Family Practice Spotlight
The Ambulatory Sentinel Practice Network does research with a plus: It begins and ends with primary care, not academia.
Since 1978, from its Denver office, ASPN has collected research data from physicians (90 percent of them family physicians), nurse practitioners, and physician's assistants. By now, about 450 FPs are among the 600 or so clinicians in ASPN.
"So much medical research today is conceived by researchers, conducted by researchers, and published and consumed by other researchers, who in turn do research without ever having any knowledge of what is going on in the real world," says ASPN Executive Director Paul Nutting, MD, a family physician. "ASPN bases its agenda on the needs, experience, and wisdom of practicing docs. We shorten the feedback loop that is often so difficult later, when researchers say, 'How do we get this research actually used in practice?'"
One of ASPN's projects, for example, began with physicians' comments that they often find cancer not because they're screening for it but simply because the patient is concerned about possibly having it. ASPN developed a project in which about 500 physicians took three minutes a week to report how they detected new cases of cancer.
Some options on the project's weekly return card: The clinician initiated a workup, the community sponsored a screening program, the cancer was an incidental finding in another workup, a physician outside the practice detected the cancer, and the workup was initiated because of the patient's concerns or worries.
"The data are still being analyzed, but it looks like the patient often triggers the workup--not in the majority of cases, but in a large proportion of them," says Dr. Nutting. "Our study is giving us information nobody's ever captured before in real practice settings."
Over the years, ASPN studies have investigated the diagnosis and management of such problems as carpal tunnel syndrome, depression, low-risk OB delivery, headache, pelvic inflammatory disease, miscarriage, chest pain, mammographic screening, and the clinical spectrum of AIDS.
In addition to conducting its own research, ASPN promotes collaboration among 20 local and regional research networks in family practice--a "network of networks" that includes about 2,700 physicians. ASPN and the Academy are in the fifth year of a five-year agreement supporting the development of ASPN.
If you'd like more information on ASPN or other family practice research networks--and especially if you'd like to spend three minutes a week in practice-based research--call ASPN at (800) 854-8283.
FP Report, October 1996
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