General Practice Research: A New Year's Resolution
Claire Burton (left), Joanne Reeve (centre) and Lorna Clarson (right)
December is a funny month. It is a time of contrasts - sparkling festive abandon interspersed with quieter end of year reflections. It is no surprise that Dickens chose this time of year to set one of his most famous illustrations of the disparity between the 'have' and 'have-not'.1 The UK's first experience of so-called Black Friday2 shone a tinsel-wrapped light on our changing perceptions of the things we 'can't live without'.3
Debates about want and need are nothing new to general practice. But as 2014 draws to a close, we suggest there is one debate which needs our urgent attention - namely the extent to which general practice research is a luxury or a necessity. Some GPs see research as a 'minority sport'4 - interesting, but a low priority especially with so many other pressures on our profession. Others argue that these put pressures on our profession. Others argue that these pressures are precisely why we need primary care research, now more than ever.5 6 Too often, the research that we use to guide improvements in care is of uncertain relevance to the individuals and populations we care for.7 8 To change that, we need more general practice research.
Here we draw on research highlights from 2014 to show how general practice research can help our patients, and make our working day better too.
General practice research addresses the real problems we face in daily practice
Professor Paul Little is an academic GP in Southampton. His research team are tackling the thorny question of how to reduce antibiotic use. We know that antibiotic resistance is rising, that we need to prescribe less, and the guidelines for 'best practice'. However, we also know that translating ideals into practice is hard. One suggestion from NICE has been to use delayed prescribing, or 'back up' prescriptions. Although, do they work?
Professor Little and his team looked at precisely that question. They randomised 889 patients aged 3 years and over with acute respiratory tract infection who were not in immediate need of antibiotics to five groups:
- re-contact for a prescription;
- post-dated prescription;
- collection of the prescription;
- given the prescription (patient led) and
- no antibiotic prescription.
The trial concluded that the use of delayed prescriptions is likely to be associated with fewer than 40% of patients using antibiotics. Their work showed that with clear guidance, any strategy of delayed prescribing is likely to reduce antibiotic use without impacting on symptom severity or duration.9 General practice-specific research like this underpins the development of tools like the TARGET resources on the RCGP website.10
General practice research focuses on the problems that our patients bring to us
Patients rarely come to us in general practice because they have had a flare of their hypertension or their diabetes. Rather they bring problems that are causing disruption to their daily life which they think are health-related. They present with symptoms not diseases, meaning we need symptom-based research.
Professor Niroshan Siriwardena, an academic GP, and his team at Lincoln University tackle another problem we commonly see - that of sleep problems.11 We know we should be minimising medication use for insomnia. Nevertheless, how else can we help our patients?
The Lincoln group have led innovative work to explore the management of sleep problems in primary care using psychological therapies such as cognitive behavioural therapy instead of traditional medication options. Their research has shown that patients are willing to try these approaches, and that the therapies work. The team's research has helped to reduce the prescription of hypnotic drugs.
General practice research challenges the 'one size fits all' model
As GPs, our aim is to offer care tailored to the needs of each individual patient. This need to recognise the differences between our patients underpins the research led by Professor Julia Hippisley-Cox. Her team is responsible for the QResearch12 work which uses data from primary care electronic health records to develop risk calculators that estimate an individual's future likelihood of problems such as cardiovascular disease, fractures or admission to hospital. The impact of this work can already be widely seen.13
General practice research: necessity or luxury
Research has given us ever more ways to measure and monitor the human body, but in doing so contributes to new concerns about over diagnosis and over treatment.14 Some might suggest we need less research, and more professional wisdom. However, as we have outlined here, research - especially research done by GPs for GPs - makes a difference. It is a necessity not a luxury. This means we need more GPs involved in it15 - more academic GPs, and more GPs shaping what research is done and how the findings are interpreted.
The Society for Academic Primary Care works in partnership with the RCGP to champion academic general practice at the heart of constant improvement in primary care provision. Our new year's resolution is to work with the College to increase opportunities for all of us to make a difference through community-based academic activity.16
To find out more about getting involved with general practice research, contact your local academic department, or SAPC.
To find out more about research at the RCGP click here.
Contact Claire Burton at Claire.firstname.lastname@example.org, Joanne Reeve at email@example.com, and Lorna Clarson at firstname.lastname@example.org (Claire, Joanne and Lorna are academic GPs in Keele and Liverpool, and Joanne is Chair of SAPC.)
1Wikipedia, Christmas Carol
2BBC, Black Friday: The tricks of the trade used by shops; Emily Thomas
3The New York Times, Luxury, or Necessity? Catherine Rampell
4CMAJ Blogs, Primary Care Research: a minority sport? Helen Carr
5Theguardian, Making primary care research a priority in the new NHS landscape
6British Journal of General Practice, Academic primary care: at a tipping point? Richard Hobbs, Clare J Taylor
7University of Liverpool, EZProxy Remote Services Menu
8British Journal of General Practice, Primary care evidence in clinical guidelines: a mixed methods study of practitioners’ views, Asmaa Abdelhamid, Amanda Howe, Tim Stokes, Nadeem Qureshi, Nick Steel
9thebmj, Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial
10RCGP, Target Toolkit
11University of Lincoln, Improving Treatment for Insomnia Sufferers
12QRESEARCH, specialises in research & analyses using primary care electronic health data
13RCGP, The University of Nottingham, QRISK: A new cardiovascular risk score to identify patients at high risk of cardiovascular disease for prevention
14Youtube, Overdiagnosis and the Epidemic of Prediabetes, John Yudkin Kenote
15British Journal of General Practice, Academic primary care: at a tipping point?
16RCGP, The 2022 GP A Vision for General Practice in the Future NHS