Attitudes of primary healthcare chief physicians towards research in Finland – a national study

Figures & data

Table 1. The three open-ended questions of the survey.

(i) ‘What issue(s) do you need more information about at your health centre? (related to diagnostics / treatment / change of function / something else?)’ (ii) ‘What benefits do you see from the research for your health centre?’ (iii) ‘Would your health centre be willing to join the researcher health centre network and participate through the network in scientific research on primary healthcare in the future? (Where the choices were “yes”, “maybe”, “I don’t know what to answer”). If you answered “yes” or “maybe” to the previous question, what influenced your positive answer?’

Table 2. Responders’ characteristics.

Characteristics of responders (n = 65)	n (%)
Age
<30	0 (0%)
30–39	13 (20%)
40–49	18 (28%)
50–59	25 (38%)
≤60	9 (14%)
Gender
Women	35 (54%)
Men	30 (46%)
Native language
Finnish	61 (94%)
Swedish	2 (3%)
Other	2 (3%)
Degrees of higher education*
Master’s degree	1 (2%)
Leadership education (e.g. MBA)	7 (11 %)
PhD in medical science	7 (11%)
Other PhD	0 (0%)
No other degrees	41 (63%)
Docent	1 (2%)
Other	14 (22%)
Professional activity at the health centre
Managerial duties	61 (94%)
Administrative duties	64 (98%)
Patient care consultation	34 (52%)
Other clinical work	17 (26%)
Research	4 (6%)
Development work	54 (83%)
Training specializing doctors or other trainees	34 (52%)
Other	9 (14%)
Tenure at HCs (total work experience)
<5	3 (5%)
5–9	8 (12%)
10–19	27 (42%)
20–29	13 (20%)
≤30	14 (22%)

*Some chief physicians had more than one higher education degree.

Table 3. Characteristics of the participating HCs.

HCs (n = 65)	n (%)
HCs per served population
<10,000	14 (21%)
10–50,000	44 (68 %)
>50,000	7 (11 %)
HCs per hospital districts
Helsinki (HUS)	10 (15%)
Tampere (TAYS)	17 (26%)
Turku (TYKS)	11 (17%)
Kuopio (KYS)	17 (26%)
Oulu (OYS)	10 (15%)
Locality of practices
Rural	22 (34%)
Sub-urban	28 (43%)
Urban	15 (23%)
Number of physicians
<10	22 (34%)
10–20	20 (31%)
>20	23 (35%)
Number of trainee doctors
<10	47 (72%)
10–20	12 (18%)
>20	4 (6%)
I don’t know	1 (2%)
GP Specialists
<10	53 (82%)
10–20	8 (12%)
>20	4 (6%)

Figure 1. The needs and interests of health centres regarding research in descending order (%).

Table 4. Main results of the thematic analysis of the three open-ended questions with representative narratives.

Question (i) ‘What issue (s) do you need more information about at your health centre? (related to diagnostics “treatment” change of function “ something else?”)’
Themes:	Subthemes:	Narratives:
Increase patient and population benefits	Health benefits for population	‘Appropriate work schemes that provide health benefits to the population’
	Patient satisfaction	‘How operational changes and new team models affect the quality of care, patient satisfaction…’
	Continuity of care	‘Continuity is a clear priority, but the relationships to increase the continuity of care are surprisingly difficult to achieve.’
	Patient segmentation	‘What groups of patients should be invited to treatment and who can treat their health independently with the support of self-care?’
Effectiveness and improvement of care	Effectiveness of operating models	‘The effectiveness of the time spent by professionals on patient contact (quick one-case visit vs longer holistic contact).’ ‘Evidence-based information on the effectiveness of different operating models (team models, job transfers between different professionals, etc.) on patient care.’
	Effectiveness of digital and remote services	‘New digital services. Impact on new ways of working.’ ‘Information on the effectiveness of telemedicine – what can really be replaced.’ ‘Testing new technologies and development.’
	Improvement of quality of care	‘What action is useless or less successful?’ ‘Effectiveness and measurement of the quality of operations.’
Clinical Effectiveness	Effectiveness of treatments and interventions	‘Treatment interventions at the health centre to avoid providing ineffective things.’ ‘On effectiveness of treatments.’ ‘(Testing) New treatments.’
	Diagnostics	‘Diagnostics related to treatment.’
Effective resource allocation/financial modelling use	Effective use of resources, cost-effectiveness, financial models for primary care	‘Cost-effectiveness. Whether the existing resources are used correctly.’ ‘Effective use of resources and assets when implementing new practices.’ ‘How to change the funding model of SHC + PHC joint organizations so that prevention would also be affordable for the organization’s finances?’
Practice organizational issues at the HCs and staff’s capability	Organizing collaboration models for HCs	‘Well-organized collaboration between professional groups is another challenge of management (…) collaboration is desired, but decision-making is slow.’
	Improving skills and adaptability among practice professionals	‘How best to support staff resilience and skills?’ ‘Education on financial management.’ ‘Evaluation of change in activity.’
Question (ii): What benefit do you see from the research for your health centre?
Themes:	Subthemes:	Narratives:
Benefits from evidence-based practice in the HC enterprise	Research is necessary for evidence-based practice and the quality improvement of clinical practice and care	‘Healthcare is undergoing a transformation. It would be good to research and find well-functioning models.’ ‘Improving the process, rationalizing the treatment path, eliminating unnecessary waiting time for both patients and staff.’ ‘Strengthening the scientific basis for the development of care and activities.’
	Implementation of evidence-based knowledge management	‘Knowledge-based management becomes more efficient, unnecessaries are reduced, and work conditions in the service are improved.’ ‘The problems are revealed. Successes are more visible.’
Benefits for the primary care professionals and other ancillary benefits for HCs and healthcare	Increases evidence-based practice implementation, upgrades professional competence and pride	‘The primary benefit is for us, the professionals, to understand what we should do, as far as possible, based on research evidence about its effectiveness and not just justify ‘what we have always done’ or ‘because the patient so desires’. Participation in research would clarify those issues.’ ‘Development of better operations. Professional growth (participation in research) gives GPs ‘shoulders’ to participate on an equal footing in stakeholder development (care chains, delegation of tasks, national networks, etc.).’ ‘In principle, I would like to support young colleagues to do research. This would increase professional pride. I would like to activate young people to participate in developing their own work.’
	Raising the image of HCs / increase the attractiveness of the job in HCs	‘Profile upgrading, attractive place to work when recruiting (…)’ ‘Encouraging those interested in research to work here.’ ‘It might increase job satisfaction and commitment?’
	Bringing research out of the ivory tower and closer to the community	‘Increasing the understanding of professionals that research work can be done in everyday life everywhere, not just in laboratories or other university research chambers. In addition, it would be important to understand that research work is valuable, even if it is seemingly ‘more modest’, e.g. creating hypotheses.’
Concerns about research participation		‘The topic is interesting, but in everyday life it seems that no one really has the resources or forces to do things related to research. There is a heavy workload to maintain the statutory care.’
Question (iii): Would your health centre be willing to join a practice-based research network and participate in primary healthcare research with this network in the future? If you answered ‘yes’ or ‘maybe’ to the previous question, what affected your positive answer?
Themes:	Subthemes:	Narratives:
Needs for practice-based evidence for the HC enterprise	Need for evidence-based knowledge management and solutions	‘We do a lot for developing knowledge-based management and ‘study’ the effectiveness of care. It would also be great to have an academic evaluation, for example, of measuring the effectiveness of activities.’
	Research is necessary for evidence-based clinical and service decision-making	‘More health centre research would definitely be needed, because that would provide information on the discrimination of the patient population.’ ‘Are the right things being done / Cost-effectiveness in health decision-making. Whether existing resources are used correctly – Development and testing of new treatments, practices, or care processes in primary care.’ ‘Primary healthcare research is becoming increasingly important in the face of fragmented medicine and SOTE reform.’
	Research is necessary to develop and improve the quality of health service/care	‘In general, healthcare always benefits from doing research, and therefore it is worthwhile, and this could be helpful for my own development work.’ ‘Through research, it is possible to develop quality improvement in services.’
Positive attitude towards research and PBRN activity	Need for collaborative research	‘We are planning studies that also require collaboration. It is not possible to conduct research without networks.’ ‘We want to work together in development activities and influence by bringing the working conditions of small municipalities to the fore. I also believe that in a larger organization, there are some things to learn from the creative solutions of small actors.’
	Positive attitude towards research	‘I very much welcome research and nationwide healthcare in the face of such severe pressures and challenges …’ ‘I consider this important, and a lot would be achievable that would benefit the HC.’ ‘In previous job positions, I have successfully promoted research activity in the HC, good experiences from it.’
	The HC is a PBRN member	‘We are already registered with Tutka.’
	Expectations for a positive impact on recruitment, profile, and job satisfaction in HCs	‘Could attract skilled doctors to work at the centres.’ ‘The staff would have a multifaceted job and a growing interest in work.’
Challenges and barriers to engaging in research		‘Only if time / resources are enough.’ ‘On the other hand, the shortage of doctors does not allow for this.’