Journal Records History of Practice-Based Research Networks

The January-February issue of the Journal of the American Board of Family Medicine, a theme issue on the work of practice-based research networks, celebrates their progress in "A Short History of Primary Care Practice-Based Research Networks: From Concept to Essential Research Laboratories."

The history's authors -- Larry Green, M.D., a professor in the family medicine department at the University of Colorado, Denver, and senior scholar in residence at the AAFP's Robert Graham Center in Washington, and John Hickner, M.D., M.Sc., a professor in the family medicine department at the University of Chicago and former director of the AAFP National Research Network -- lead with the caveat, "This synopsis does not adequately capture the enthusiasm, energy, professional risk, volunteerism and devotion of the many academic and community physicians, researchers, office staffs and patients who have worked together to improve and transform primary care by carefully observing and interpreting the phenomenon of primary care practice as it unfolds each day."

The authors review research pioneers' contributions, the international research scene from the 1950s through the 1970s, early U.S. efforts and the creation of the Ambulatory Sentinel Practice Network. ASPN's first studies addressed headache, pelvic inflammatory disease and miscarriage. "These three descriptive studies changed the way physicians approach these common problems and removed doubt that important research could be accomplished" by a PBRN, say Green and Hickner. ASPN, with 50 published manuscripts, "outgrew its revenues in 1999" and was reborn as an AAFP program now called the National Research Network.

The authors also track the development of other national and regional networks and the 1997 creation of the Federation of Practice-Based Research Networks, which transferred its secretariat to the AAFP in 2000.

Concerning PBRN financing, Green and Hickner note the impact of the Agency for Healthcare Research and Quality, the only federal agency designated by law to conduct primary care research. The authors also discuss NIH support. "It was ultimately congressional pressure to translate the fruits of basic and clinical research into improved health of the United States population that is gradually forcing NIH to recognize the value of primary care research networks," say the authors. "PBRN leaders are advising NIH on feasible ways to train a national clinical research workforce of 50,000 to 75,000 clinicians, of which half are likely to be primary care physicians.

In their conclusion, Green and Hickner say, "These networks are now both a place and a concept. As a place, they are laboratories for surveillance and research. As a concept, they express the still unmet need for practicing primary care clinicians to accept responsibility to improve front-line clinical care by understanding what is happening in their practices. Successes to date have been sufficient to incite the prestigious Institute of Medicine to recommend support to stabilize and expand practice-based primary care research networks. There is hard work ahead, work likely to transform front-line medical practice."