Improving links between general practice and clinical research

Amanda Lyons

9/03/2018 2:39:49 PM

GP researcher Professor Clare Heal chronicled the experience of conducting five randomised controlled trials in a general practice setting, showing it can be done successfully.

Professor Clare Heal believes there can be a significant gap between academia and on-the-ground general practice.
Professor Clare Heal believes there can be a significant gap between academia and on-the-ground general practice.

More Australians see their GPs than any other medical specialist, and a strong primary healthcare system lowers hospitalisation rates and health inequalities and promotes better health outcomes.
Despite such outcomes, it has been found that Australian general practice-based research remains underfunded, a situation that can lead to the use of clinical guidelines in general practice that are not based on evidence relevant to primary care.
According to Professor Clare Heal, GP and Professor in the Department of General Practice and Rural Medicine at James Cook University, while lack of funding is a key reason for the relative paucity of general practice-based research, there are other important reasons, such as a significant gap between academia and on-the-ground general practice.
‘General practice registrars are not required to undertake research as part of their training, unlike other specialty trainees, and this may lead to less of a culture of research in general practice,’ Professor Heal told newsGP. ‘GPs may also feel that academics are out of touch with what actually goes on in practical general practice.’
There can also be issues for general practice-based research in terms of research design, especially for randomised controlled trials (RCTs), a cornerstone of modern clinical research.
‘Tertiary-based RCTs have classically had strict protocols [such as small sample sizes, difficulties in randomising participants and interference with the long-term nature of the GP–patient relationship] which are difficult to adhere to in a general practice setting,’ Professor Heal said.
In the face of these challenges, Professor Heal and her research team wanted to show that conducting RCTs was possible in general practice, and also provide a pathway by which other GPs could launch their own projects. With this in mind, they undertook a study, ‘Building a bridge from the swamp to the ivory tower: Conducting randomised controlled trials in general practice’, that followed the experience of conducting five RCTs in a general practice setting in north Queensland between 2003–17.
GPs came up with the research topic for the north Queensland RCTs, which was the management of skin excisions in general practice. This topic was extremely relevant to their daily practice, as Queensland has the highest incidence of skin cancer in the world and GPs are largely responsible for its management in regional towns due to a lack of dermatologists and plastic surgeons.
‘Because the research ideas belonged to the GPs, they were motivated to take part in their own trials,’ Professor Heal said.
GPs were also directly involved in the research design.
‘The studies were designed in partnership with the GPs to be pragmatic and for the methods to work practically in a general practice setting,’ Professor Heal said.
As a result, the RCTs contained general practice-friendly elements, such as ensuring minimal extra work for participating GPs and the assignment of paid data-collection duties to practice nurses. 
Professor Heal believes her experience with the study and the RCTs can provide some helpful advice for GPs interested in conducting their own practice-based research.
‘Research in a general practice setting is feasible, but I would encourage getting expert help from the beginning to navigate through more complicated parts of the process, like study design and ethics applications, such as a partnership between GPs and local academic departments,’ she said.
Access Professor Clare Heal’s paper in the March 2018 edition of AJGP for further information on conducting randomised controlled trials in general practice.

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