Commentary on Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 5: Needs and implications for future research and policy

Spearheads for research in general practice/family medicine and primary health care in Europe

The European General Practice Research Network (EGPRN) has provided the discussions on priorities in research in general practice/family medicine (GP/FM) and primary health care (PHC) with an important background document. In this issue the conclusions are presented, framing a broad perspective for setting the future research agenda (1). It will be strategically important to define some spearheads that may guide priority setting for the next decade. The following principles could be used to underpin the debate: relevance, equity, quality, cost effectiveness, sustainability, person-centeredness, and innovation.

Translational research

A first strategic spearhead is related to the positioning of research in GP/FM and PHC in the framework of translational research. Dzau et al. have defined the sequence of ‘discovery, translation, clinical research, translation and adoption, global health’ for the full continuum of research. Research in GP/FM is perfectly suited to explore the translation from clinical research to the community: development of practice guidelines, practice adoption, community assessment, systems of care delivery and health-services research all contribute to the ‘fourth translation’ (2). Departments of GP/FM and PHC have an excellent position within the academic health sciences systems to initiate a creative synthesis in which technological innovations; effective treatments and delivery of care are combined to formulate common solutions that can be applied to individuals and large populations. By doing so, they can bridge the gap between expert acceptance of the application and its broad adoption in practice by local and global communities. Already in 2005, Woolf et al. have demonstrated that society's huge investment in technological innovations that only modestly improve efficacy, by consuming resources needed for improved delivery of care, may cost more lives than it saves. The misalignment of priorities is very often driven partly by the commercial interests of industry and by the public's appetite for technological breakthroughs, but health outcomes ultimately suffer. Health, economic and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care (3).

Equity

A second spearhead could be related to ‘equity.’ The Commission on Social Determinants of Health of WHO in the report ‘Closing the gap in a generation’ recommends that national governments with civil society and other stakeholders build health-care services on the principle of universal coverage of quality services, focusing on primary health care (4). GP/FM has an essential role to play in improving accessibility of health care (5). More research is needed to explore how social, cultural and environmental circumstances influence health differences and how PHC can be a strategy to achieve equitable care (6). New research methods e.g. action-research may document possibilities of interventions, not only at the practice-level but also at the community level, e.g. through ‘Community Oriented Primary Care’ (7).

Chronic disease

A third spearhead can be related to the most important demographic and epidemiological challenge of the 21st century: the care for people with chronic conditions. GP/FM is the discipline that is well placed to look at chronic care from a comprehensive perspective. We deal with patients with multi-morbidity that need more than a set of guidelines, related to their conditions. Research should explore the need for a paradigm-shift from ‘problem-oriented’ to ‘goal-oriented’ care and how ‘chronic disease management’ may evolve towards ‘participatory patient management’ (8). Research is needed to look critically at vertical disease oriented programs that take into account complexity and living conditions of chronic patients (9). Interdisciplinary research will help to understand the importance of medical, contextual and policy evidence and how this can be integrated in primary care practices.

Health systems research

A final spearhead could be research on Global Health Systems Impact Assessment (10). Every change in care delivery has implications for the health system. Access to expensive therapies, may be a threat on equity, development of selective disease-oriented care programs may affect social cohesion…. Therefore, primary health care should, together with other disciplines (e.g. health economics, public health), engage in Health Systems Research embracing a global perspective, with special attention to underserved groups and developing countries.

In summary: spearheads of future research in Europe in the field of GP/FM and PHC should be socially accountable and could include translational research, equity, chronic care, health systems research. We will need to find the necessary resources, the knowledge and the skills to realise this new research contribution for the 21st century.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.