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Research Advocacy Committee Mission

The Research Advocacy Committee's purpose is multifaceted as follows:

  • Provide tools, training and resources for NAPCRG members to use in their own advocacy work at the local, state and national levels in the U.S. and Canada
  • Disseminate primary care research advocacy messages to key federal, state/provincial public policy leaders in the U.S. and Canada 
  • Identify and build strong partnerships with organizations around collaboration, sponsorship, funding and/or support for NAPCRG’s efforts
  • Promote primary care research opportunities to define the direction of primary care research in the U.S. and Canada.


Chair
Winston Liaw, MD, MPH
winstonrliaw@gmail.com
 

  Staff Liaison
Tom Vansaghi, PhD
tvansaghi@napcrg.org

 

Canadian Workgroup  
Rick Glazier, MD, MPH
rick.glazier@ices.on.ca
  Marianna LaNoue, PhD
Marianna.LaNoue@jefferson.edu
     
Wendy V. Norman, MD, CCFP, FCFP, DTM&H, MHSc
wendy.norman@ubc.ca
  John Salsberg, BA, BA (hons), MA, PhD
jon.salsberg@mcgill.ca

 
Sabrina Wong, RN, PhD
Sabrina.Wong@nursing.ubc.ca
   
     
United States Workgroup    
Victoria Adewale
vadewale@gmail.com 
  Frederick Chen MD, MPH
fchen@u.washington.edu 
     
Sean Lucan, MD, MPH, MS 
slucan@yahoo.com
  Dan Merenstein, MD
djm23@georgetown.edu

   
Christopher Morley, PhD
MorleyCP@upstate.edu
  Julie Phillips, MD, MPH
Julie.Phillips@hc.msu.edu
     
Derjung Mimi Tarn
DTarn@mednet.ucla.edu 
  Sebastian Tong, MD
sebastian.tc.tong@gmail.com 


ADFM Representative
Bernard Ewigman, MD, MSPH, FAAFP
bewigman@uchicago.edu
bewigman@northshore.org


 

NAPCRG Research Priorities (CAN-Canadian Priorities; US-US Priorities)


Primary Care Research through Practice-based Research Networks (PBRNs) (CAN/US)
Primary care research includes: translating science into the practice of medicine and caring for patients, understanding how to better organize health care to meet patient and population needs, evaluating innovations to provide the best health care to patients, and engaging patients, their families, communities, and practices to improve health. And yet, the majority of research funding supports research of one specific disease, organ system, cellular or chemical process, and is not related to issues surrounding the total needs of a real life patient  in primary care. Not only does the majority of health care take place in the primary care setting, this setting is the key interface between the patient and the primary care provider. The importance of what happens in that space is crucial to improving care, improving outcomes, reducing errors, and realizing meaningful PCOR.  We see an unmet need in strong funding support for research that is conducted with and by primary care practices and their patients -- essentially what PBRNs do. 

Practice Transformation (US)

Practice Transformation in the Patient’s Medical Home (CAN)
Very little is known about important topics such as how primary care services are best organized, how new technologies impact care, how to maximize and prioritize care, how to introduce and disseminate new discoveries so they work in real life, and how patients can best decide how and when to seek care. We know from our members and our patients that the need is great to understand what works for patients and practices. Part of this transformation includes the establishment of and reliance on inter-professional teams for training and patient care. More research into best practices related to this integration is needed in both the training and practice arenas. Since a top priority of AHRQ is the implementation of Patient Centered Outcome Research findings into primary care practices, we would like to see enhanced investment in this area. Transforming primary care practices to be effective medical homes for our patients should be a key priority – and one that can only be accomplished with studies in the primary care environment.

Patient Quality and Safety in Non-Hospital Settings (
CAN/US)
There is an awareness of the research related to the many improvements in patient care in hospital settings, and the continued work in this area. Our patients tell us that one of the key areas that is problematic for them is in the non-hospital setting. For example, the communication between specialist and patient and primary care provider is an area that needs work to understand how to improve. Improved methods for engaging patients in the management of their health conditions is a key area that needs further study.
PCOR informs the evidence needed for guidelines that we can trust, but the voice of patients in the development of clinical practice guidelines remains a promise unfulfilled. As NIH has retreated from disease specific guideline development, it is important that a coalition of stakeholders take up the task of guideline development and we support AHRQ as a vital and prominent leader in this process.  

Multi-Morbidity Research (
CAN/US)
We know that the majority of research funding supports research of one specific disease, organ system, cellular or chemical process – not for primary care. More attention and research needs to be directed to the “real-life” patient; the one who doesn’t have diabetes alone, for example, but also has cardiovascular disease, as well as renal disease; or the patient who has cancer as well as heart disease. In 2000, an estimated sixty million Americans had multiple chronic conditions. By 2020, an estimated eighty-one million people will have multiple chronic conditions. In addition, care for people with chronic conditions is expected to consume 80 percent of the resources of publicly funded health insurance programs by 2020. When private and public expenditures are combined, fifty-one percent of total expenditures are for those with multiple chronic conditions. More research funding and attention needs to be directed at multi-morbidity research. 

Mental and Behavioral Health Provision in Communities and Primary Care Practices (US only)
Research addressing best practices for integrated mental and behavioral health provision in communities and primary care practices, and ways to increase the uptake of these models in primary care practices is needed. As a 2011 Robert Wood Johnson policy brief states, “Comorbidity between mental and medical conditions is the rule rather than the exception. In the 2003 National Comorbidity Survey Replication (NCS-R), more than 68% of adults with a mental disorder had at least one medical condition, and 29% of those with a medical disorder had a comorbid mental health condition. Moreover, models that integrate care to treat people with mental health and medical comorbidities have proven effective, but despite their effectiveness, these models are not in widespread use.” Typically mental health treatment is separate from primary medical care. More research is needed to identify best practices regarding integrated behavioral and mental health care in primary care, as well as identify barriers to adoption of these best practices into primary care practices and communities.

Training Future Investigators (CAN/US)
One piece critical to the successful engagement and development of primary care research is the constraint of not having an adequate cadre of well-trained researchers. We believe there is a need to deliberately promote this training. AHRQ has researcher training mechanisms in place, which we believe are important, but we think attention should be paid to revisiting them to retool so they can better prepare investigators for new research priorities.


Activities:

  • Develop and implement strategy for supporting primary care research
  • Prioritize primary care research objectives
  • Provide advocacy training for NAPCRG members
    Provide evidence to describe primary care research funding, activities, and needs  

Products:

Health Resources and Services Administration Administrative Academic Unit grants have provided research support for 6 of 23 projects. Two practice based research networks are supports with AAU funds, and at least 79 publications.

Our reply to Joe Selby and Jean Slutsky's primary care PCORI commentary. We discuss how Selby and Slutsky inappropriately equate specialty care with complexity and disagree that research done in specialty settings applies to primary care. Finally, we discuss that PCORI should not limit its research to single studies.

Jack Westfall's JABFM commentary about creating an Institute of Primary Care Research at NIH, billionizing AHRQ, and reauthorizing PCORI.

This paper discusses how family medicine can accelerate the generation of new knowledge. The authors discuss building on the existing current research foundation, increasing the relevance and pace of our research, reconceiving the research workforce to engage new partners, disseminating findings more rapidly into the hands of those who can take action, and building a question ready research infrastructure to make this possible.

NIH and AHRQ funding is concentrated at three family medicine departments (Dartmouth, UCSD, and University of Minnesota). The primary administering agency for FM grants is the National Cancer Institute (28%), followed by AHRQ (11%), and the National Heart, Lung, and Blood Institute (8%).

NIH funding from 2002 to 2014, at roughly 0,2% of total NIH funding.

One-third of PCORI studies involve or are relevant to primary care.


Additional Resources

Academic Family Medicine Advocacy Committee (AFMAC) - United States

Action Group for Advocacy in Research (AGAR) - Canada


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