Practice-based Research Network - History of Primary Care Research

History of Primary Care Research

Before there were research institutes or networks of practices, there were individual practitioners who studied their patients’ problems with scientific rigor. Among these were five general practitioners who have been recognized for their seminal work during the past 125 years. They are James Mackenzie, Will Pickles, John Fry, F.J.A. Huygen and Curtis G. Hames. Each of these pioneers demonstrated that important new knowledge could be discovered by practicing family physicians. And this is far from an accepted principle in the United States. These doctors all wondered about their patients’ problems and they developed a means of gathering and recording data on their patients.

Each of these research pioneers provide inspiration for the development of practice-based, primary care research networks because each demonstrated that important new knowledge could be discovered by the practicing family doctor. They each wondered about their patients, developed means of gathering and recording data, and found collaborators and support from their staff and local communities. Unfortunately, they practiced in an era that was over-committed to specialism. Research focused on molecular mechanisms of disease. The rush to specialization by the medical community and the linking of research to specialists resulted in decades of neglect of primary care and virtually no recognition of the need to investigate care in the primary care setting. Instead, the common wisdom viewed primary care practices as relatively boring places that could be potential sites of application of the fruits of research done elsewhere in research laboratories, hospitals and institutes.

Among the early regional networks started in the 1970s were the Family Medicine Information System in Colorado (FMIS) and the Cooperative Information Project. These regional networks learned from each other and succeeded in conducting studies focused on what was happening in primary care. They attracted funding from medical schools, national philanthropic foundations and federal programs such as Health for Underserved Rural Areas. As the 1970s closed, these early networks enjoyed sufficient success to stimulate debate about the next steps in the context of the microcomputer’s development. Among them was a small group convened by Gene Farley in Denver in 1978 to consider establishing a national sentinel practice system. It was this idea that lead to the Ambulatory Sentinel Practice Network and provided in retrospect what appears to have been a nidus for the establishment of primary care PBRNs in the United States.

PBRNs are feasible and that represent a useful infrastructure for the scientific discovery of family practice and primary care. Experience to date points out the great advantages enjoyed by those with enduring, core financial support — such as the Dutch with their early national commitment to primary care and their willingness to invest in primary care research. It is also obvious that these networks require collaboration, coop- eration and a spirit of sharing and trust.

These networks are now at once both a place and a concept. As a place, they are a laboratory for surveillance and research. As a concept, they express the still unmet need for practicing primary care clinicians to accept responsibility to improve frontline clinical care by understanding what is happening in their practices. Successes to date have been sufficient to incite the Institute of Medicine’s 1994 committee studying the future of primary care to recommend support to stabilize and expand practice-based primary care research networks.