Primary care research leads to the triple aim of healthier patients, higher quality and lower costs, yet financial support from federal agencies remains limited, according to speakers at a recent forum.
Andrew Bindman, M.D., a former director of the Agency for Healthcare Research and Quality, discusses funding and logistical support for primary care research at a recent policy forum hosted by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
A panel of researchers at the May 25 forum(www.graham-center.org) sponsored by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care discussed how primary care-focused research is improving patient care even though other research into a narrow band of aliments gets outsized attention.
In 2016, the NIH research budget was $32 billion, but just $300 million of that -- less than 0.01 percent -- was allocated to the Agency for Healthcare Research and Quality (AHRQ), which has authority over primary care research but lacks dedicated funding for specific primary care studies. President Donald Trump's proposed 2018 budget would cut NIH grant funds by 17 percent.
Such funding represents a major imbalance between the type of care patients seek and the type of medical research that is supported, given that 53 percent of all patient office visits are made to primary care physicians(www.cdc.gov) and that half of these visits generate a patient care question that remains unanswered.
- Panelists at a May 25 health policy forum discussed how primary care-focused research improves patient care even though other types of research get better financial support.
- They noted an imbalance between the type of care patients seek and the type of medical research that is supported.
- For instance, NIH is heavily focused on studying isolated diseases although an aging population of patients is commonly making office visits with more than one ailment at a time.
Alex Fiks, M.D., director of the American Academy of Pediatrics' Pediatric Research in Office Settings network, recalled how a physician assistant noticed during patient consultations that children appeared to be reaching puberty earlier. A team of researchers received grant funding that led to confirmation of the observation. The study results led to a complete revision of the topic in medical textbooks.
"Nowhere else (but in primary care) could that kind of information have been acquired," Fiks said.
Bernard Ewigman, M.D., M.S.P.H., chair of the Department of Family Medicine at the University of Chicago, recalled treating a patient with swollen lymph nodes during his days as a resident. A medical textbook he used at the time noted that 50 percent of patients with swollen lymph nodes had cancer, so he consulted the attending physician about seeking a biopsy for the patient. The physician dismissed the suggestion, and Ewigman later saw that the statistic was based on a study that had been conducted in a cancer center.
The account highlighted a drawback of overreliance on subspecialty research.
"In the late 70s and early 80s we had little information on chronic disease and prevention," Ewigman said. "What has become a product of (recent) research is incredibly powerful because the answers that we had in the past were wrong."
The NIH remains heavily focused on studying isolated diseases, yet with an aging population of patients who commonly make office visits for more than one ailment at a time, it is important to understand how multiple chronic conditions interact.
"When you are testing for hepatitis, diabetes, hypertension or depression, the integration of all of this is a primary care problem, not a diabetes problem," Ewigman said.
The panelists agreed that more research should focus on combinations of ailments, not just one disease.
Jennifer Carroll, M.D., M.P.H., director of the AAFP's National Research Network, discussed some of the pending studies being conducted in a primary care setting.
One study is evaluating the effectiveness of complex medication management by bringing clinical pharmacists into the primary care office. Another is focusing on chronic kidney disease management in primary care with coaching and decision-making support tools embedded into the medical team's electronic health record. A third study targets health disparities seen among asthma patients in African-American and Latino communities. Each of these projects involves care coordination and management of complex situations, hallmarks of primary care.
Former AHRQ Director Andrew Bindman, M.D., said primary care research needs a home in a federal agency, as well as adequate funding and higher visibility. An institute that is dedicated to primary care studies with its own funding source and a recognized name would be an appropriate start.
He noted that patients are asking their primary care physicians crucial questions about concerns such as the necessity, side effects, risks and costs of specific tests and treatments.
"These are the kinds of questions you ask of somebody you trust," Bindman said. "We need research to answer these questions. Ultimately, primary care is the backbone of patient-centered care."