May 2001 • Volume 7 • Number 5
Practicing FPs form backbone of research team
BY SHARON DICKINSON DENT
Family medicine is experiencing a cultural revolution, according to John Hickner, M.D., M.S., director of the AAFP National Network for Family Practice and Primary Care Research. The AAFP and medical practice are moving toward a more evidence-based approach, and the practice-based research network is part of that evolution.
"The old culture was 'We do practice,'" Hickner said. "The immediate past culture was 'We do practice, and we teach medical students in our offices.' The new culture is 'We do practice, we teach and we are involved in generating new knowledge.'"
Hickner pointed out that practice-based research networks involve three key participants: the family physician, the principal investigator and the network director. Three attendees at the national network's convocation March 21 - 24 in Colorado Springs, Colo., explained their roles in the process.
Practicing FP
As a solo family physician in Baton Rouge, La., Linda Stewart, M.D., sees about 35 patients each day and serves as a preceptor for medical students and family practice residents. But she also finds time to take part in office-based research studies, including research projects of the AAFP national network.
"I've always been interested in the research end, but I am not in a huge research hospital. I'm out in the trenches by myself," said Stewart. "I can't go hire a staff and writers and statisticians. But I can participate at this level. I can help with creating ideas; I can be a research tool. One of the big perks for me is it keeps me stimulated and it helps answer the questions that come up in my mind."
Although her practice may have two or three studies under way at any given time, most projects ask for short-term involvement, she said. "For example, you have 10 patients to recruit to do a diabetic questionnaire. It's a no-brainer. It's not a big invasion in my practice."
Family physicians provide an important reality check for researchers, Stewart said. "We can try to help them understand that if they modify how they're representing the material, the time constraints or the paperwork involved, then they'll get a better result."
Patients are surprisingly positive about participating in office-based research studies, she said. "I can't say they're always enthusiastic about everything we do, but we gave our diabetic patients a 10-page questionnaire, and they were filling it out saying, 'Gee, Doc, I'm so glad someone's interested in what I think.' That's the response we get."
Linda Stewart, M.D.:
"I've always been interested in the research end, but I am not in a huge research hospital. I'm out in the trenches by myself.'"
Linda Stewart, M.D.,
practicing FP
Principal investigator
FP Dan Vinson, M.D., M.S.P.H., from the family and community medicine department at the University of Missouri in Columbia, caught the research bug about 12 years ago while working with a group of family practice residents. They were trying to decide how to treat a patient who was experiencing alcohol withdrawal.
After looking into the options, "I began to realize that there was a lot that wasn't known," Vinson recalled. "I had an idea for a little alcohol research project, just chart review, but it worked. One thing led to another, and I began to think more philosophically about what was important to study about alcohol and problem drinking in primary care."
At the convocation, Vinson presented details about his current study, "Comfortably Engaging: Which Approach to Screening for Problem Drinking Is More Effective?"
Doctors in the AAFP's national network will enroll patients in the study later this spring to compare the use of a four-question approach with the use of a single question.
"Problem drinking is very common," said Vinson, noting that 15 percent of U.S. adults have at least one episode of binge drinking per month, and 7.4 percent meet the criteria for alcohol abuse or dependence. "There is a lot that primary care clinicians can do to help patients identify the risks, think about them and begin to change. And we don't do that for a lot of reasons. To try to find a way to make those alcohol-related discussions more effective, part of it has to be with an eye toward making it better for the clinician."
Dan Vinson, M.D., M.S.P.S.:
"I had an idea for a little alcohol research project, just chart review, but it worked. One thing led to another.'"
Dan Vinson, M.D., M.S.P.H.,
principal investigator
Network director
With new practice-based networks springing up around the country, many new network directors at the convocation sought advice from seasoned veterans such as Kevin Peterson, M.D., M.P.H., of Lake Elmo, Minn., the Minnesota AFP Research Network director.
Peterson, whose network includes about 200 members, said a network director wears many hats in a largely administrative role. "The network director needs to protect the interests of the family physician in the community," he explained. "He needs to ensure that research that's brought in won't negatively affect the physician's bottom line, that it doesn't encumber his practice or disillusion him as a researcher. On the other hand, he needs to ensure -- from a primary investigator's standpoint -- that a project is done in a fashion that is consistent with the protocol, that is scientifically sound and rigorous, and that eliminates as much bias as possible."
In his network, a steering committee evaluates each potential research project and determines issues such as its practice-friendly factor and the time required to conduct the study. Committee members then determine whether to support the project.
At the convocation, Peterson was elected to wear yet another hat: chairman of the Federation of Practice-Based Research Networks steering committee. The FPBRN includes 33 networks representing more than 7,000 members. The AAFP national research network is a network member of the FPBRN and helps coordinate and facilitate its activities.
Kevin Peterson, M.D., M.P.H.:
"The network director needs to protect the interests of the family physician in the community."
Kevin Peterson M.D., M.P.H.,
network director
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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