Patient and professional attitudes towards research in general practice: the RepR qualitative study

Primary care involvement in clinical research - prerequisites, motivators, and barriers: results from a study series

BACKGROUND

Long-term reinforcement in the role of primary care and improvement the healthcare system as a whole requires the involvement of GPs in clinical research processes. However, many clinical studies fail due to failure to achieve sample population targets amongst GPs and their patients. This issue has been identified and discussed, but effective strategies to overcome it are still lacking. One of the reasons is that the positions, requirements, and experiences of GPs on participating in clinical research have hardly been examined up to now.

METHODS

The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research.

RESULTS

Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost-benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project.

CONCLUSIONS

Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.

General practice-related MeSH terms in main journals: a bibliometric analysis from 2011 to 2021

BACKGROUND

There are various Medical Subject Headings (MeSH) terms used to index general practice research, without consistency.

AIM

To understand how general practice-related research is indexed in the main general practice journals between 2011 and 2021, and to analyse the factors that influenced the choice of the general practice-related MeSH.

DESIGN AND SETTING

This was a quantitative bibliometric study conducted on MEDLINE.

METHOD

MeSH were selected according to the international definition of General Practice/Family Medicine: 'General Practice', 'Primary Health Care', 'Family Practice', 'General Practitioners', 'Physicians, Primary Care', and 'Physicians, Family'. Their use was studied from 2011 to 2021 on MEDLINE, reviewing the 20 general practice journals with the highest impact factors. A descriptive and analytical approach was used; the association of the country, journal, and year with the choice of general practice-related MeSH terms was analysed.

RESULTS

A total of 8514 of 150 286 articles (5.7%) were using one of the general practice-related MeSH terms. The most used were 'Primary Health Care' (4648/9984, 46.6%) and 'General Practice' (2841/9984, 28.5%). A total of 80.0% (6172/7723) of the articles were related to the UK or US and 71.0% (6055/8514) of the articles came from four journals (BJGP, BMJ, Journal of General Internal Medicine, and Annals of Family Medicine). Two main country clusters emerged from the use of general practice-related MeSH: a British cluster mainly using 'General Practice' and an American cluster using 'Primary Health Care'. The journals also mainly differed in their used of these two MeSH terms.

CONCLUSION

Important variations in the indexation of general practice research were found. Researchers should consider combining 'Primary Health Care' and 'General Practice' in their PubMed searches to access all the general practice research, regardless of their country of origin.

Expectations of general practitioners on a practice based research network in Germany- a qualitative study within the Bavarian Research Practice Network (BayFoNet)

BACKGROUND

Despite general practitioners' (GPs') key role in Germany`s primary health care, clinical research in general practice is scarce. Clinical research is mainly conducted at inpatient facilities, although their results are rarely transferable. German GPs have no extra time or funding for research, as well as limited research training. To support clinical research in German primary health care, practice-based research networks (PBRNs) are developed. As they will be based on an active involvement of GPs, we need more information on GPs` participation-readiness. The aim of this study was to explore facilitators and barriers to participation in the Bavarian Research Practice Network (BayFoNet) from the GPs`perspective before clinical trials will be performed.

METHODS

We have performed semi-structured qualitative interviews with a purposive sample of 20 Bavarian GPs in 2022 under the application of the consolidated framework for implementation research (CFIR). Transcriptions were analysed according to Kuckartz` qualitative content analysis. The five domains of the CFIR framework served as initial deductive codes.

RESULTS

N = 14 interviewees already agreed to participate in BayFoNet, whereas n = 6 interviewees opted not to participate in BayFoNet at the time of data collection. Main facilitators to conduct clinical research within BayFoNet were the motivation to contribute to evidence strength and quality in general practice, professional development and training of practice staff, as well as networking. Barriers for an active participation were bad experiences with previous clinical studies and lack of resources.

CONCLUSIONS

PBRNS in Germany have to be promoted and the entire practice team has to be involved at an early stage of development. Professional training of general practice staff and a living network might enhance engagement. Participatory approaches could help to develop acceptable and feasible study designs. Furthermore, PBRNs should support patient recruitment and data collection in general practices and disseminate the results of their research projects regularly to maintain GPs` engagement.

TRIAL REGISTRATION

DRKS00028805, NCT05667207.

Research in family medicine: Contribution, priorities, and barriers in Saudi Arabia

BACKGROUND

Research in family medicine is important. The objectives of this study were to explore the contribution of family physicians, their attitudes and practice, and the barriers to research in family medicine in Saudi Arabia.

MATERIALS AND METHODS

This study was conducted on Saudi family physicians in 2021. A self-administered questionnaire was sent to family physicians through WhatsApp and email. Information sought included demographic data, scientific profile, number of publications, reasons for conducting research, barriers to the conduct of research, attitudes and skills for the conduct of research, and priority areas of research. Data were analyzed using SPSS version 15. Descriptive statistics included mean and standard deviation for continuous variables and frequencies and percentages for categorical variables. Student's t-test was used to compare the means of two groups of physicians. Chi-square test and logistic regression analysis were performed to determine the association between categorical variables.

RESULTS

A total of 313 family physicians filled the questionnaire; majority were male (65%), were married (90%), and worked under the Ministry of Health (73%). The total number of publications since graduation was 1165 papers with an average of 3.8 papers per physician. More than 70% were interested in conducting research, and more than two-thirds considered research important to the advancement of family medicine. One-third of the family physicians were currently involved in conducting research, while 30% were supervising at least one research project. The top five areas of priority were chronic diseases, mental health, health promotion, quality of healthcare, and medical education/training; whereas the top five obstacles to the conduct of research were the lack of time, lack of research environment, lack of financial and technical support, and the absence of skills.

CONCLUSION

Saudi family physicians make a good contribution to research. The researchers and research bodies should focus on identifying the priority areas for research in family medicine in the next few years and provide support to achieve some of the objectives of the National Vision of 2030.

General practitioners' willingness to participate in research networks in Germany

OBJECTIVES

To investigate general practitioners' (GPs') willingness to participate in long-term medical research and in research networks (RNs).

DESIGN AND SETTING

Cross-sectional survey among German GPs around Halle-Wittenberg and Leipzig in 2020.

SUBJECTS

Random sample of 905 GPs.

MAIN OUTCOME MEASURES AND RESULTS

Response rate 37%, 69% female. Overall, 57% were interested in participating in medical research, 34% in an active role in a RN. Interest in RN participation was positively associated with male sex, younger age, previous experiences in medical research, being involved in teaching undergraduates, and having qualification in a further specialty. Main motivators were improving patient care, giving a more realistic picture of GP care, and carrying out research on topics within their own interest areas and a reliable contact person at the leading institution. Most GPs were not afraid of reduced earnings; however, time investment was the main barrier for participation. GPs were willing to dedicate twice as much time to research when remuneration was offered. High rated topics were polypharmacy, chronic diseases, drug safety and adverse drug reactions.

CONCLUSION

GPs are interested to participate in practice-based research. The study results providing useful and generalizable insights in barriers and motivators should be considered when building and running GP-RNs.KEY POINTSThere is a difference between general practitioners' (GPs') overall interest in clinical research and their job and socio-demographic related readiness to participate in research networks (RNs).GPs are interested in RNs when it is a resource of and leading to enhanced patient-oriented care.GPs are willing to dedicate twice as much time to research when remunerated.GPs need a reliable counterpart within the leading institution.

The University of Limerick Education and Research Network for General Practice (ULEARN-GP): practice characteristics and general practitioner perspectives

Background

A well-functioning general practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland’s newest general practice-based research network and to analyse the perspectives of the network’s members on research engagement.

Method

A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network’s profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement.

Results

All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future.

Conclusion

This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process.

Motivations and willingness of general practitioners in France to participate in primary care research as investigators

BACKGROUND

Clinical research is mostly conducted among hospitalized patients, which restricts the generalizability of research results. The involvement of GPs in research has been consistently highlighted as a factor associated with successful study recruitment.

OBJECTIVES

To assess GPs' motivations and willingness to participate in primary care research as investigators and to identify factors associated with their willingness.

METHODS

We conducted an observational, cross-sectional study in Normandy, France, with a self-questionnaire sent to 3002 GPs. We collected data on GPs' socio-demographic characteristics, their experiences and their expectations regarding research, and their reasons for non-participation.

RESULTS

Overall, 489 questionnaires were collected. Two hundred and forty-six GPs (50.3%) were interested in participating in clinical research as investigators. The two main conditions for participation as investigators were the relevance of the study topic for clinical practice (80.5%) and the feedback of study results (80.1%). The two main reasons for non-participation were lack of time (79.4%) and administrative burden (43.6%). Age between 27 and 34 years (adjusted odds ratio [AOR] = 2.86, P = 0.004) and GP trainer status (AOR = 2.41, P < 0.001) were associated with willingness to participate in primary care research. Age between 60 and 70 years (AOR = 0.53, P = 0.03) and locum status (AOR = 0.40, P = 0.04) were associated with non-participation in research.

CONCLUSIONS

Based on our results, we were able to establish a profile of GPs willing to participate in primary care research as investigators. GPs' involvement should be based on their preferred areas of research. Different incentives such as a dedicated clinical research nurse or financial support could also be considered.

Maximising response from GPs to questionnaire surveys: do length or incentives make a difference?

Background

General Practitioners (GPs) respond poorly to postal surveys. Consequently there is potential for reduced data quality and bias in the findings. In general population surveys, response to postal questionnaires may be improved by reducing their length and offering incentives. The aim of this study was to investigate whether questionnaire length and/or the offer of an incentive improves the response of GPs to a postal questionnaire survey.

Methods

A postal questionnaire survey was sent to 800 UK GPs randomly selected from Binley’s database; a database containing contact details of professionals working in UK general practices. The random sample of GPs was assigned to one of four groups of 200, each receiving a different questionnaire, either a standard (eight sides of A4) or an abbreviated (four sides of A4) questionnaire, with or without the offer of an incentive (a prize draw entry for a £100 voucher) for completion. The effects of questionnaire length and offer of incentive on response were calculated.

Results

Of 800 mailed questionnaires, 19 GPs did not meet inclusion criteria and 172 (adjusted response 22.0%) completed questionnaires were received. Among the four groups, response ranged from 20.1% (standard questionnaire with no incentive and abbreviated questionnaire with incentive) through 21.8% (standard questionnaire with incentive), to 26.0% (abbreviated questionnaire with no incentive). There were no significant differences in response between the four groups (p = 0.447), between the groups receiving the standard versus the abbreviated questionnaire (% difference -2.1% (95% confidence interval (CI) -7.9, 3.7)) or the groups offered an incentive versus no incentive (% difference -2.1% (95% CI -7.9, 3.7).

Conclusions

Strategies known to improve response to postal questionnaire surveys in the general population do not significantly improve the response to postal questionnaire surveys among GPs. Further refinements to these strategies, or more novel strategies, aimed at increasing response specifically among GPs need to be identified in order to maximise data quality and generalisability of research results.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2288-15-3) contains supplementary material, which is available to authorized users.