DRAFT REPORT FOR COMMENT

Australian Association of Academic General Practice

Research Meeting 2001: Building Research Capacity in Primary Care

Friday June 1 to Saturday 2 June 2001

Stamford Grand, Adelaide.

Introduction

The Australian Association of Academic General Practice (AAAGP) has over 100 members, including general practitioners and their colleagues at the forefront of health research and medical education in the Australian community. AAAGP represents this membership in general and specifically the University Departments of General Practice and Rural Health where the majority of senior researchers are based.

Research is essential to strengthen and develop the fundamental role of general practitioners within primary health care. The danger of accepting findings in secondary and tertiary centres and applying those findings in the community is well known. General practitioners can provide high quality health care at substantially lower cost than other specialists and need to be encouraged to maintain their critical role in management and diagnosis of health problems. AAAGP members are all involved in this process and welcome participation from all those undertaking research in general practice.

The Association gave unanimous support at the Annual General Meeting in Adelaide, 1999 to establish an annual research meeting.

The Association is committed to building the research capacity of the wider general practice community via members’ involvement in the Primary Health Care Research and Development Strategy 2000-2004. In order to devise the best way to move forward with the challenge the PHC RED program provides, the Association agreed to encourage all members to attend the GP and PHC research conference in May in Adelaide in conjunction with a one day AAAGP conference on the following day. Both meetings were held at the same venue, the Stamford Grand in Adelaide.

The agreed aims of the 2001 meeting were:

  • To position the AAAGP membership and university departments of general practice and rural health at the centre of the PHC RED program 2000-2004
  • To consider an AAAGP response to the PHC RED Priority setting process
  • To consider an AAAGP response to the National Institute of Primary Health Care RED developments
  • To raise the standard of general practice research and outcomes evaluation through development of skills and knowledge of the membership of the AAAGP
  • To enable departments to share their approaches to the PHC RED program within their state in a ‘safe’ and supportive environment
  • To enable senior researchers to comment on current work in progress in a constructive way that encourages less experienced members in their endeavours
  • To provide a ‘safe’ environment to share the strengths and weaknesses of current work in progress
  • To encourage cooperative research in general practice
  • To hold an annual Heads of Departments meeting
  • To provide recommendations to the Federal Government on research in general practice

The AAAGP meeting differs from other conferences by focussing on developing researcher knowledge and skills. To this end, the presentations are longer and involve more public discussion in a safe and supportive environment - concentrating on the methods and process of research in progress or undertaken rather than outcomes or publicising results. Presentations were selected by the Committee of the AAAGP on the grounds of the importance of the research question, quality and importance of the research. The discussions, led by senior researchers, aim to elucidate the strengths and weaknesses of current research efforts, difficulties encountered and possible solutions. The meeting is not a forum to publicise research results.

AAAGP committee 2001

President: Chris Del Mar

Secretary: Sam Heard

Treasurer: Mark Nelson

AAAGP Conference Secretariat 2001

Jane Gunn

Maria Potiriadis

Nicola Vance

Department of General Practice, University of Melbourne.

Sponsorship

The AAAGP acknowledges the sponsorship of the Commonwealth Department of Health and Aged Care – General Practice Branch.


Meeting outline

Friday June 1 2001

4.30 pm Registration for AAAGP meeting

5.00pm - 6.30pm AAAGP Annual General Meeting

7.00 pm Conference dinner, Art Gallery of South Australia after Gallery tour of the Collection with Angus Trumble (curator, European Art)

9.00pm After dinner talk: "Has academic general practice really come of age?" Prof Max Kamien reflects on the successes, challenges and opportunities that face academic general practice.

Saturday June 2 2001

8.45am-9.30am Plenary

What is Priority research for AAAGP members? Prof Dimity Pond reports on the AAAGP priority setting process and how it fits in with the National priority setting process

Presentation – 15mins : Discussion & recommendations – 30 mins

9.30am-10.15am Primary Health Care Research, Evaluation and Development Strategy:

Prof Chris Del Mar (President, AAAGP) reports on the strategy to date and the place of AAAGP in the strategy.

Presentation – 15mins : Discussion & recommendations – 30 mins

10.15am Dr Marie Pirotta: Report of the inaugural travelling fellow

10.30am-11.00am: Coffee

11.00am-12.30pm: 2 parallel sessions:

Paper Presentations: 10 mins each, followed by 10 mins discussion for each paper

Session 1. Investigator Driven research

Michael Yelland Trials and tribulations – survival skills in running an RCT on the treatment of back pain.

Marie Pirotta Accurate sampling in general practice waiting room surveys: methodological issues

Barry McGrath The relationship between authority prescribing and the quality use of medicines.

Jonothan Newbury Indigenous Australian cultural awareness training of medical students by the Ngarrindjeri people

Session 2. PHC RED

Liz Farmer, Louis Pilotto Through the looking glass darkly: some perspectives on capacity building in general practice research.

Doris Young From SERU’s to PHCRED

Tracy Cheffins Developing a collaborative population health program for Townsville Division of General Practice

Sam Heard Partnerships for General Practice Education.

12.30 – 1.30 Lunch

1.30 – 2.30 pm Workshops

1. Chris Del Mar: How to engage GPs in evidence based medicine

2 Louis Pilotto, Ellen McIntyre, Libby Kalucy: Assessing research proposals under the PHC research grants program: developing criteria.

3. Patty Chondros: To cluster or not to cluster: Does clustering matter in my study design?

4. Remi Guibert & Ann Ellison: Balance between the PHCRED Strategy and local and regional issues : does "one size fit all"?

2.30 – 3.30 pm Closing Plenary

Four key speakers – Roger Strasser, Kelsey Hegarty, Brian MacEvoy, and Sam Heard were asked to follow the theme throughout the conference and address the plenary session with recommendations in a 10 min talk each, followed by 20 mins discussion.

3.40 pm Coffee, close, taxis to airport.

Powerpoint presentations(those that have been submitted) will be made available on AAAGP website

Summary of AAAGP 2001 research meeting

This report comprises a summary account of each program item of the meeting. It includes recommendations arising from the plenary, from notes taken by designated AAAGP members (Barry McGrath, Jane Sims, Mark Nelson, Jane Gunn, Sam Heard, Maria Potiriadis, Marie Pirotta) and by staff from the National Information Service (Ellen McIntyre and Libby Kalucy) who were invited to act as independent reporters.

Eighty-three people were registered to attend the 2001 meeting, considerably more than the 50 people attending the 2000 meeting in Hobart. During one meeting session, about half of these identified themselves as general practitioners.


Plenary

Chair: Jane Gunn

What is priority research for AAAGP members?

Assoc Professor Dimity Pond, Discipline of General Practice, Newcastle University.

The study, which was conducted by the Discipline of General Practice at Newcastle University, was one of the actions arising out of the AAAGP 2000 research meeting in Hobart. The study aim was to determine AAAGP members’ perceptions of the priority areas for research funding in primary health care. The three-round Delphi process highlighted clinical practice and conditions, health systems and services and IT/IM as the most highly ranked areas. However the main subcategories were alternative models for service delivery in rural areas and medical education. The generalisability of the findings is limited by the low response rate (just over a half, albeit raised by follow-up by fax ).

Key issues

  • The desired outcome of priority research depends on the focus and this has not been explicitly stated, either by DHAC or AAAGP.
  • It is of key importance that research questions of distinct relevance to practising GPs are met somewhere within the funding mechanisms.
  • Need to use and maximise our academic skills in responding innovatively to specific funding rounds.
  • Fax may achieve better response rates amongst AAAGP membership than email or mail.

Key recommendations arising from this presentation

  • AAAGP should optimise its role in eventual framing of funding calls by highlighting specific gaps in the evidence base that could be addressed under the broad headings outlined in the PHC RED priority setting process.
  • AAAGP to consider modes of collaborating across departments in order to best use existing resources in responding to forthcoming grant rounds. Eg Special interest groups within AAAGP.
  • DHAC to be lobbied to produce a consistent communication strategy on PHC RED particularly regarding the evaluation component of PHC RED.
  • AAAGP research priorities should feed into the priority areas identified through the PHC RED process.
  • Priority driven research, investigator driven research, and capacity-building research serve different objectives and should all be considered under the framework of the PHC RED funding program.

Primary Health Care Research, Evaluation and Development strategy

Chris Del Mar (President AAAGP, Director, Centre fro General Practice, University of Queensland)

Chris Del Mar assured the audience that most of the difficulties between negotiations between DHAC and the Heads of the University Departments of General Practice and Rural Health relating to contracts ($200 000 for 5 years) have been resolved. There had been problems with changes in federal government representation and contract negotiations. The areas of difficulty included funding contingencies, annual renewals of contracts, performance, reporting, intellectual property, external audit, penalty clauses and many others. The presenters indicated they now had most of the answers, and were prepared to negotiate on the remainder. The presentation was a very positive low-key approach to smoothing the troubled waters of the PHC RED submission process. Margaret MacDonald was invited to join the presentation and be available for questions.

Key issues

  • The tortuous history in developing contracts seems to have come to an end – Heads of Departments are optimistic.
  • PHC RED contracts will be for 4 years.
  • Commonwealth perspective – DHAC staff now stable, Margaret McDonald staying 3-4 years. She is happy to deal with both AAAGP and individual academic departments.
  • Heads of Departments will now have monthly meetings by teleconference.
  • Collaboration between departments.
  • Need to link urban/rural/Divisions/DHAC/ National Primary Health Care Research Institute (PHCRI)
  • Some rural health units/departments involved in research have been left out of the funding process.
  • Reporting requirements are important to allow DHAC to respond to questions from the Minister of Health, and also to provide information relating to performance indicators for capacity building
  • Academic General Practice is constant, regulated, vigorous, and committed.
  • AAAGP needs to enhance its public image. Members need to become lobbyists (to the health minister and government.)
  • The National Institute should be integrated with the Academic community of general practice

Key recommendations

  • Continue contract negotiations with Margaret MacDonald, Director, Research and Quality Section, GP Branch.
  • AAAGP needs to have strong overt links to National PHCRI.
  • Improve links by formalizing relationships between Academic Departments of General Practice and Rural Health
  • Effective PHC RED requires collaboration between Government, Divisions, National PHCRI, urban/rural, universities and departments.
  • AAAGP needs to increase its public image and to lobby where appropriate.
  • Regional GP education issues, including funding of academic registrar positions, need to be considered in relation to PHC RED activities

AAAGP Travelling Fellowships

The AAAGP Travelling Fellowships were launched in 2000 to foster collaboration between academic departments of general practice and to assist members of AAAGP to undertake study leave within Australia. They will be offered on an annual basis, where the executive deem that the Association holds sufficient funds.

Report of the inaugural travelling fellow

Marie Pirotta

See full report at http://www.aaagp.org/Reports/2001/report_Travel_Fellow_2000.htm

Marie spent two weeks in January with the Flinders University Graduate Entry Medical Program (GEMP), including one week in the Riverland during the orientation period for the Parallel Rural Community Curriculum (PRCC) students and the second week at Flinders Medical Centre for the intensive week of teaching in general practice for the third year students. She also spent a fortnight at the University of Queensland’s Graduate Medical Course (GMC), based in the Centre for General Practice in the Department of Social and Preventive Medicine.

Outcomes

Personal:

  • useful networking
  • opportunity to compare teaching and curriculum development experiences
  • forged some wonderful friendships and linkages at each university.
  • revitalised my commitment to academic general practice
  • different ways to approach both curriculum and assessment development and research cocooning processes within institutions.

My department:

  • Experiences and observations at both Flinders and Queensland will be useful to stimulate ideas and discussions in the planning phase of the new curriculum.
  • Informed other academics of what we do in our department, gave names to researchers for possible collaborations and encouraged people to consider a visit to our department in the future.

Wider AAAGP Community: The linkages made will run in both directions and opportunities for further exchanges may have been laid.

Advice to further applicants for this Travelling Fellowship

  1. Do it. It is well worth the experience.
  2. Plan where to visit according to your major interests – this may require some research beforehand. Visit the departments’ websites.
  3. Once you have chosen your preferred universities, liaise closely with them regarding the timing of your visit. There is definitely a trade-off between arriving at a busy teaching time to get a lot of exposure but finding that staff may be too busy to spend much other time with you.
  4. To get the most from the visit, ask the university to identify an academic to oversee your visit and help you to locate the people you will benefit most from meeting.

 

Paper Presentations: Investigator Driven Research

Chair – Geoff Mitchell, University of Queensland

Trials & Tribulations – survival skills in running an RCT on the treatment of back pain

Dr Michael Yelland, General Practitioner and PhD Student, University of Queensland.

This paper described the processes and pitfalls of setting up an RCT on the treatment of chronic back low pain (prolotherapy) in which 110 participants were recruited. They are currently being managed through a 12 month follow-up period. Pilot studies, recruitment strategies and the management of non-respondents and withdrawals were discussed.

Key issues arising:

  • Prolotherapy has not been investigated in primary health care before.
  • Planning took a long time – 7 proposals. Determining what was the best control group was very difficult, even with input from experienced researchers at the University of Queensland.
  • Doing pilot studies is highly recommended.
  • Sample size was really an estimate in absence of prior research.
  • Juggling the budget constraints.
  • Recruitment was a substantial task because the intervention was painful and onerous.

Key recommendations arising from this presentation:

  • Need to apply to several granting bodies and read the fine print
  • "Surgically graft" yourself to an experienced researcher
  • Develop realistic recruitment timeframe and strategies – newspaper articles, radio and TV were most significant recruitment strategies
  • Do not loosen recruitment criteria – the recruitment committee should be the only ones allowed to change the protocol
  • Do not "un-blind" people too easily if intervention does not work – use other modalities
  • PASSION is needed
  • Have a good research question

Accurate sampling in general practice waiting room surveys: methodological issues

Marie Pirotta, University of Melbourne

This paper considered the problems in recruitment of subjects for research using waiting room surveys. A literature review was presented, as well as the results of a 5-practice pilot study conducted to examine the difficulty in obtaining an accurate estimate of the number of eligible subjects missed.

Results:

Audits of appointment books can be reliable. It is possible to obtain good capture rates in motivated clinics with fully computerised systems. Audit of billing system may be an alternative. Recommend research assistant in each clinic but this will affect the budget. An accurate estimate of denominator is particularly important in prevalence surveys.

Key issues arising:

  • Generalisability is questionable if clinics are not randomly selected.
  • Literature review did not reveal the number of eligible subjects that were missed. Two studies suggested that there is great variability in defining the denominator. Most studies do not report how they determine the denominator.
  • Those studies that do quote denominator rely on audit of appointment book. However the appointment book was an incomplete record of attendees.
  • Is it possible to measure those missed??
  • Do the denominator omissions introduce bias?
  • Can the number of eligible subjects be calculated?
  • Variability in practices (size/computerise/business)
  • Receptionists do not always keep to protocol, particularly when busy.

Key recommendation/s arising from this presentation:

  • Need to be rigorous in defining the number of eligible subjects missed in waiting room studies.
  • Research assistant may be one way to train and oversee reception staff.
  • Conducting pilot study was good idea.
  • Do not always trust appointment books.
  • Computerised systems may assist the process.
  • Project budget needs to include measures to address these issues.
  • Be specific about the purpose of the research and methods needed.

The relationship between authority prescribing and the quality use of medicines

Barry McGrath, The University of Melbourne

This study researched the view of prescribers on the place of authority prescribing (AP) in enhancing the quality use of medicines (QUM). The study was conducted in two phases: (a) a qualitative phase and (b) a national survey. This paper reported on the perception of prescribers as revealed in in-depth interviews and focus groups.

Results:

  • AP – Praxis mismatch between AP and QUM
  • Attitudes to AP: rationing process for expensive drugs, not a method for quality control
  • AP viewed as solely cost containment mechanism, accepted uncritically, possess substantial opportunity costs
  • Evidence for initial listing of AP drugs does not reflect community needs
  • No monitoring of AP impacts, implications – specific anomalies were found
  • Tensions between specialists and GPs, especially in rural settings
  • AP link to Quality Use of Medicines (QUM) is tenuous.
  • Open up this issue to debate, and give voice to prescribers

Key issues arising:

  • Ethical – confidentiality concerns re phone approval, perceived gender inequalities in drugs listed, lies commonly used to gain phone approval
  • Future QUM activities may influence linkages with AP
  • Should we get rid of AP?
  • Inability for prescribers to inform process

Key recommendations arising from this presentation:

  • Need for increased communication and dialogue between GP - prescribers and PBS/PBAC responsible for AP.
  • Research report to be submitted to PBS/PBAC responsible for AP.

Indigenous Australian cultural awareness training of medical students by the Ngarrindjeri people.

Jonathon Newbury, Adelaide University

This project sought to develop a strategy to increase cultural awareness among medical students. A field trip to Camp Coorong (a rural area) was organized for first year students so that students could be included in indigenous cultural activities. Evaluation of the field trip was performed.

Key issues arising:

  • Acknowledgement of the contribution of indigenous people
  • Provision of health services will not change health status
  • Land, culture and health are linked
  • Such trips break down stereotypes
  • Variability of medical students attitudes
  • Would like to follow the attitudes of medical students over time but not sure how to maintain confidentiality

Key recommendations arising from this presentation:

  • Encourage this strategy in other university departments
  • AAAGP needs to be more involved in medical student education
  • Indigenous health requires further development
  • Need to get medical students’ participation in indigenous health
  • Need to follow medical students/doctor attitudes over time to evaluate the impacts of educations
  • Valuable for researcher and for other academics to hear about research as it is being done as well as hearing the results

Investigator Driven Research Session

Chair: Geoff Mitchell, University of Queensland

Key recommendation/s arising from presentations

  • AAAGP to encourage Commonwealth to find ways to assist GP researchers to meet granting body requirements for a track record in research. Suggestions include scholarships, attachments to established research units, and academic departments nurturing junior staff.
  • Research effort is not recognised by peers, and GPs have published in large number of journals. AAAGP should find a means of developing a repository of Australian research in general practice – the actual level of productivity. This may require aggregating and disseminating the output of research, work-in-progress and grants won. NIS offered assistance, as such activities fit NIS mission, and this needs dedicated administrative resources.
  • Publicity of above, public statements offered on major issues (will follow from policy officer appointment)
  • AAAGP to consider commissioning a monograph on methodology of general practice research, and collecting papers for this, such as developing RCTs in general practice, identifying denominators in waiting room surveys.
  • Encourage Commonwealth initiatives in promoting experience in research – encourage mentoring within institutes
  • Look at research into medical education as a priority activity
  • Use senior members as resource to AAAGP.

Paper Presentations: PHC RED Initiative

Chair: Mark Nelson, Monash University

 

Through the looking glass darkly: some perspectives on capacity building in general practice research

Elizabeth Farmer and Louis Pilotto, Flinders University

This paper investigated some of the many issues facing contemporary general practice both nationally and internationally in building a sustainable capacity for research. The presentation was illustrated by reference to definitions of capacity building and an example from practice. Various perspectives about the change process required to achieve this aim were presented, such as:.

1 Social marketing theory: determining constituents’ needs and assessing predisposition to change

2 Social cognition: Identifying drivers for change and using a variety of techniques to address receptivity and preparedness for change

The need to adopt a systematic, multifaceted and well resourced approach, drawing upon existing change theories and the evidence base was noted as a means for developing and implementing capacity building under the PHC RED initiative.

Key issues arising:

  • Use of existing resources to guide our efforts
  • Focus on different levels of intervention – individual, organisation, regional
  • Different levels of receptivity and readiness – need for multifaceted strategies, well supported by funding and marketing

Key recommendation/s arising from this presentation:

  • AAAGP to support DHAC in development of strategies to enable receptivity and readiness for change in the GP community
  • AAAGP to liaise with other stakeholders eg ADGP and RACGP to encourage the above process

 

From SERU’s to PHC RED

Doris Young, The University of Melbourne

The common objectives of the extinct SERU’s and the PHC RED Strategy were highlighted. The experience and resources arising from SERU’s can contribute to the future success of PHC RED. The way forward will include the endorsement of collaborative networks to conduct strategic evaluative projects using and building upon the evidence base.

Key issues arising:

  • PHC RED can learn from what SERUs did and did not do as well as how they were treated. (eg perception of over-reporting)
  • PHC RED will need to work with the market "where it is at".
  • PHC RED will benefit from clear purpose and the marketing and dissemination of both its goals and deliverables to Divisions of General Practice and other potential beneficiaries.
  • PHC RED will benefit from a long term support base with an integral corporate memory.

Key recommendation/s arising from this presentation:

  • AAAGP continue to emphasise the outcomes of previous work in discussions with PHC RED funders.

 

Developing a collaborative population health program for Townsville Division of General Practice

Tracey Cheffins, James Cook University

The population health focus arising from the GP strategy has been subsequently developed over the past decade, supported by initiatives and incentives such as JAG, EPC and PIP. Townsville Division of General Practice has been pro-active in gathering resources to embed the population health approach in their area, assisted by linkages to the resources eg databases, from relevant stakeholders at local and regional level. Other program ‘essentials’ included a preliminary needs analysis, an evaluation strategy, cross agency collaboration and multidisciplinary involvement at practice level, supported by office systems, evidence updates and report back mechanisms.

Key issues arising:

  • Population health is an important approach to the delivery of primary health care. Its implementation has been supported by various initiatives.
  • Grassroots players require consolidated resources and guidance to encourage further adoption, implementation and sustainability of the approach within the primary health care sector.

Key recommendation/s arising from this presentation:

  • AAAGP can support the usage of population health initiatives, to act as a mutually feasible and beneficial vehicle for the implementation of PHC RED goals.

 

Partnerships for General Practice Education

Sam Heard, Flinders University

The GP Education Research Unit in the Northern Territory provides a regional model for multifaceted partnerships at individual, local and national level. These all entail commitment to meet the breath of medical, cultural, and administrative objectives. It was noted that the core business domains of the GP Education Research Unit are intimately linked. Emerging vertical partnerships in these domains can be used to develop valuable horizontal partnerships, as exemplified by the construction of the GP Education Research Unit Board.

Key issues arising:

  • Any organisation has a wide network of partners associated with its core business. Means of optimising and sustaining the horizontal linkages amongst these partners deserves further consideration.
  • Changes in one area can change partnerships elsewhere
  • Funding is usually linked to output not to the sustainability of partnerships

Key recommendation/s arising from this presentation:

  • AAAGP ‘policy’ person to explore making better usage of the vast partnerships existing between and within academic departments for both education and research purposes.

     


Workshops

How to engage GPs in evidence based medicine

Chris Del Mar, University of Queensland

Whilst evidence based medicine is trendy, ambivalence towards it exists amongst GPs and even in the academic community, given that:

  1. evidence based medicine is often not derived from GP setting
  2. the evidence based medicine ‘hierarchy’ is not always appropriate for general practice research issues
  3. traditional practice and experience is valued

An intensive 2 day workshop to upskill GPs in using available databases and distilled literature resources to answer questions relevant to their clinical practice was discussed. Delegates learn to filter the evidence base, particularly with regard to validity and clinical relevance and to conduct purposive reading. To date 7% of Queensland Divisions of General Practice GPs have attended.

Key issues arising:

  • Need to engage GPs and upskill them in relevant techniques. Helpful if educators are well versed in associated issues in order to overcome the antipathy towards evidence based practice and disillusions with the imperfections of evidence based medicine.
  • Need to change culture and receptivity to research from undergraduate level onwards

Key recommendation/s arising from this presentation:

  • AAAGP endorse sharing of the:

(1) materials

(2) process evaluation products of such ventures amongst their membership.

  • AAAGP liaise with other undergraduate and postgraduate educators to enhance systematic usage of this education.

 

Assessing research proposals under the PHC research grants program: developing criteria

Ellen McIntyre, Louis Pilotto, Libby Kalucy, National Information Services Flinders University

This interactive workshop provided an opportunity for participants to develop appropriate criteria for assessing research proposals under the PHC research grants program. In addition, discussion focused on what skills are required for a reviewer and a panel and how assessors should be selected.

Key issues arising:

  • Strengths of previous system included seeding grants and opportunity to review reviewers comments
  • Need for proposals to include a systematic review of questions to avoid duplicating research.
  • NHMRC defines track record in terms of publication in high impact journals. What are the criteria for a good publication record in our discipline?
  • Is a more lenient approach to publication track record appropriate in capacity-building research, when access to advice rather than publication record is required?
  • Inexperienced researchers should include an expert researcher as part of team to reduce mistakes.
  • Should publication record be the only outcome? What else is relevant and measurable in terms of track record of dissemination of research to stakeholders?

Key recommendation/s arising from this presentation:

  • Definition of research and publication track record to be appropriate for this area of research
  • AAAGP input is required into selection of assessors for PHC RED grant proposals. Assessors should include academics with diverse research interests and primary care practitioners.
  • NIS & DHAC to compile notes from this workshop and disseminate to AAAGP (via e-network)
  • Workshop notes to be sent to DHAC
  • Draft guidelines on how to apply for PHC RED funds, with discussion, to be developed by NIS (to be critiqued by AAAGP and other stakeholders)
  • AAAGP to run a training workshop in each state on detailed interpretation of criteria for assessors who may not be familiar with primary health care.
  • AAAGP to run a workshop to educate researchers and peer reviewers about criteria for funding.

 

To cluster or not to cluster: Does clustering matter in my study design?

Patty Chondros, The University of Melbourne

Following a brief explanation of cluster randomization (ie groups of individuals are randomized to an intervention or control group rather than individuals) each small group was given an exercise to discuss a described study using the following questions. When do we use cluster randomization? What are the weaknesses and strengths of this approach? What is the intra-class correlation and design effect? How is sample size calculated?

Key issues arising:

  • Need to think about unit of randomization when designing a trial and doing sample size estimations
  • If you need to increase the sample size due to clustering, it is usually better to increase the number of clusters rather than the number in each cluster.
  • Individual randomization is preferable
  • Consider contamination rate when calculating sample size

Key recommendation/s arising from this presentation:

  • AAAGP should continue to promote the use of rigorous analysis techniques that are appropriate to study design
  • AAAGP should continue to provide high quality research methods workshops
  •  

 

Balance between the PHC RED Strategy and local and regional issues: does "one size fit all"?

Remi Guibert, Ann Ellison, Monash University

This workshop formed the first part of a larger study on issues affecting collaboration and organizational change as it relates to the PHC RED Strategy. An outline of core principles of collaboration and organizational change was presented followed by discussion of the participants’ perspectives of collaboration and organizational change, in particular what they saw as easy or difficult to achieve in practice.

Key issues arising:

  • Communication between departments is not optimal
  • Will one size fit all?
  • Partnerships have emerged as important to DHAC negotiation

Key recommendation/s arising from this presentation:

  • Need to be mindful of baseline variability and ongoing evolution of PHC RED emphasis

Closing Plenary

Key recommendations from speakers

Roger Strasser (School of Rural Health, Monash University)

  • Lessons to be learned from history, and from the experience of senior academics in this discipline (such as Max Kamien, Charles Bridges-Webb, Peter Mudge).
  • Collaboration linking GP, PHC and Rural Health who have more in common than they are different.
  • Need to work together to support each other in research development and raise the standard
  • AAAGP to contribute by facilitating across departments, and providing constructive advice from skilled and expert people.

Kelsey Hegarty (Department of General Practice, University of Melbourne)

  • Being an academic registrar plays a key role on career development in research and elsewhere
  • The need for collaborative grant proposals
  • There are gaps of knowledge and skills in the following – education and peer review, mentors, project management, gender issues (balancing family and other roles), team building
  • Social scientists and others are essential in GP research, but career path is poor for them.
  • Building research capacity in primary health care practice
    • Include multiple disciplines – nurses, psychologists. Rural practice nurses may have greater capacity to do research than GPs.
    • Research secondments in rural/urban areas, between practitioners and academics.
    • Provide protected time for research
    • Establish a code of conduct: be clear what researchers can offer to a health service
    • Upskill divisional staff to a critical mass, with a training and support network.
    • No PHC team in Australia, and it is hard to invent. Intersectoral collaboration is difficult at most levels.

Brian McAvoy (Research and Practice Support, RACGP)

  • This is a critical moment in time for GP and PHC research, the PHC RED strategy is the best opportunity ever for Australian general practice.
  • "Carpe diem" or Yogi Bear philosophy - "if you find a fork in the road, take it"
  • Key role for AAAGP in leadership, bringing people together, direction, ideas, to be proactive not reactive
  • Learn from history – the struggles of academic general practice, lessons of the SERUs such as how not to over-manage and report
  • Learn from others – the research literature and the evidence base for capacity building and change management
  • Form partnerships in health care here and overseas

Sam Heard (General Practice Research & Education Unit, Flinders University)

  • The Director of the new PHCRI should be from this diverse group of people in AAAGP, or with the strong support of this group.
  • PHC research networks: activity in this area is motivating and should be trialled early.

(Sam had other notes on his Powerpoint which he could not display. Could these please be included here )

Other comments/questions/recommendations:

  • Do not undervalue the support networks. Departments should encourage staff to work together and network,
  • Middle level grants – what should they look like? Margaret MacDonald suggested sending DHAC ideas to AAAGP for review.
  • Build on the relationships between Commonwealth and University departments, and judge by the success of the partnership between Commonwealth and AAAGP. Set performance indicators for this.
  • Working groups formed to assist DHAC as required
  • Role of AAAGP in broader PHC research – build bridges with other organizations, do not just look at GP component of PHC research
  • Grants will be advertised in November. These will give preference to a multidisciplinary focus.
  • Stimulating three days, diversity of ideas, enthusiasm.

 

Overarching recommendations – pulling it all together

The AAAGP 2001 conference participants have addressed the issue of building research capacity in primary care in a number of ways. AAAGP have recommended the development of partnerships/networks between academic departments, and with other organisations such as Divisions of General Practice, the Commonwealth DHAC and with the National PHCRI. Collaborating across departments and with other disciplines will ensure the best use of existing resources and will strengthen the response to forthcoming grant rounds. This provides more opportunities for researchers to support each other as well as to build research capacity.

AAAGP needs to promote the collective expertise of the membership across the spectrum of research methods in the primary care setting. The Association should take a key role in the development of programs to create a sustainable career structure for primary care researchers. This is particularly relevant to the establishment of the National PHCRI.

AAAGP needs to enhance its public image and become a more powerful lobbying organisation so that it can promote its aims and objectives. It needs to strengthen its links with DHAC through the provision of expertise and knowledge of research to policy makers and research funders. The implementation of the PHC RED initiative provides many opportunities for AAAGP to contribute.

AAAGP needs to encourage and support the aggregation and dissemination of Australian research efforts in general practice and primary health care.

A number of recommendations have arisen from the AAAGP meeting. To assist the PHC RED strategy the AAAGP recommends that urgent attention is paid to the following key recommendations:

  • To build a vibrant, productive and internationally recognised primary care research culture in Australia the Australian Association of Academic General Practice recommends that the Department of Human Services and Aged Care:
  • Continue to develop the relationship between the Commonwealth and the University departments of general practice and rural health in all aspects of the PHC RED strategy
  • Ensure that priority driven research, investigator driven research, and capacity-building research (which all serve different objectives) are included in funding allocations of the PHC RED strategy
  • Utilise the expertise of the AAAGP to highlight the specific gaps in the evidence base and to assist in the framing of funding calls for the PHC RED research programs.
  • Engage and Involve the AAAGP in the development of the National PHCRI
  • Involve AAAGP in the development of the framework of assessment and training of assessors for PHC RED research proposals"
  • Consider funding initiatives that will formalise the links between departments of general practice and rural health and other departments and institutions involved in primary health care research.
  • Consider funding initiatives that will assist novice PHC researchers to develop a recognised track record in research. Suggestions include scholarships, short and long-term attachments to established research units (including both full and part-time placements).
  • Consider funding initiatives that will assist experienced PHC researchers to develop national and international collaborations that will lead to internationally recognised track records in research. Suggestions include post-doctoral fellowships, collaborative program grant funding, fellowship and travel grants.
  • Consider funding to develop and maintain a repository of Australian research in general practice and primary health care and assist in its dissemination. Suggestions include: building on the National Information Service functions, a National ‘research holding house’, and grants specifically for the dissemination of successful research.