Moving the research agenda to where it matters

Learning and caring in communities of practice: using relationships and collective learning to improve primary care for patients with multimorbidity

We introduce a primary care practice model for caring for patients with multimorbidity. Primary care for these patients requires flexibility and ongoing coordination, and it often must be tailored to individual circumstances. Such complex and flexible care could be accomplished within communities of practice, whose participants are willing to learn from their shared practice, further each other's goals, share their stories of success and failure, and promote the continued evolution of collective learning. Primary care in these communities would be conceived as a complex adaptive process in which the participants use an iterative approach to care improvement that integrates what they learn and do collectively over time. Clinicians in these communities would define common goals, cocreate care plans, and engage in reflective case-based learning. As community members manage their knowledge, gain insights, and develop new care strategies, they can improve care for patients with multiple conditions. Using a mix of methods, future research should explore the conditions that are necessary for collective learning within communities of clinicians who care for patients with multimorbidity and who develop new knowledge in practice. By understanding these conditions, we can foster the development of collective learning and improve primary care for these patients.

Future of research in family medicine: where to from here?

Desired research outcomes in family medicine vary according to the developmental stage of the discipline and the context of practice. Several milestones in the evolution of family practice research worldwide have been achieved. Now family medicine researchers face the challenge of discovering how evidence-based primary health care can be delivered in a sustainable way to individuals within communities. To advance family medicine research, we must ensure that trainees have a positive research attitude, develop academic clinician-researchers, lobby for primary care research funding, support practitioners who wish to do research in their own practices, sustain practice-based research networks, and study important questions.

A service-academic partnership in primary care research: one practice's experience

Further development of a strong research base for general practice is important if the profession is to respond appropriately to its central role in service provision. It can be difficult for general practitioners (GPs) who have not pursued an academic career path to make a significant contribution to research. The development of a service-academic partnership is described, together with an honest account of the difficulties encountered.

The impact of health economics on healthcare delivery. A primary care perspective

With the increasing emphasis on providing efficient and equitable services from primary care and against a background of increasing demands on limited resources, economic theory seeks to facilitate both the direction of primary care and the decisions that are made within it. This paper argues that the impact of health economics, particularly at the microeconomic level, has been limited. This is because health economists have failed to recognise the importance of context, and also reflects their attempts to force reality into a disciplinary matrix which is not always accessible and acceptable to end users. Argument is made for a closer relationship between health economists and those who commission and deliver primary care. It is also desirable to develop pragmatic decision-making frameworks which draw upon economic concepts and principles but reflect the realities of the environment in which they are applied.