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- Page navigation anchor for Integrating research and clinical care must include primary careIntegrating research and clinical care must include primary care
We thank Dr. Lamontagne and colleagues for their timely analysis.(1) We agree that Canada can and should do better: research can be better integrated with clinical care.
Some of the most significant opportunities for transformative research lie within the sector providing most of the care for most Canadians most of the time: primary care. By conducting clinical research in primary care, studies are more pragmatic and the findings more generalizable to the real world.
To develop and sustain the infrastructure needed to grow clinical research in primary care, Canada should invest in supporting primary care practice-based learning and research networks (PBLRNs). PBLRNs can be critical building blocks in constructing a pan-Canadian network that integrates knowledge production, dissemination, and practice improvement. PBLRNs have operated in many countries for over 25 years as networks connecting primary care practices and academic researchers. More than 15 primary care PBLRNs are currently active across Canada; they manage data collected from electronic medical records(2) and support clinical research ranging from randomized controlled trials to longitudinal cohort studies and qualitative projects. However, funding to support PBLRNs’ operating costs is scarce. Training opportunities, protected time for PBLRN clinician-scientists, and support for administrative and analytic activities are all limited.(3)
The College of Family Physicians of Canada and...
Show MoreCompeting Interests: None declared.References
- 1. Lamontagne F, Rowan KM, Guyatt G. Integrating research into clinical practice: challenges and solutions for Canada. Canadian Medical Association Journal. 2021;193(4):E127.
- 2. Birtwhistle R, Keshavjee K, Lambert-Lanning A, Godwin M, Greiver M, Manca D, et al. Building a pan-Canadian primary care sentinel surveillance network: initial development and moving forward. J Am Board Fam Med. 2009;22(4):412-22.
- 3. Weidner A, Peterson LE, Mainous AG, 3rd, Datta A, Ewigman B. The Current State of Research Capacity in US Family Medicine Departments. Fam Med. 2019;51(2):112-9.
- 4. RCGP RSC Workload Observatory 2020 [Available from: https://clininf.eu/index.php/rcgprscworkloadobservatory/.
- 5. Tu K, Sodhi S, Kidd M, Grunfeld E, Ji C, Greiver M, et al. The University of Toronto Family Medicine Report: Caring for our Diverse Populations. Toronto, Ontario: Department of Family and Community Medicine, University of Toronto; 2020.
- Page navigation anchor for Clinical Research in non-traditional Canadian research settingsClinical Research in non-traditional Canadian research settings
Lamontagne and colleagues provided a timely analysis, outlining some of the challenges of conducting clinical research in Canada (1). While most research is conducted in traditional academic centres, the majority of Canadians are cared for in community hospitals; our institution has over 800 admissions annually to intensive care units (2). Including community hospitals and non-traditional centres in research is important for answering important clinically relevant questions for the health of Canadians, as well as integrating knowledge translation (2–3). The novel coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for rapid research and knowledge translation. As a relatively nascent research hospital in Canada, participating in several multicentre critical care research trials (4-5), we would like to share some of our recent experience in establishing research at a non-traditional research centre.
At our institution, pre-existing infrastructure was largely non-existent and required development. For most community-based hospitals, research is not a principal organizational or institutional mandate (2). Consequently, several barriers exist – namely the lack of research personnel, experience, funding, familiarity of clinical staff with research, and institutional support. At our centre, the lack of an electronic research database has made the conduct of epidemiological research, or even quality improvement difficult. The COVID-19 pandemic had...
Show MoreCompeting Interests: None declared.References
- (1) François Lamontagne, Kathryn M. Rowan, Gordon Guyatt. Integrating research into clinical practice: challenges and solutions for Canada. CMAJ 2020;10.1503/cmaj.202397.
- (2) Gehrke P, Binnie A, Chan SPT, Cook DJ, Burns KEA, Rewa OG, et al. Fostering community hospital research. Can Med Assoc J. 2019 Sep 3;191(35):E962–6.
- (3) Gagliardi AR, Berta W, Kothari A, Boyko J, Urquhart R. Integrated knowledge translation (IKT) in health care: A scoping review. Implement Sci. 2016;11(1):1–12.
- (4) Alhazzani W, Guyatt G, Marshall JC, Hall R, Muscedere J, Lauzier F, et al. Re-evaluating the Inhibition of Stress Erosions (REVISE): a protocol for pilot randomized controlled trial. Ann Saudi Med. 2016 Nov;36(6):427–33.
- (5) Angus DC, Berry S, Lewis RJ, Al-Beidh F, Arabi Y, van Bentum-Puijk W, et al. The REMAP-CAP (Randomized Embedded Multifactorial Adaptive Platform for Community-acquired Pneumonia) Study. Rationale and Design. Ann Am Thorac Soc. 2020 Jul;17(7):879–91.
- Page navigation anchor for RE: Integrating research into clinical practice: the full benefits come from a systems approachRE: Integrating research into clinical practice: the full benefits come from a systems approach
François Lamontagne and colleagues very usefully raise important questions about how health research in Canada might be better organised to enhance its impact on clinical practice (1). Given the achievements of health research in the UK during the COVID-19 pandemic, the authors rightly laud the Clinical Research Network infrastructure for facilitating research that leads to key advances.
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There are additional reasons for building research infrastructure widely across a health service. English NHS hospitals in the cancer research network that participated in colorectal cancer (CRC) trials had lower CRC mortality than others after adjustments for case-mix and hospital level variables. It was not restricted to academic centres or large hospitals, but there was a dose effect (2). This phenomenon, though, is not unique to England, or research networks. A review of global literature on research engagement by healthcare providers found North America provided the majority of studies reporting improved healthcare performance associated with research active clinicians or healthcare organisations (3).
That leads to the observation that perhaps the most important aspect of Sally Davies’ formation of the English National Institute for Health Research (NIHR) was not the adoption of any one specific element, but rather the creation of the overall system. This achievement was recognised in a recent WHO review identifying the NIHR as world-leading in implementing a comprehensive...Competing Interests: None declared.References
- 1) François Lamontagne, Kathryn M. Rowan, Gordon Guyatt. Integrating research into clinical practice: challenges and solutions for Canada. CMAJ 2020;10.1503/cmaj.202397.
- 2) Downing A, Morris EJA, Corrigan N, et al. High hospital research participation and improved colorectal cancer survival outcomes: a population-based study. Gut 2017;66:89–96. http://dx.doi.org/10.1136/gutjnl-2015-311308
- 3) Boaz A, Hanney S, Jones T, Soper B. Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open 2015;5:e009415. doi: 10.1136/bmjopen-2015-009415
- 4) Hanney S, Kanya L, Pokhrel S, Jones T, Boaz A. What is the evidence on policies, interventions and tools for establishing and/or strengthening national health research systems and their effectiveness? Health Evidence Network (HEN) synthesis report 69.
- 5) Hanney SR, Ovseiko PV, Graham KER. et al. A systems approach for optimizing implementation to impact: meeting report and proceedings of the 2019 In the Trenches: Implementation to Impact International Summit . BMC Proc 2020;14:10. https://doi.org/10.11