Primary care involvement in clinical research - prerequisites, motivators, and barriers: results from a study series.

Cluster-randomised controlled trial General practitioner Health services research Innovation Fund Medical research Primary care Research network

Journal

Archives of public health = Archives belges de sante publique

ISSN: 0778-7367

Titre abrégé: Arch Public Health

Pays: England

ID NLM: 9208826

Informations de publication

Date de publication:
20 Mar 2024

Historique:

received: 31 08 2023

accepted: 12 03 2024

medline: 20 3 2024

pubmed: 20 3 2024

entrez: 20 3 2024

Statut: epublish

Résumé

Long-term reinforcement in the role of primary care and improvement the healthcare system as a whole requires the involvement of GPs in clinical research processes. However, many clinical studies fail due to failure to achieve sample population targets amongst GPs and their patients. This issue has been identified and discussed, but effective strategies to overcome it are still lacking. One of the reasons is that the positions, requirements, and experiences of GPs on participating in clinical research have hardly been examined up to now. The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research. Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost-benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project. Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research.

RESULTS RESULTS

Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost-benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project.

CONCLUSIONS CONCLUSIONS

Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.

Identifiants

DOI: 10.1186/s13690-024-01272-x PMID: 38504310

pubmed: 38504310

doi: 10.1186/s13690-024-01272-x

pii: 10.1186/s13690-024-01272-x

doi:

Types de publication

Journal Article

Langues

eng

Pagination

Informations de copyright

Références

Lech S, O’Sullivan JL, Wellmann L, et al. Recruiting general practitioners and patients with dementia into a cluster randomised controlled trial: strategies, barriers and facilitators. BMC Med Res Methodol. 2021;21(1):1–3. https://doi.org/10.1186/s12874-021-01253-6 . PMID: 33784967.

doi: 10.1186/s12874-021-01253-6

Virnau L, Braesigk A, Deutsch T, et al. General practitioners’ willingness to participate in research networks in Germany. Scand J Prim Health Care. 2022;40(2):237–45. https://doi.org/10.1080/02813432.2022.2074052 . PMID: 35770652.

doi: 10.1080/02813432.2022.2074052 pubmed: 35770652 pmcid: 9397419

Fletcher B, Gheorghe A, Moore D, et al. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review. BMJ Open. 2012;2(1):e000496. https://doi.org/10.1136/bmjopen-2011-000496 . PMID: 22228729.

doi: 10.1136/bmjopen-2011-000496 pubmed: 22228729 pmcid: 3253423

Ngune I, Jiwa M, Dadich A, et al. Effective recruitment strategies in primary care research: a systematic review. Qual Prim Care. 2012;20(2):115–23 PMID: 22824564.

pubmed: 22824564

Bower P, Wallace P, Ward E, et al. Improving recruitment to health research in primary care. Fam Pract. 2009;26(5):391–7. https://doi.org/10.1093/fampra/cmp037 . PMID: 19549623.

doi: 10.1093/fampra/cmp037 pubmed: 19549623

Foster A, Horspool KA, Edwards L, et al. Who does not participate in telehealth trials and why? A cross-sectional survey. Trials. 2015;16(1):258. https://doi.org/10.1186/s13063-015-0773-3] . PMID: 26044763.

doi: 10.1186/s13063-015-0773-3] pubmed: 26044763 pmcid: 4464859

Williamson MK, Pirkis J, Pfaff JJ, et al. Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study. BMC Med Res Methodol. 2007;7(1):42. https://doi.org/10.1186/1471-2288-7-42 . PMID: 17875219.

doi: 10.1186/1471-2288-7-42 pubmed: 17875219 pmcid: 2147023

Hummers-Pradier E, Bleidorn J, Schmiemann G, et al. General practice-based clinical trials in Germany – a problem analysis. Trials. 2012;13(1):205. https://doi.org/10.1186/1745-6215-13-205 . PMID: 23136890.

doi: 10.1186/1745-6215-13-205 pubmed: 23136890 pmcid: 3543296

Hummers-Pradier E, Chenot J-F, Scherer M. Are primary care practices research infrastructure? [Sind Hausarztpraxen Forschungsinfrastruktur?]. Z Allg Med. 2014;90(7/8):317–22. https://doi.org/10.3238/zfa.2014.0317-0322 .

doi: 10.3238/zfa.2014.0317-0322

Page MJ, French SD, McKenzie JE, et al. Recruitment difficulties in a primary care cluster randomised trial: investigating factors contributing to general practitioners’ recruitment of patients. BMC Med Res Methodol. 2011;11(1):35. https://doi.org/10.1186/1471-2288-11-35 . PMID: 21453543.

doi: 10.1186/1471-2288-11-35 pubmed: 21453543 pmcid: 3076278

Huibers MJ, Bleijenberg G, Beurskens AJ, et al. An alternative trial design to overcome validity and recruitment problems in primary care research. Fam Pract. 2004;21(2):213–8. https://doi.org/10.1093/fampra/cmh219 . PMID: 15020394.

doi: 10.1093/fampra/cmh219 pubmed: 15020394

Sahin D, Yaffe MJ, Sussman T, et al. A mixed studies literature review of family physicians’ participation in research. Fam Med. 2014;46(7):503–14 PMID: 25058542.

pubmed: 25058542

Voorhees JR, Xierali IM, Bazemore AW, et al. A small percentage of family physicians report time devoted to research. J Am Board Fam Med. 2013;26(1):7–8. https://doi.org/10.3122/jabfm.2013.01.120125 . PMID: 23288274.

doi: 10.3122/jabfm.2013.01.120125 pubmed: 23288274

Johnston S, Liddy C, Hogg W, et al. Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre. BMC Med Res Methodol. 2010;10(1):109. https://doi.org/10.1186/1471-2288-10-109 . PMID: 21144048.

doi: 10.1186/1471-2288-10-109 pubmed: 21144048 pmcid: 3017524

Leathem CS, Cupples ME, Byrne MC, et al. Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care. BMC Med Res Methodol. 2009;9(1):40. https://doi.org/10.1186/1471-2288-9-40 . PMID: 19545366.

doi: 10.1186/1471-2288-9-40 pubmed: 19545366 pmcid: 2709635

Rosemann T, Szecsenyi J. General practitioners’ attitudes towards research in primary care: qualitative results of a cross sectional study. BMC Fam Pract. 2004;5(1):31. https://doi.org/10.1186/1471-2296-5-31 . PMID: 15613246.

doi: 10.1186/1471-2296-5-31 pubmed: 15613246 pmcid: 545488

van der Wouden JC, Blankenstein AH, Huibers MJH, et al. Survey among 78 studies showed that Lasagna’s law holds in Dutch primary care research. J Clin Epidemiol. 2007;60(8):819–24. https://doi.org/10.1016/j.jclinepi.2006.11.010 . PMID: 17606178.

doi: 10.1016/j.jclinepi.2006.11.010 pubmed: 17606178

van der Gaag WH, van den Berg R, Koes BW, Bohnen AM, et al. Discontinuation of a randomised controlled trial in general practice due to unsuccessful patient recruitment. BJGP Open. 2017;1(3):bjgpopen17X101085. https://doi.org/10.3399/bjgpopen17X101085 . PMID: 30564680.

doi: 10.3399/bjgpopen17X101085 pubmed: 30564680 pmcid: 6169930

Jowett S, Macleod J, Wilson S, et al. Research in primary care: extent of involvement and perceived determinants among practitioners from one English region. Br J Gen Pract. 2000;50(454):387–9 PMID: 10897537.

pubmed: 10897537 pmcid: 1313704

Mason V, Shaw A, Wiles N, et al. GPs’ experiences of primary care mental health research: a qualitative study of the barriers to recruitment. Fam Pract. 2007;24(5):518–25. https://doi.org/10.1093/fampra/cmm047 . PMID: 17698979.

doi: 10.1093/fampra/cmm047 pubmed: 17698979

FerrandDevouge E, Biard M, Beuzeboc J, et al. Motivations and willingness of general practitioners in France to participate in primary care research as investigators. Fam Pract. 2019;36(5):552–9. https://doi.org/10.1093/fampra/cmy126 . PMID: 30605509.

doi: 10.1093/fampra/cmy126

Loskutova NY, Smail C, Ajayi K, et al. Recruiting primary care practices for practice-based research: a case study of a group-randomized study (TRANSLATE CKD) recruitment process. Fam Pract. 2017;35(1):111–6. https://doi.org/10.1093/fampra/cmx064 . PMID: 28985294.

doi: 10.1093/fampra/cmx064 pmcid: 6454459

Messner DA, Moloney R, Warriner AH, et al. Understanding practice-based research participation: The differing motivations of engaged vs. non-engaged clinicians in pragmatic clinical trials. Contemp Clin Trials Commun. 2016;4:136. https://doi.org/10.1016/j.conctc.2016.08.003 . PMID: 29736476.

doi: 10.1016/j.conctc.2016.08.003 pubmed: 29736476 pmcid: 5935887

Peters-Klimm F, Freund T, Bentner M, et al. “In the Practice and for the Practice!” A Workshop Report of the Development of an Academic Practice-Based Research Net [„Aus der Praxis und für die Praxis!“ Aufbau eines Netzes von akademischen hausärztlichen Forschungspraxen – ein Werkstattbericht]. Z Allg Med. 2013;89(4):183–8. https://doi.org/10.3238/zfa.2013.0183-0188 .

doi: 10.3238/zfa.2013.0183-0188

Tan ACW, Clemson L, Mackenzie L, et al. Strategies for recruitment in general practice settings: the iSOLVE fall prevention pragmatic cluster randomised controlled trial. BMC Med Res Methodol. 2019;19(1):236. https://doi.org/10.1186/s12874-019-0869-7 . PMID: 31829133.

doi: 10.1186/s12874-019-0869-7 pubmed: 31829133 pmcid: 6907149

Groenewegen PP, Greß S, Schäfer W. General practitioners’ participation in a large, multicountrycombined general practitioner-patient survey: recruitment procedures and participation rate. Int J Family Med. 2016;2016:4929432. https://doi.org/10.1155/2016/4929432 . PMID: 27047689.

doi: 10.1155/2016/4929432 pubmed: 27047689 pmcid: 4800081

Tong SF, Ng CJ, Lee VKM, et al. Decision making process and factors contributing to research participation among general practitioners: a grounded theory study. PLoS One. 2018;13(4):e0196379. https://doi.org/10.1371/journal.pone.0196379 . PMID: 29694439.

doi: 10.1371/journal.pone.0196379 pubmed: 29694439 pmcid: 5919004

Gorringe J. Initial preparation for clinical trials. Princ Pract Clin Trials Edinburgh Livingstone. 1970;4146:38.

Wangler J, Jansky M. Real progress for care? viewpoints and experiences of family physicians with regard to the german innovation fund [Echter Fortschritt für die Versorgung? - Standpunkte und Erfahrungen von Hausärzt*innen in Bezug auf den Innovationsfonds]. Z Allg Med. 2022;98(4):148–53. https://doi.org/10.53180/zfa.2022.0148-0153 .

doi: 10.53180/zfa.2022.0148-0153

Wangler J, Jansky M. The German Innovation Fund and primary care – What expectations and experiences do general practitioners have with regard to participating in innovative care models? [Innovationsfonds und Primärversorgung – Welche Erwartungen und Erfahrungen vertreten Hausärzt*innen in Bezug auf die Teilnahme an innovativen Versorgungsmodellen?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2022;65(6):697–705. https://doi.org/10.1007/s00103-022-03533-y . PMID: 35476151.

doi: 10.1007/s00103-022-03533-y pubmed: 35476151 pmcid: 9132806

Wangler J, Jansky M: Experiences with Innovation Fund healthcare models in primary care: A qualitative study amongst German general practitioners. Wien Med Wochenschr 2022 [Online First]. PMID: 35503146 https://doi.org/10.1007/s10354-022-00935-0 .

Deutscher Bundestag: Drucksache 19/8500. Available from: URL: https://dipbt.bundestag.de/doc/btd/19/085/1908500.pdf . Cited 2023; May 26.

Schmitt J, Petzold T, Nellessen-Martens G, et al. Prioritization and consentation of criteria for the appraisal, funding and evaluation of projects from the german innovationsfonds: a multi-perspective delphi study [Priorisierung und Konsentierung von Begutachtungs-, Förder- und Evaluationskriterien für Projekte aus dem Innovationsfonds: Eine multiperspektivische Delphi-Studie]. Gesundheitswesen. 2015;77(8/9):570–9. https://doi.org/10.1055/s-0035-1555898 . PMID: 26270043.

doi: 10.1055/s-0035-1555898 pubmed: 26270043

Heytens H, Walther F, Keßler L, et al. Characteristics of innovation fund-supported intervention studies: review and document analysis of study protocols, publications and final reports [Charakteristika von durch den Innovationsfonds geförderten Interventionsstudien: Review und Dokumentenanalyse von Studienprotokollen, Publikationen und Abschlussberichten]. Gesundheitswesen. 2021;83(5):20–37. https://doi.org/10.1055/a-1448-2412 . PMID: 34015857.

doi: 10.1055/a-1448-2412

Schmitt J, Geraedts M, Maier B, et al. On the status quo and the planned further development of the Innovation Fund (Version 3, February 4th, 2020) [Zum Status quo und der vorgesehenen Weiterentwicklung des Innovationsfonds (Version 3, 4.2.2020)]. Gesundheitswesen. 2020;82(5):374–7. https://doi.org/10.1055/a-1119-3984 .

doi: 10.1055/a-1119-3984

Bablok I, Binder H, Stelzer D, et al. Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare. BMC Geriatrics. 2021;21(1):222. https://doi.org/10.1186/s12877-021-02114-z . PMID: 33794789.

doi: 10.1186/s12877-021-02114-z pubmed: 33794789 pmcid: 8012747

Wangler J, Geschke K, Wuttke-Linnemann et al.: Prevention of dementia-related care crises in a general practitioner-based setting—the innovative care model DemStepCare [Prävention von demenzbedingten Versorgungskrisen im hausarztbasierten Setting – das Projekt DemStepCare als innovative Versorgungsform]. Präv Gesundheitsf 2022 [Online First]. https://doi.org/10.1007/s11553-022-00931-7 .

Wangler J, Jansky M. Evaluation of elevated liver values in primary care - a series of studies on the status quo of care in Germany with special reference to alcoholic liver disease. BMC Prim Care. 2022;23(1):104. https://doi.org/10.1186/s12875-022-01714-x] . PMID: 35501826.

doi: 10.1186/s12875-022-01714-x] pubmed: 35501826 pmcid: 9063320

Wangler J, Jansky M. Attitudes to and experience of disease management programs in primary care – an exploratory survey of general practitioners in Germany. Wien Med Wochenschr. 2021;171(13–14):310–20. https://doi.org/10.1007/s10354-021-00867-1 . PMID: 34338907.

doi: 10.1007/s10354-021-00867-1 pubmed: 34338907 pmcid: 8484225

Wangler J, Jansky M. What is the significance of guidelines in the primary care setting? Results of an exploratory online survey of general practitioners in Germany. Wien Med Wochenschr. 2021;171(13–14):321–9. https://doi.org/10.1007/s10354-021-00849-3 . PMID: 34101082.

doi: 10.1007/s10354-021-00849-3 pubmed: 34101082 pmcid: 8484242

Mayring P: Qualitative content analysis. Theoretical foundation, basic procedures and software solution. Available from: URL: https://nbn-resolving.de/urn:nbn:de:0168-ssoar-395173 . Cited 2023; May 26.

Jones KM, Dixon ME, Dixon JB. General practice research–does gender affect the decision to participate? Aust Fam Physician. 2012;41(6):419–23 PMID: 22675685.

pubmed: 22675685

Tawo S, Gasser S, Gemperli A, et al. General practitioners’ willingness to participate in research: a survey in Central Switzerland. PLoS One. 2019;14(3):e0213358. https://doi.org/10.1371/journal.pone.0213358 . PMID: 30822332.

doi: 10.1371/journal.pone.0213358 pubmed: 30822332 pmcid: 6396922

Güthlin C, Beyer M, Erler A, et al. Recruitment of family practitioners for research – experiences from five studies [Rekrutierung von Hausarztpraxen für Forschungsprojekte - Erfahrungen aus fünf allgemeinmedizinischen Studien]. Z Allg Med. 2012;88(4):173–81. https://doi.org/10.3238/zfa.2012.0173-0181 .

doi: 10.3238/zfa.2012.0173-0181

Hummers-Pradier E, Scheidt-Nave C, Martin H, et al. Simply no time? Barriers to GPs’ participation in primary health care research. Fam Pract. 2008;25(2):105–12. https://doi.org/10.1093/fampra/cmn015 . PMID: 18417465.

doi: 10.1093/fampra/cmn015 pubmed: 18417465

Poß-Doering R, Kunz A, Pohlmann S, et al. Engaging family physicians in a research project to pilot an electronic health record [Hausarztpraxen für ein Forschungsprojekt zur Erprobung einer elektronischen Patientenakte gewinnen]. Z Allg Med. 2019;95(12):515–9. https://doi.org/10.3238/zfa.2019.0515-0519 .

doi: 10.3238/zfa.2019.0515-0519

Bleidorn J, Heim S, Lingner J, et al. Family Practitioners’ View of Research in Practice Based Research Networks. A Focus Group Analysis [Wie sehen Hausärzte allgemeinmedizinische Forschung im Praxennetz? Eine Fokusgruppenanalyse]. Z Allg Med. 2014;90(9):348–53. https://doi.org/10.3238/zfa.2014.0348-0353 .

doi: 10.3238/zfa.2014.0348-0353

Bleidorn J, Voigt I, Wrede J, et al. Keeping the wire hot with calls? recruiting family practices for a health care research project [Anrufen ohne Ende? Über das Gewinnen hausärztlicher Praxen für ein Versorgungsforschungsprojekt]. Z Allg Med. 2012;88(2):61–8. https://doi.org/10.3238/zfa.2012.0061-0068 .

doi: 10.3238/zfa.2012.0061-0068

Wolf F, Kreuse M, Wiegand S, et al. Family physicians’ participation in a research practice network: which motivations play a decisive role? results of a survey in Thuringia [Was motiviert Hausärztinnen und Hausärzte, sich an einem Forschungspraxennetz zu beteiligen? Ergebnisse einer Befragung in Thüringen]. Z Allg Med. 2020;96(12):490–5. https://doi.org/10.3238/zfa.2020.0490-0495 .

doi: 10.3238/zfa.2020.0490-0495

Beerheide R: Projects with an uncertain future [Projekte mit ungewisser Zukunft]. Dtsch Arztebl 2020; 117: A 188–190.

Cadwallader J-S, Lebeau J-P, Lasserre E, et al. Patient and professional attitudes towards research in general practice: the RepR qualitative study. BMC Fam Pract. 2014;15:136. https://doi.org/10.1186/1471-2296-15-136 . PMID: 25047280.

doi: 10.1186/1471-2296-15-136 pubmed: 25047280 pmcid: 4115489

Brodaty H, Gibson LH, Waine ML, et al. Research in general practice: a survey of incentives and disincentives for research participation. Ment Health Fam Med. 2013;10(3):163–73 PMID: 24427184.

pubmed: 24427184 pmcid: 3822664

Schmid S. Innovation Fund and standard care. Hardly any effects for general practitioners [Innovationsfonds und Regelversorgung. Kaum Effekte für Hausarztpraxen]. doctors|today. 2021;1(7):38.

Hoffmann AE, Leege EK, Plane MB, et al. Clinician and staff perspectives on participating in Practice-based Research (PBR): a report from the Wisconsin Research and Education Network (WREN). J Am Board Fam Med. 2015;28(5):639–48. https://doi.org/10.3122/jabfm.2015.05.150038 . PMID: 26355136.

doi: 10.3122/jabfm.2015.05.150038 pubmed: 26355136 pmcid: 4934613

Huas C, Petek D, Diaz E, et al. Strategies to improve research capacity across European general practice: the views of members of EGPRN and Wonca Europe. Eur J Gen Pract. 2019;25(1):25–31. https://doi.org/10.1080/13814788.2018.1546282 . PMID: 30607993.

doi: 10.1080/13814788.2018.1546282 pubmed: 30607993 pmcid: 6394293

Supper I, Ecochard R, Bois C, et al. How do French GPs consider participating in primary care research: the DRIM study. Fam Pract. 2011;28(2):226–32. https://doi.org/10.1093/fampra/cmq073 . PMID: 20829279.

doi: 10.1093/fampra/cmq073 pubmed: 20829279

Peters-Klimm F, Hermann K, Gagyor I, et al. Experiences and attitudes regarding practice-based clinical trials: results of a survey among German primary care physicians Erfahrungen und Einstellungen zu Klinischen Studien in der Hausarztpraxis. Ergebnisse einer Befragung von deutschen Hausärzten Gesundheitswesen. 2013;75(5):321–7. https://doi.org/10.1055/s-0032-1321742 . PMID: 22893207.

doi: 10.1055/s-0032-1321742 pubmed: 22893207

Tsiligianni I, Oikonomou N, Papaioannou A, et al. Exploring primary care physician experiences conducting practice-based research on adult vaccination: a qualitative evaluation study in Greece. Fam Pract. 2020;37(6):828–33. https://doi.org/10.1093/fampra/cmaa063 . PMID: 32779702.

doi: 10.1093/fampra/cmaa063 pubmed: 32779702

Koskela TH. Building a primary care research network – lessons to learn. Scand J Prim Health Care. 2017;35(3):229–30. https://doi.org/10.1080/02813432.2017.1358439 . PMID: 28847229.

doi: 10.1080/02813432.2017.1358439 pubmed: 28847229 pmcid: 5592348

Souza DLB, Oliveras-Fabregas A, Minobes-Molina E, et al. Trends of multimorbidity in 15 European countries: a population-based study in community-dwelling adults aged 50 and over. BMC Public Health. 2021;21(1):76. https://doi.org/10.1080/02813432.2017.1358439 . PMID: 28847229.

doi: 10.1080/02813432.2017.1358439 pubmed: 33413239 pmcid: 7792098

Rieckert A, Trampisch US, Klaaßen-Mielke R, et al. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. BMC Fam Pract. 2018;19(1):113. https://doi.org/10.1186/s12875-018-0795-5 . PMID: 30021528.

doi: 10.1186/s12875-018-0795-5 pubmed: 30021528 pmcid: 6052592

Calmbach WL, Ryan JG, Baldwin L-M, et al. Practice-based research networks (PBRNs): meeting the challenges of the future. J Am Board Fam Med. 2012;25(5):572–6. https://doi.org/10.3122/jabfm.2012.05.120064 . PMID: 22956692.

doi: 10.3122/jabfm.2012.05.120064 pubmed: 22956692

Pirotta M, Temple-Smith M. Practice-based research networks. Aust Fam Physician. 2017;46(10):793–5 PMID: 29036782.

pubmed: 29036782

O’Regan A, Hayes P, O’Connor R, et al. The university of Limerick education and research network for general practice (ULEARN-GP): practice characteristics and general practitioner perspectives. BMC Fam Pract. 2020;21(1):25. https://doi.org/10.1186/s12875-020-1100-y . PMID: 32024480.

doi: 10.1186/s12875-020-1100-y pubmed: 32024480 pmcid: 7003418

Salmon P, Peters S, Rogers A, et al. Peering through the barriers in GPs’ explanations for declining to participate in research: the role of professional autonomy and the economy of time. Fam Pract. 2007;24(3):269–75. https://doi.org/10.1093/fampra/cmm015 . PMID: 1750477.

doi: 10.1093/fampra/cmm015 pubmed: 17504773

Bjorvatn B, Kristoffersen ES, Halvorsen PA et al. New infrastructure for research in general practice [Ny infrastruktur for allmennmedisinsk forskning]. Tidsskr nor Laegeforen 2019; 139(1). https://doi.org/10.4045/tidsskr.18.0689 . PMID: 30644691.

Goodyear-Smith F, Bazemore A, Coffman M, et al. Primary care research priorities in low-and middle-income countries. Ann Fam Med. 2019;17(1):31–5. https://doi.org/10.1370/afm.2329 . PMID: 30670392.

doi: 10.1370/afm.2329 pubmed: 30670392 pmcid: 6342597

Beasley JW, Dovey S, Geffen LN, et al. The contribution of family doctors to primary care research: a global perspective from the international federation of primary care research networks (IFPCRN). Prim Health Care Res Dev. 2004;5(4):307–16. https://doi.org/10.1191/1463423604pc221oa .

doi: 10.1191/1463423604pc221oa