‘The future of general practice’: Practice-based research networks

Associate Professor Michelle Guppy helped re-establish a practice-based research network (PBRN) in rural New South Wales while undertaking a major research project in 2017.
 
Funding received from an RACGP Foundation/Diabetes Australia Research Grant was critical to the revival of the PBRN and to Associate Professor Guppy’s research, which she said was ‘a good continuer’ for the work the New England-based PBRN had been doing for years.
 
‘This project helped to support and build a research culture in general practice through the re-invigoration of the New England PBRN,’ she told newsGP.
 
‘This network was established years ago for a specific research project but [had] recently been in abeyance and essentially existing on paper only.  
 
‘It [had not] really been active because [New England] lost all the funding for the Division of General Practice, then Medicare Locals picked up the diabetes program, [but then] the writing was on the wall for Medicare Locals to then be defunded … and the funding that had been associated with it was wound up.
 
‘That’s when I got the [RACGP Foundation/Diabetes Australia] research grant.’
 
Associate Professor Guppy’s project was a retrospective cohort study of the New England Diabetes Program (NEDP), which was established in 1997 and has involved 39 GPs from 16 practices in five towns within the New England area (in north-west NSW), collecting data on 2572 patients with diabetes, forming the nexus of a PBRN.
 
‘They didn’t call themselves a PBRN,’ Associate Professor Guppy noted. ‘But, in reality, that is what they were.
 
‘It probably wasn’t until the early 2000s that the idea of a PBRN was a thing, and that’s when I moved to the New England region.’
 
The NEDP invited patients to re-enrol in the program for the 2016–17 period and added estimated glomerular filtration rate (eGFR) to the parameters. Associate Professor Guppy used this data to investigate previously unknown statistics between the prevalence of chronic kidney disease (CKD) and cardiovascular disease (CVD).
 
‘Because the program started in 1997, this was before any of the kidney disease guidelines had been published,’ she said.
 
‘I retrospectively found patient data on eGFR and added that into the review to investigate kidney function of patients on the program. I also compared actual patient outcomes from CVD with their risk prediction for CVD.’
 
Associate Professor Guppy credits the NEDP’s success to having been ‘developed in general practice by GPs who saw a need to be doing quality improvement’.
 
‘To me, that’s the primary purpose of PBRNs: to do general practice and primary care practice-generated research,’ she said.
 
‘I think a lot of people see them as labs for other research to be put onto GPs to do, but I really see them as the ground up, identifying research questions from general practice and following them through.’
 
Associate Professor Guppy also held important conversations with other New England-based practices – who ultimately declined involvement in the diabetes project.
 
‘Whilst not interested in diabetes research and not coming on board for this particular project, we now understand the capacity and interest of each of these practices to be involved in further research projects that might eventuate through a PBRN,’ she said.
 
‘PBRNs are something that I think quite a lot of us in general practice academia have been interested in for quite a long time, and I am excited about it.’
 
The Federal Government recently pledged $32 million to the medical research sector, following the Medical Research Future Fund’s (MRFF) increases to primary care research and clinician researcher pathways in the Australian Medical Research and Innovation Priorities 2018–20.
 
The RACGP has been a long-time advocate for increased funding in primary care research and addressed this in a submission to the MRFF priority consultation process.
 
The Australian Medical Research and Innovation Priorities 2018–20 declared it would support the establishment of PBRNs and work to boost scholarships for GPs considering completing a PhD.
 
‘This will hopefully lead to more data on chronic disease management in general practice – not just for diabetes and kidney disease, but other chronic diseases as well,’ Associate Professor Guppy said.
 
‘General practice is a very interesting and stimulating career. Part of being a “generalist” means that you are interested and involved in a lot of very different aspects of medicine – from a disease perspective [and] from the perspective of being a clinician, a medical educator and a researcher.
 
‘It is very hard to fit all of this into one life and career.’
 
The RACGP Foundation/Diabetes Australia Research Grant also helped Associate Professor Guppy to progress a component of her PhD study.
 
‘I am still an early career researcher, despite having worked in academic medicine for 14 years – with most of that time devoted purely to teaching roles,’ she said.
 
‘The most significant aspect of the funding for me was to be able to employ a research assistant in order to progress this research, particularly to get so much done over a short time frame. It enabled me to focus on looking at the interesting questions that the research was attempting to solve [and] think about the further questions that the research generated.’
 
Applications for the 2019 RACGP Foundation/Diabetes Australia Research Grant have closed for this year; the recipient will be announced during the first week of August. Grant applications for 2020 open in March next year.

general practice research grants PBRNs RACGP Foundation