Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Research Potential of Practice Nurses: What Contribution to Primary Health Care Research?

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Research Potential of Practice Nurses: What Contribution to Primary Health Care Research?

Article excerpt

HOW IMPORTANT IS PRIMARY HEALTH CARE RESEARCH?

Internationally, it is recognised that there is a clear association between the PHC orientation of a country's health system and improved population health outcomes, particularly within the context of chronic conditions (Starfield, Shi and Macinko 2005; Atun 2004). In addition, patient satisfaction is higher and aggregate health spending lower in countries where PHC is readily available (Atun 2004). Good clinical practice and quality patient care are dependent on a sound evidence-base derived from high quality research and development (Mant 1997). Indeed, PHC research has been described as 'the missing link in the development of high-quality, evidence-based health care for populations (van Weel and Rosser 2004, Suppl: 5-16). The 'gatekeeping' role of the general practitioner (GP) is a key factor in the provision of cost-effective and patient-centred health care (Starfield 1994). To be most effective in this role, GPs require a sound evidence base, yet this is absent or limited in many areas of decision-making (Mant 1997; Medical Research Council 1997; Horton 1999). Development of PHC research is central to the strengthening of this evidence base. Increasing interest and focus on the practice nurse role in Australia is a promising initiative, in not only facilitating PHC but also increasing PHC research (Halcomb et al. 2004; Hegney et al. 2003). The knowledge base of all branches of clinical practice is incomplete, and general practice-based primary health care is more problematic than most because of the importance of integrated problem solving that embraces biological, individual and contextual dimensions (Medical Research Council 1997).

HOW IS PRIMARY HEALTH CARE RESEARCH DISADVANTAGED?

Trying to establish a global figure for expenditure on PHC research is difficult, but data show that public expenditure on PHC research is nominal in Australia, New Zealand, the Netherlands and the United Kingdom. During the period 2002 to 2003 less than AUD1.40 per capita was spent on primary care research (McAvoy 2005). Compared with hospital and laboratory-based research, PHC research receives significantly fewer resources. In Australia, this amounts to a mere 4.1% of total public expenditure on health and medical research (McAvoy 2005). As output is clearly linked to resources and infrastructure, it is therefore not surprising that in Australia throughout the 1990's there was only one publication/1000 GPs/year, compared with 60, 100 and 150 for surgeons, physicians and public health physicians respectively (Askew, Glasziou and Del Mar 2001). Moreover less than half of the Australian general practice research papers published in the 1980's and 1990's focused on clinical topics - over two thirds of the research was observational and only about 5.1% involved randomised controlled trials (RCTs) (Ward, Lopez & Kamien 2000). In addition, practice nurses' publishing in the PHC setting is only in its infancy (Halcomb, Patterson & Davidson 2006).

IS THE SITUATION IMPROVING IN PRIMARY HEALTH CARE?

Despite starting from a low funding base, resources and support for PHC research is increasing. A major impetus has been the Australian Government's Primary Health Care Research, Evaluation and Development (PHCRED) Strategy, a $50 million, 5-year program introduced in 2000 (Primary Health Care Research and Information Service 2006).

The PHCRED program incorporates four key components:

* A PHC research priority setting process;

* Funding for PHC research, evaluation and development capacity-building for university departments of general practice and of rural health;

* Establishment of a national PHC research institute;

* A general practice and PHC research program, encompassing investigator and priority-driven research, as well as scholarships and fellowships.

Following an evaluation in 2005 (Oceania Health Consulting 2005), a further four years of funding has been granted, with a view to expanding the existing PHC research workforce, while improving relevance and uptake of evidence into PHC (Primary Health Care Research and Information Service 2006). …

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