Research in general practice……

1. Research in general practice…… Rawiri Keenan, MBChB (Otago)

2. So why should you care or even think or try research?How can you as a ‘everyday’ GP do/partake in research?

3. Objectives/overview • Background to me and my role/journey • Different ways to be part of research • Research types/methods • How to come up with an idea • Research Process • Ethics Applications

4. Not covering • Detail of research methods • Stats • EBM – Literature reviews

5. Who am I? • GPEP2 Research Registrar • Waikato Faculty Rep • Honorary Academic in General Practice – UoA • GP in TeAwamutu • Medical Advisor – Midlands Health Network

6. Who are you all? • Where are you currently working? • What stage of GPEP are you at? • Any prior experience in research? • Any interest in research? • If so where/what field?

7. WHY RESEARCH

9. Asking a question • Each day health care practitioners have questions about patients they are treating: • How common is this condition? • How accurate is this diagnostic test? • What is the best treatment?  • What is the likely prognosis for this patient?

10. Finding Answers • Dr Google • Medscape • Bpac • Local PHO/DHB/Specialist etc • Journals or Librarian

11. Research Types • Quantitative • RCT/case control/cohort etc – all the usual big medical stuff • Qualitative • Talking to people – education/ lifestyle change

12. Ways of doing research • In practice audit – CQI • Local audit – groups of practices • Part of university course • Join up with other experienced researchers • Lead own project • Academic Teaching

13. Why is research important? • Informs our decision making • Furthers the cultural growth of primary care • Real in the field work – not academic • Not top down - secondary based • Do we know this applies to primary care?

14. Why is research important? • Studying the natural historyor prevalence of common problems and major diseases • Understanding how patients, families, communities, and systems deal with health and illness • Improving doctor-patient communication, decision making, and partnership • Testing systems to improve patient satisfaction, safety, and outcomes

15. 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 • Engaging patients, communities, and practices to improve health

16. Simplified & Repeated • Observational study to show what is really there • Show how well we are or aren’t doing things • Show how hospital studies show one thing – real world shows another • Shows things with a patient focus

17. Master of Medical Science/Masters of General Practice • Taught masters • Dissertation (60 Points) • and 60 points from the courses listed in the Master of Medical Science Schedule, including an approved research methods course if such a course has not already been passed. • Research masters • Research Portfolio (90 Points) and 30 points from approved courses listed in the Master of Medical Science Schedule.

19. A group of practices devoted to the primary care of patients, and affiliated in their mission to investigate questions and to improve the quality of primary care. PBRNs often link practicing clinicians with investigators experienced in clinical and health services research, while at the same time enhancing the research skills of the network members.

20. The research process • Learn by doing

22. Research process • Choose a broad topic • CLINICAL QUESTION OR INTEREST • 2. Get and overview of the topic • WHAT HAS BEEN DONE ALREADY • 3. Narrow the topic • ACTUAL CLINICAL PART YOU WANT TO KNOW • 4. Develop thesis/ purpose statement • WHAT IS THE ACTUAL AIM/ RESEARCH QUESTION

23. PICO(t) • Participants/Patients • Intervention • Comparison • Outcome • Time

24. Exercise

25. Research process • Plan for research and production • QUESTIONS TO GUIDE YOU • Find, analyse, evaluate sources • HOW YOU MIGHT OBTAIN INFO • Have practice runs – need collection form for ethics

26. Ethics Committees • POPLHLTH 701 – essentially the assignment is ethic application so can do both with one go • Expedited review cover here – full ethics a lot more work and definitely needs input • Essential for publishing, even things covered under QI initiatives

27. Filling out a form

28. exercise

29. exercise

30. FEEDBACK

32. Feedback • Papers • Conferences • Peers • Be prepared to skip over stuff • Decide what is critical

33. So why should you care or even think or try research?

34. We all need to know how to answer clinical questions • Using local info far more powerful than overseas

35. How can you as a ‘everyday’ GP do/partake in research?

36. If nothing else – audit in your own practice, but think about getting ethics application and teaming up with others in your area • Think about a PG Dip – can always add the masters part later

37. General Tips • If you have an idea – talk to someone • If you are interested in research but have no idea talk to someone • Watch for scope creep • Be prepared for set backs

38. Some resources • http://www.researchtoolkit.org/ • www.annfammed.org • Journal of Primary Health Care

39. Search techniques Look/search the core journal Or following links from a key article/document

40. Database searching • Limits – different year/study types etc • *Truncation - Search for different word stems and word endings • $Wild cards – search for spelling variants

41. Boolean operators Join keywords:ANDORNOT