Research priorities in primary care

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Research priorities in primary care
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Overview of presentation

• Role of primary care in healthcare system
• Key issues face by primary health care
• Developing research capacity in primary care
• Conclusions

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What is primary healthcare?

• An academic and scientific discipline, with its
  own educational content, research, evidence base
  and clinical activity, and a clinical specialty
  orientated to primary care
• Normally the point of first medical contact
  within the health care system, providing open and
  unlimited access to its users, dealing with all
  health problems regardless of the age, sex, or
  any other characteristic of the person concerned
• Makes efficient use of health care resources
  through co-ordinating care, working with other
  professionals in the primary care setting, and by
  managing the interface with other specialities
  taking an advocacy role for the patient when
  needed
• Develops a person-centred approach, orientated to
  the individual, his/her family, and their
  community

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US Health Plans
UK
Patients Referred/Year
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Global context of primary care

• Poverty 1.2 billion people live on less than
  US1 per day 1 in 6 are chronically hungry.
• Population 6.2 Billion, 200,000 people added
  each day In 68 countries gt40 of population is
  under age 15
• Environment Billions face water shortages and
  air pollution temperature will rise 1.0-4.5oF
  this century
• Civil Society Civil and Foreign Wars, Displaced
  Persons and Refugees, Failed States

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Drivers of change in primary healthcare

• Ageing populations
• Increased focus on chronic diseases
• Rising levels of obesity
• Focus on quality of healthcare
• Increased public accountability
• Cost containment
• Greater managerialism
• New medical technology
• Computerisation of healthcare
• Internet technologies

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Age distribution of heart disease in England
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The rise of chronic diseases

• Obesity Diabetes
• Cardiovascular Disease and Stroke
• Cancer
• Neuropsychiatric disease and dementias
• Pulmonary Disease

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The burden of chronic disease

• About three quarters of those over 75 have long
  term illness
• Accounts for 80 of GP consultations and 60 of
  hospital bed days in the UK
• Two thirds of medical emergency admissions are
  caused by exacerbations of chronic disease or
  occur in patients with chronic disease
• In the USA. patients with chronic disease account
  for 78 of health costs

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Diabetes in Primary Care

• Increasing in prevalence in UK
• Around 2 in 1990s
• 3.4 in 2004-05 (GP contract data)
• 3.7 in 2006-07 (GP contract data)
• Prevalence higher in NW London
• Prevalence substantially higher in Middle East,
  Asia, parts of Africa
• Major implications for morbidity, mortality and
  quality of life
• Economic impact on healthcare systems

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Improving quality of diabetes care

• A range of initiatives to improve quality of care
  for people with diabetes in the UK
• National Service Framework
• National Institute of Health Clinical
  Excellence (NICE) guidelines
• New GP contract in April 2004

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Control of HBA1c lt 7.5 in patients with
diabetes in general practices in NW London in
2005-2006
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Meeting the challenge of chronic diseases

• Primary care changing from managing acute
  illnesses to managing chronic diseases
• Prevention and early diagnosis
• Structured care recognised quality measures
• Inter-disciplinary teams
• Patient empowerment
• Innovative use of information technology

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Research on chronic diseases in primary care

• Prevention early diagnosis
• Evaluation of models of care
• Impact of patient education and self-management
  programmes
• Assessment of new technology
• Effectiveness of new drugs and drug combinations

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Information Technology

• Clinical care
• Management
• Patient clinician education

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IT Clinical care

• Computerised records at point of care
• Structured medical records
• Decision support systems
• Easier access to clinical data
• Improved chronic disease management

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IT Healthcare Management

• Integrated health records
• Needs assessment
• Case mix measurement
• Quality of care
• Service development
• Research

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Case Mix Measurement
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IT Patient Clinician Education

• Access to online resources
• Better informed patients increased self care
• More informed general practitioners primary
  care professionals
• Development of comprehensive, accurate and
  reliable sources of information

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Diagnostics

• Endoscopy, imaging, pathology, physiological
  measurement
• Near patient testing (NPT) / point of care
  testing (POCT)
• Increased speed of diagnosis more appropriate
  treatment, e.g. near patient test for bacterial
  infections
• Home testing, e.g., glucose, anticoagulation,
  blood pressure

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Impact on diagnostics Heart disease

• Heart disease can be influenced by genetic
  environmental factors
• Doctors cant currently determine the precise
  cause of heart disease
• Hence, treatment of heart disease is similar in
  different patients
• In the future, genetic tests may determine the
  role of specific genetic factors
• May allow treatment to be tailored to each patient

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Prescribing

• Prescribing costs increasing rapidly
• Increased pressure for appropriate,
  evidence-based prescribing
• Increased awareness about drugs amongst patients
• New drugs in development by pharmaceutical
  industry
• Potential for considerable health gain

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Prescribing pressures in England
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Prescribing by therapeutic area in England
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Building research capacity in primary care

• Training programmes for primary care researchers
• F2 doctors, Academic Clinical Fellows, Clinical
  Research Fellowships, Clinical Lecturers,
  Clinical Senior Lecturers
• Research methods training MSc, MPH, PhD
  programmes
• Medical Research Council (basic science)
• www.mrc.ac.uk
• National Institute of Health Research (applied
  research)
• www.nihr.ac.uk
• Clinical research networks, topic specific
  research networks (e.g. diabetes), primary care
  research networks
• Clinical audit, evidence based medicine, journal
  clubs

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Conclusions

• Exciting developments in information technology,
  diagnostics, genomics
• Higher demands costs for healthcare
• Population growth
• Increased life expectancy
• Improved health awareness
• Better access to healthcare services
• Large research development agenda