Research in general practice……

Rawiri Keenan, MBChB (Otago)

So why should you care or even think or try research?

How can you as a ‘everyday’ GP do/partake in research?

Objectives/overview

• Background to me and my role/journey• Different ways to be part of research• Research types/methods• How to come up with an idea• Research Process• Ethics Applications

Not covering

• Detail of research methods• Stats• EBM – Literature reviews

Who am I?

• GPEP2 Research Registrar • Waikato Faculty Rep• Honorary Academic in General Practice

– UoA• GP in Te Awamutu• Medical Advisor – Midlands Health

Network

Who are you all?

• Where are you currently working?• What stage of GPEP are you at?• Any prior experience in research?• Any interest in research?• If so where/what field?

WHY RESEARCH

Asking a question

• Each day health care practitioners have questions about patients they are treating:– How common is this condition? – How accurate is this diagnostic test? – What is the best treatment?  – What is the likely prognosis for this

patient?

Finding Answers

• Dr Google• Medscape• Bpac• Local PHO/DHB/Specialist etc• Journals or Librarian

Research Types

• Quantitative– RCT/case control/cohort etc – all the usual

big medical stuff

• Qualitative– Talking to people – education/ lifestyle

change

Ways of doing research

• In practice audit – CQI• Local audit – groups of practices• Part of university course• Join up with other experienced

researchers• Lead own project• Academic Teaching

Why is research important?

• Informs our decision making• Furthers the cultural growth of primary

care• Real in the field work – not academic• Not top down - secondary based

– Do we know this applies to primary care?

Why is research important?

• Studying the natural history or prevalence of common problems and major diseases

• Understanding how patients, families, communities, and systems deal with health and illness

• Improving doctor-patient communication, decision making, and partnership

• Testing systems to improve patient satisfaction, safety, and outcomes

Primary care research includes: – Translating science into the practice of medicine

and caring for patients – Understanding how to better organize health care

to meet patient and population needs – Evaluating innovations to provide the best health

care to patients – Engaging patients, communities, and practices to

improve health

Simplified & Repeated

• Observational study to show what is really there

• Show how well we are or aren’t doing things

• Show how hospital studies show one thing – real world shows another

• Shows things with a patient focus

• Master of Medical Science/Masters of General Practice

• Taught masters– Dissertation (60 Points)– and 60 points from the courses listed in the Master

of Medical Science Schedule, including an approved research methods course if such a course has not already been passed.

• Research masters– Research Portfolio (90 Points) and 30 points from

approved courses listed in the Master of Medical Science Schedule.

A group of practices devoted to the primary care of patients, and affiliated in their mission to investigate questions and to improve the quality of primary care.

PBRNs often link practicing clinicians with investigators experienced in clinical and health services research, while at the same time enhancing the research skills of the network members.

The research process

• Learn by doing

1. Choose a broad topicCLINICAL QUESTION OR INTEREST

2. Get and overview of the topicWHAT HAS BEEN DONE ALREADY

3. Narrow the topicACTUAL CLINICAL PART YOU WANT TO

KNOW4. Develop thesis/ purpose statement

WHAT IS THE ACTUAL AIM/ RESEARCH QUESTION

Research process

PICO(t)

• Participants/Patients• Intervention• Comparison• Outcome

– Time

Exercise

Research process

• Plan for research and production• QUESTIONS TO GUIDE YOU

• Find, analyse, evaluate sources• HOW YOU MIGHT OBTAIN INFO• Have practice runs – need collection form for

ethics

Ethics Committees

• POPLHLTH 701 – essentially the assignment is ethic application so can do both with one go

• Expedited review cover here – full ethics a lot more work and definitely needs input

• Essential for publishing, even things covered under QI initiatives

Filling out a form

exercise

exercise

FEEDBACK

Feedback

• Papers• Conferences• Peers

• Be prepared to skip over stuff• Decide what is critical

So why should you care or even think or try research?

• We all need to know how to answer clinical questions

• Using local info far more powerful than overseas

How can you as a ‘everyday’ GP do/partake in research?

• If nothing else – audit in your own practice, but think about getting ethics application and teaming up with others in your area

• Think about a PG Dip – can always add the masters part later

General Tips

• If you have an idea – talk to someone• If you are interested in research but

have no idea talk to someone• Watch for scope creep• Be prepared for set backs

Some resources

• http://www.researchtoolkit.org/• www.annfammed.org • Journal of Primary Health Care

Search techniques

Look/search the core journal

Or following links from a key article/document

Limits – different year/study types etc

*Truncation - Search for different word stems and word endings

$Wild cards – search for spelling variants

Database searching

Boolean operators Join keywords:

ANDORNOT