1

2

How different is research in GP and does it make a difference ?

Prof.J.Degryse Md PhDK.U.Leuven

Профессор Йан Дегрис

3

Conference Sint-Petersburg RussiaMay 26-27th 2014

Introduction

Is primary-care research a lost cause ? (The Lancet 361, 2003 editorial)

The state of primary-care research (Mant et al The Lancet 364, 2004)

The need for research in primary care(De Maeseneer et al The Lancet 362 2003)

4

Two main issues

1. The purpose of research in GP

2. Is primary care research different from other biomedical research ?

5

1.The purpose of primary care research

Primary care needs an evidence base Primary care research focusus on

clinical practice The main function is to inform clinical

practice in primary care. Primary care research can influence

clinical practice effectively

A few examples: 6

7

Fig 1 Odds ratios of various outcomes among children with acute otitis media who were treated with antibiotics or placebo

Del Mar, C. B et al. BMJ 1997;314:1526

8

«The strength of primary-care research in any country is probably a good indicator of the strength and quality of primary care in that country. »

Douglas JD. Lancet 2003

9

Or vice-versa ?

2. Is research in GP different ?

NO: « There is only ONE kind of research:

good research »

YES:« It is different and it makes a

difference »

10

Primary Care research is different: The huge variety of methods that are used.

(Methodology)

The very large domain of interest. (Domain and focus)

An interest for the outcome for a particular individual

(the individual patient as focus of research)

As much interested in health and health promotion as in diseases and their therapies

(focus on mechanisms of health conservation)

11

Yes !

Primary Care Research can also make a difference

It’s dilligence to generate scientific knowledge and better understanding of « every day life-problems and complaints ».

It’s purpose to produce results that can trigger better quality of care for chronic diseases i.e. better understanding as well as better management of patients wilth multiple disabilties resulting from thos diseases.

It’s ambition to integrate scientific reflection in to clinical practice.

12

13

14

15

Is research in primary care different?

16

NO !

A rigourous scientific methodology should be used. (Methodology)

A clear and detailed focus should be formulated. (Domain and focus)

As combination of psychometric and traditonal biomedical aproches should be used

(the individual patient as focus of research)

Not the research topic matters but the correct methodology . (Domain and focus)

Results should also be published in high impact journals(Publish or perish ! )

Part 2: Three strategic examples

• Recruiting teaching practices to participate in a punctual research.(example: respiratory research)

• Building a network of sentinel practices(example: the INTEGO network)

• Investing in large scale observational cohort studies.

(example: the BELFRAIL study)

« L'aveugle se détourne de la fosse où le clairvoyant se laisse tomber. »[ Averroès ]

Averroës , a primary care research network

AverroësAverroes was a defender of Aristotelian philosophy against Ash'ari theologians led by Al-Ghazali. Although highly regarded as a legal scholar of the Maliki school of Islamic law, Averroes' philosophical ideas were considered controversial in Muslim circles.Averroes had a greater impact on Western European circles and he has been described as the "founding father of secular thought in Western Europe

Why such a research network ?

To promote and implement relevant clinical research « on site ».

To sensitize clinciens for clinical research. To bring “added value” to the daily work of

family physicians. To create a group of motivated experienced

and competent clinicians that can collect data and provide reliable and relevant input.

19

Some outcomes:

DIDASO I, DIDASCO II SPIROSTOP Chronic Cough in children

20

Differential diagnosis What is the diagnostic accuracy for asthma and

COPD of subsequent diagnostic steps in a population older than 40 years with probable obstructive airway disease?

21

Spirometry and smoking cessation ? Smokers with documented airflow obstruction

have higher odds for smoking cessation (Bednarek, Thorax 2006)

•If randomized allocation to spirometry or not there is no significant difference in smoking cessation rate (Buffels J, Degryse J Respir Med 2006)

22

. .

.“The BFC80+ was designed to acquire a better understanding of the epidemiologyand pathophysiology of chronic diseases in the very elderly and to study the dynamic interaction between health, frailty and disability in a multi-system approach”.

Intego: a continuous registration network.

25

Since 1994220.000 patients86 GPs-55 practices1.500.000 patient-yearsDiagnoses, prescribed drugs, laboratory

results, backgroundAll contacts

Thesaurus (+ ICPC/iCD10

Incidence of asthma & COPD according to age & sex

0

5

10

15

20

25

0-4

10-1

4

20-2

4

30-3

4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4

90-1

04

COPD Vrouwen

COPD Mannen

Astma Vrouwen

Astma Mannen

Myocardial infarction & COPD : time trends

0

0.5

1

1.5

2

2.5

3

3.5

4

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

COPD Mannen Myocard infarct Mannen

Smoking?

2828

Table 8: Top 20 most frequent new diagnoses, 2007-2009

  women       men    

code diagnosis n diagnoses‰

YCG code diagnosis n diagnoses ‰ YCG1 R74 Upper respiratory infection, acute 37277 353 R74 Upper respiratory infection, acute 33283 3392 R80 Influenza 12256 116 R80 Influenza 12498 127

3 D73Gastroenteritis, presumed infection 11181 106 D73

Gastroenteritis, presumed infection 11143 113

4 R78 Acute bronchitis/bronchiolitis 9506 90 R78 Acute bronchitis/bronchiolitis 9789 995 U71 Cystitis/urinary infection, other 7869 74 L03 Low back symptom/complaint 6813 696 L03 Low back symptom/complaint 6718 63 L87 Bursitis/tendinitis/synoviitis nos 5238 537 L83 Neck syndrome 6618 62 S16 Bruise/contusion 4469 45

8 R75 Sinusitis acute/chronic 6133 58 L83 Neck syndrome 3851 399 L87 Bursitis/tendinitis/synoviitis nos 5641 53 H71 Acute otitis media/myringitis 3754 38

10 S16 Bruise/contusion 3933 37 R75 Sinusitis acute/chronic 3622 3611 R76 Tonsillitis, acute 3914 37 R76 Tonsillitis, acute 3165 3212 R77 Laryngitis/tracheitis, acute 3764 35 R77 Laryngitis/tracheitis, acute 2742 2713 D87 Stomach function disorder 3705 35 S74 Dermatophytosis 2572 2614 H71 Acute otitis media/myringitis 3661 34 D87 Stomach function disorder 2439 2415 L86 Back syndrome with radiating pain 2462 23 L86 Back syndrome with radiating pain 2109 2116 D84 Oesophagus disease 2434 23 D84 Oesophagus disease 2085 2117 L92 Shoulder syndrome 2380 22 R96 Asthma 2060 2118 R05 Cough 2294 21 R05 Cough 1922 1919 R96 Asthma 2281 21 L92 Shoulder syndrome 1884 1920 A04 General fatigue/weakness 2196 20 K86 Hypertension, uncomplicated 1857 18

More specific analyses:

29

Continuous morbidity registration: requirements

(One) structured software package with a thesaurus enabling coding of the main information in background

Denominator Central database (will soon become a

big one) GPs selected on the basis of the good

quality of their registration (rare) Small group of researchers centrally

To summarize

31

•Yes research in primary care has a great future !

•Yes it can make a difference !

Спасибо!