3 months (35+18)= 547

6 months (51+12)= 537

9 months (67+8)= 525

12 month

follow-up

12 month final data collection

Intensive n= (9+10)=543

Opportunistic n=(15+16)=569

Opportunistic n=3X200

6

6.05

6.1

6.15

6.2

6.25

6.3

Intensive Opportunistic

Ab

solu

te C

ard

iova

scu

lar

Ris

k (%

)

599 537 599 563

*

(1.17-11.39) (1.17-11.37)

(1.16-11.04)

(0.68-11.62)

MULTIMORBIDITY STUDIES

Methods

Cummulative Illness Rating Scale (CIRS)

Patient records reviewed

42+ chronic conditions across 14 body domains graded

0 : No problem

Grade 1 : Mild current problem or past significant problem

Grade 2 : Moderate morbidity/requires first line therapy

Grade 3 : Severe problem/constant and significant morbidity/hard to

control

Grade 4 : Extremely severe/immediate treatment required/organ

failure/severe functional repair

•Maximum score in each domain counted~ presence within a domain

•Total score: addition of maximum score across all domains

•Severity Index: Total score divided by number of domains affected

1 2 3 4 5 6 7 8 9 10 11 12 13 14

VALUE TO CLINICAL PRACTICE

•Currently, risk calculators sub-optimally used

•Use of risk calculators helps identify at-risk patients In our study at baseline, 19% had 10% or above risk

•Many GPs and specialists still rely on single risk factors

•Can introduce strategies to modify risk factors

•Study - targeted interventions can produce change

•Primary care should streamline assessment, care plans

•Overall better patient management

Fremantle Primary Prevention Study

Multimorbidity Study

•Identify at risk age group

•Consult length

•Care plans / integrative approaches

•Medication review / withdrawal

•Overall better patient management

•Care team / Allied health / Carers

FUTURE DIRECTIONS

A pragmatic exercise programme delivered through general

practice for pre-diabetic patients

Multimorbidity in underserved populations:

•expand with data linkage

•health economic evaluations

•other services WA, NSW and Victoria

•Multimorbidity in mainstream general practice

•expand with data linkage

•health economic evaluations

•other States

Translational studies:

•Familial hypercholesterolaemia and dyslipidaemia- GP approaches

to identification and care (data based and interventional)

•Effectiveness of iron infusion in primary care setting

Current/future projects

Keeping management in primary care