Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Research consultation clinic: impetus towards facilitating primary care research

Research consultation clinic: impetus towards facilitating primary care research Background: In Singapore, SingHealth Polyclinics (SHP) is an accredited Family Medicine (FM) training centre which managed 1.8 million primary care patient-visits in 2012. To promote research in the institution, research consultation clinics (RCC) are being introduced in 2010 to enable free face-to-face consultation between experienced and novice researchers on specific research topics. Each RCC session allows about an hour or more for the SHP staff, medical undergraduates and general practitioners to seek advice and clarification on key research areas, ranging from research question refinement, study design and execution, data analysis, result presentation to publication. The consultants comprise of two FM researchers with postgraduate research qualification. Aim: This article aims to review the implementation of RCC from 2010 to 2012 and its impact on research activities and outcome indicators in the same period of time. Methods: The study comprised of two segments. Part I was a three-year retrospective review of the RCC administrative record. The total number of RCC sessions, hours utilised, participants’ profiles, the number of research studies initiated by them and their research presentations at local and overseas scientific meetings/conferences were computed. Part 2 was an anonymous web-based questionnaire survey fielded to RCC participants to collect their feedback on the RCC service and their self-reported initiation and completion of research study after the RCC consultation. Results: The RCC sessions increased from 17 to 40 sessions, resulting in increment of 2 to 14 research presentations and from 2 to 6 initiations of new research studies per annum from 2010–2012. The response rate to the questionnaire survey was 70.3%, with the majority of multi-disciplinary respondents rated the RCC service to be accessible, adequate and were satisfied with its quality. Study design, data management and study execution were ranked as important areas of research for consultation. 79% of them had started a research project and 36% had completed their studies. Conclusions: The RCC is a feasible model to catalyse multi-disciplinary research in primary care institutions. Further study is needed to evaluate its relevance when research advances and novice researchers become experienced investigators to take on more complex projects. Keywords: Research, Consultation, Primary care * Correspondence: tan.ngiap.chuan@singhealth.com.sg Research Department, SingHealth Polyclinics Head Office, 167 Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore 150167, Singapore DUKE-NUS Graduate Medical School, 8 College Rd, Singapore 169857, Singapore © 2013 Tan et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 2 of 7 http://www.apfmj.com/content/12/1/4 Background and in the respective master degree programmes for A strong primary healthcare system is vital to improve community nurses and pharmacists who take on ad- the health of the general population and reduce the vanced professional training. healthcare burden to the nation [1,2]. Research in pri- Aside from training, mentorship appears to be pivotal mary care aims largely to seek better understanding of in moulding primary care practitioners into researchers. disease management in relation to the individuals, fam- Curtis P et al. reported that amongst Family Medicine ilies and the community, and to evaluate the effective- (FM) graduates who received the American National Re- ness and efficiency of healthcare practices and health search Service Awards, they were less successful in policies [3]. Beyond general practice and family medi- terms of research and publication output compared to cine, primary care research is multi-disciplinary, cove- fellow recipients such as internists and paediatricians ring community nursing and pharmacy, sociology, health [10]. The authors attributed the differences to a lack of service and policy research. As primary care supports protected time and sustained research mentorship for the base of the population pyramid and amidst a rapidly the family physicians. Likewise, in Israel, FM residents expanding global population, there is an urgency to scale trained under pro-research mentors were likely to be up primary care research to seek medical evidence to more intensely involved in research when they became prevent, cure, and care for diseases; to translate these family physicians [11]. evidences into regular clinical practice and to formu- A strong and increased level of commitment from pri- late policies to ensure universal equity of care [4]. mary care organisations is needed to provide support and However, primary care research faces challenges, even resources and to reduce barriers for family physicians to in resource-rich countries, due to limitations of research carry out research [12]. Hannaford P et al. showed that a capacity in general practice, inadequate research infra- modest investment of resources and support will create structure in primary care and poor provision of support substantial increases in both the quality and quantity of to individual general practitioners to conduct research. primary care research [13]. They recommended that this Saad H. Al-Abdullateef in a survey of general practi- investment should be targeted at both existing primary tioners in selected primary care centres in Saudi Arabia care professionals working in service settings in primary showed that while a majority expressed interest (66%) care and those in the academic departments in the univer- and planned to carry out research (74.2%), they cited sities [13]. Various funding models for primary care re- insufficient time (83.5%) and lack of support (58.8%) as search have since been developed and implemented in key barriers to research [5]. various countries, centred largely on channelling govern- Practice-based research networks (PBRNs) are groups ment funding via FM departments in universities in of practices networked together to undertake research Australia & the Netherlands, or via the Royal College of relevant to general practice and the local community's General Practitioners in Britain [14-16]. However how needs [6,7]. These PBRNs, often involving collaborations effective and efficient are these funding models in promo- between practitioners and academicians, can expand the ting primary care research and enhance research-related capacity and bandwidth of primary care physicians [8]. training for the general practitioners are seldom measured, Nonetheless, these PBRNs are largely medical, whist and its translation into actual research endeavours are nurses and other researchers tend to form their respec- rarely evaluated. A new model to expedite primary care tive research networks. Furthermore, a survey of a New research in terms of effective individual coaching and effi- York based PBRNs revealed that only 25% of the physi- cient application is urgently needed to empower the pri- cians had formal research training and 21% of them had mary care practitioners. clinical research certification [9]. Lack of time or com- Primary care research faces similar challenges in peting demands for time was the top ranked barrier Singapore, where infrastructure constraints and healthcare resources were hithertho barriers to its development [17]. (92%) in the survey, and 80% of the clinicians reported that their lack of appropriate training was a barrier [9]. However in recent years, despite the lack of dedicated Thus, participation in PBRNs may not adequately ad- research funding for primary care researchers from the local official research agencies, rapid development of aca- dress the specific research needs nor provide training for the individual primary care researchers; neither does it demic medicine in the local public healthcare institutions add impetus towards multi-disciplinary research in pri- resulted in unprecedented support for primary care re- search from primary healthcare organisations, such as mary care. Nevertheless, there are ample research related training SingHealth Polyclinics (SHP). The latter comprises a clus- opportunities that are available from the local academic ter of nine public primary care clinics or polyclinics in institutions to equip primary care professionals with Singapore, which is also a recognised FM training centre basic research skills. Basic research training is incorpo- accredited by the American College of General Medical rated in medical undergraduate education curriculum, Education. Whilst governance, policy and finance are Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 3 of 7 http://www.apfmj.com/content/12/1/4 centrally administered in SHP, the polyclinics operate at FM researchers within the institution with post-graduate various sites to serve the local communities in the south- qualifications in research. ern and eastern parts of Singapore using a common and Periodic evaluation of the service provided by RCC integrated electronic medical records system. Thus in from the participants is vital to ensure that this model of terms of primary care research, the institution can be research support remains relevant and its service caters regarded as a de-facto practice-based multi-disciplinary adequately to their needs. This study aims to determine research network. the level of satisfaction amongst the RCC participants in Novice researchers from SHP can seek seed funding terms of their perception of the accessibility of the ser- from SHP to support their approved research projects vice, adequacy of the duration of the consultation, effec- whilst established researchers are encouraged to vie for tiveness of the consultancy, the key research areas in competitive research grants from national research agen- which they seek consultation, and the outcomes of the cies. Whilst financial support to kick-start research for RCC consultation. these researchers is no longer a barrier, approval for seed funding is based on the evaluation of research proposals’ Methods scientific merits and logistic considerations. Hence novice The evaluation of the RCC service comprises of two seg- researchers find it propitious to consult experienced re- ments. The first part was a retrospective review of the searchers for guidance in order to optimise their success RCC records from 2010–2012 to determine the short- rates in their seed funding or other grant applications. term accomplishments of past participants in terms of With the endorsement from senior management in SHP, their research study initiation and subsequent oral or pos- research consultation clinics (RCC) are established in May ter presentation at academic meetings and/or scientific 2010 to support budding FM researchers in the institution. conferences. “New study” is defined as study initiated Dedicated resources are channelled centrally from institu- within the respective calendar year with reference to its tion annual operating budget to set up the RCC service. date of approval from the institutional review board. The This caters to the opportunistic cost for the consultants, research presentations refer to investigators’ presentations as well as the participants to meet at the RCC for free of their research findings at local or overseas scientific face-to-face consultations during clinic operating hours. It meetings or conferences which are approved by SHP. Both also provides for the seed funding for researchers to sup- outcomes were traced from the respective databases in the port the execution of their project. SHP Department of Research. Each RCC session allows at least an hour for any indi- The second segment was a questionnaire survey of the vidual or group of multi-disciplinary SHP staff to seek same cohort of participants. Each participant was invited advice and clarification on any issues pertaining to their to undertake a web-based questionnaire survey regar- research endeavours. During the consultation sessions, dless of the frequency of RCC participation. The sam- the topics covered include the various domains in re- pling frame comprised of participants who had utilised search, ranging from exploring research idea, definition the RCC service at least once and who had provided of research question, research method, project design, their email contact. The records show a list of 75 RCC application for ethics committee review, logistic plan- participants between January 2010 and December 2012, ning, data analysis and interpretation to results presenta- of which email addresses were provided by 64 of them. tion and publication. The participants can arrange for The questionnaire collected data on the participant’s multiple consultations to clarify queries for their same study or repeat consultation for another study. 1. demographic profile such as age, gender, education The RCC sessions are taken up by SHP multi- status, staff category disciplinary staff, including doctors, nurses and phar- 2. views on accessibility of the service, macists who plan to commence research as part of their 3. quality of the consultancy, professional development or are pursuing advanced 4. ranking of key research domains for which they training programmes which incorporate research as sought consultation part of the curriculum. The service is also open to ex- 5. outcome measures of RCC in terms of initiation and ternal primary care researchers, including private ge- completion of their respective research projects neral practitioners, and medical students from the two local medical colleges, under the over-arching objective The questionnaire survey was anonymous to ensure of enhancing primary care research development and truthful responses from the participants. The investiga- foster research collaborations between different pri- tors notified the participants of the survey via their email mary healthcare providers in Singapore. This necessi- addresses. Second and third round of notices were deli- tates the increase of consultants from one to two to vered to the participants’ email addresses to serve as re- manage the expanded RCC capacity. The consultants are minders to participate in the survey on the second and Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 4 of 7 http://www.apfmj.com/content/12/1/4 third week respectively after the commencement of the the key areas of research for which participants sought first survey. consultation at RCC (Figure 2). Almost 8 out of 10 The survey was designed using the web-based Qualtrics (79%) participants had started a research project after platform to field the questionnaire. The participants would RCC consultation and 36% (14/39) of them had com- read the study’s objectives and other research-related in- pleted their studies (Figure 3). formation according to the Participant Information Sheet Some investigators have already started their study and prior to answering the questionnaire. Due to anonymity of sought consultation at RCC in the midst of their study the questionnaire and the minimal risk nature of the execution. This accounted for the difference between study, approval was obtained from the Institutional Review those who indicated that they had initiated their research Board (CIRB reference no: 2013/253/E ) to waive the writ- (79%) and those who have completed or in the process of ten consent of the participant. The data from the com- carrying out their studies (36% + 49% or 85%). pleted questionnaire were imported into MS Excel for computation and analysis. Discussion The study shows that the establishment of RCC can be a Results catalyst to facilitate research in primary healthcare institu- The number of RCC sessions and hours increased from tion. It is a system approach to empower novice re- 17 sessions (17 hours) in 2010, 47 sessions (48.5 hours) searchers to embark on research. The RCC serves as a in 2011, to 40 sessions (46 hours) in 2012. The number platform for researcher-centric coaching, which caters to of new research projects or conference presentations their individual or team’s specific needs when they plan or resulting directly from the investigators’ participations in are in the midst of executing research. Most of the partici- the RCC also increased from 2010 to 2012 (Figure 1). pants have undertaken basic research training at local aca- For the questionnaire survey, 64 email addresses from demic institutions. However these generic structured a list of 75 participants were found to be unique and training programs may not provide answers to specific currently valid. 45 of them responded to the survey, con- questions or solutions to problems encountered by the stituting a response rate of 70.3% (45/64). 39 of them individual or team members during the planning or execu- completed the entire questionnaire, which formed the tion stages. The RCC bridges this gap, with the consul- denominator for the computation of the results. tants functioning as mentors to guide these researchers. Majority of participants were medical staff of SHP Once these researchers gain hands-on experience and (56%), predominantly females (67%), aged 21–40 years confidence after these beginners’ trials or studies, it sets (58%) and with post-graduate qualifications (49%). Table 1 the stage for them to pursue advanced research training shows the demographic profile of participants in the ques- program and to take on more complex studies. tionnaire survey. The key elements for a successful set-up include sup- Most participants considered the RCC as accessible and port from senior management to provide the appropriate adequate in time provision. All of them were satisfied with resources, ensuring that the service is accessible and the quality of consultancy at RCC (Table 2). Study design, convenient. Adequate time allocation and quality of the data management and study execution were ranked as consultancy are essential elements for successful service Number of Research Projects 6 initiated by Non-RCC participants No. of oral/poster Number of Research Projects presentations and initiated by RCC participants no. of research projects initiated by SHP investigators Non-RCC participants who presented 6 RCC participants who presented 2010 2011 2012 Year Figure 1 New research projects initiated in SHP and research presentation by SHP staff. Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 5 of 7 http://www.apfmj.com/content/12/1/4 Table 1 Demographic profile of RCC participants Retrospective review of department record Questionnaire survey Demographic characteristics Number (n) Total = 64 % Number (n) Total = 45 % Domain of work SHP Staff 43 67 33 73 Non-SHP Staff (e.g. GP, Medical students) 21 33 12 27 Gender Male 23 36 15 33 Female 41 64 30 67 Age group (Year) 21-40 37 58 26 58 41-60 26 41 18 40 61 and above 1 2 1 2 Education status Undergraduate 12 19 6 13 Degree holder 21 33 17 38 Post graduate 31 48 22 49 Profession Medical (Medical students and GP inclusive) 39 61 25 56 Nursing and pharmacy 25 39 20 44 delivery to the participants. Based on their rankings, the RCC consultation. Further research will be required most participants value the consultation in critical areas to understand their other unmet needs and identify of research, such as study design, execution and data other barriers that could have hindered their initiation. management. These components will appeal to novice There is also a lag time between research consultation researchers who are commencing their early phases and the initiation of new studies due to logistic reasons of research planning and execution. Nonetheless, es- such as application for ethics approval and lack of re- tablished researchers can also use the RCC service, as search funding. peer reviews by consultants serve to polish up their The evaluation of the research support service needs presentations and publications. to be implemented on a regular basis to stay relevant to This study is the first in the healthcare institution and the evolving research developments in SHP. As novice provides a timely evaluation of the needs of the staff researchers become more experienced and take on more members, who are planning or have already embarked complex research studies, the service will need to expand. on research for the past three years. However, about one To enhance the RCC service, additional expertise is re- in five participants have yet to initiate their study after quired to augment the small pool of family physicians Table 2 Accessibility, quality and perceived value of consultancy at RCC Accessibility to RCC Views of participants n = 39 Total disagree/disagree n/(%) Totally agree/agree n/(%) I can easily book a RCC appointment. 4 (10) 35 (90) I feel that the RCC, currently held on two afternoons per week are adequate. 7 (18) 32 (82) The venue at a centralised location in HQ is convenient. 1 (3) 38 (97) The one-hour time slot per RCC session is adequate. 8 (21) 31 (79) Quality and perceived value of consultancy at RCC Views of participants n = 39 Agree n/(%) Totally agree n/(%) The consultant at RCC is qualified to provide the consultation. 21 (54) 18 (46) The consultation provides the information that I need for my research project. 23 (59) 16 (41) The consultation helps in my research. 22 (56) 17 (44) I appreciate that RCC service is currently free of charge. 12 (31) 27 (69) Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 6 of 7 http://www.apfmj.com/content/12/1/4 Rank 1 Rank 2 Rank 3 No. of participants who 15 selected the respective areaof research 16 8 Define research Study design Study Data Results Publications question execution management presentation Figure 2 Participants’ ranking of top three key areas of research for their consultation at RCC. cum consultants, including biostatistician, epidemio- participants’ contacts are periodically updated, which logist and bioinformatics professional. A biostatistical may ameliorate the response rate of subsequent surveys. consultation clinic, facilitated by a biostatistician, has In addition, absolute and opportunistic cost of providing been set up in SHP to complement the RCC in Septem- the resources in operating the RCC, including time and ber 2012. Further study will be carried out to determine manpower, will be computed in future surveys, as the its effectiveness in providing biostatistical support to basis of cost effectiveness analysis. the researchers. Gathering qualitative feedback from the consultants on the RCC service will close the evaluation Conclusions loop in future study. The establishment of research consultation clinic in a One limitation of the survey is the failure of the inves- primary healthcare institution helps to support and facili- tigators to reach out to all the RCC participants. These tate research amongst its staff. Accessibility, convenience, include individuals who had left the organisation or adequacy and quality of the consultancy are key elements medical students who had already graduated, resulting for its successful implementation. It can be measured by in change of their email addresses. Administrative sup- process outcomes such as the number of new research port will need to be enhanced to ensure that the projects initiated and publications in journals. Yes No Did not start 15% (6) 21% (8) Did not start No % of RCC 49% (19) participants No 79% (31) Yes 36% (14) Yes Initiation of research project Completion of research project Figure 3 Outcomes of consultation at RCC. Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 7 of 7 http://www.apfmj.com/content/12/1/4 Competing interests 15. van Weel C, Rosser WW: Improving health care globally. A critical review The authors declare that they have no competing interests. of the necessity of family medicine research and recommendations to build research capacity. Ann Fam Med 2004, 2(Suppl 2):S5–S16. 16. Campbell SM, Roland MO, Bentley E, Dowell J, Hassal K, Pooley JE, et al: Authors’ contributions Research capacity in UK primary care. Br J Gen Pract 1999, 49:967–970. TNC contributed in the conception and design of the study, the content 17. Tan NC, Goh LG: Primary Care Research – A Blueprint for Action for of the survey questions, analysis of data publication and manuscript drafting. Singapore. APJPH 2001, 43(1):49–53. KPT contributed in the content of the survey questions, survey distribution and the review of manuscript. TYT participated creating the web base doi:10.1186/1447-056X-12-4 survey, collection and processing of data and the review of manuscript. Cite this article as: Tan et al.: Research consultation clinic: impetus All authors read and approved the final manuscript. towards facilitating primary care research. Asia Pacific Family Medicine 2013 12:4. Authors’ information KPT is the manager of department of research, SingHealth Polyclinics. TYT is the executive of department of research, SingHealth Polyclinics. TNC is the director of department of research, SingHealth Polyclinics. He is also a family physician (senior consultant) at SingHealth Polyclinics (Pasir Ris), an adjunct assistant professor of Duke-NUS Graduate Medical School. Acknowledgements We would like to thank Qualtrics which provided us free online platform to carry out data collection and analysis. Received: 7 June 2013 Accepted: 13 September 2013 Published: 16 September 2013 References 1. Macinko J, Starfield B, Shi L: The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res 2003, 38(3):831–865. 2. Starfield B, Shi L, Macinko J: Contribution of primary care to health systems and health. Milbank Q 2005, 83:457–502. 7. 3. Green LA: The research domain of family medicine. Ann Fam Med 2004, 2(Suppl 2):S23–S29. 4. De Maeseneer JM, van Driel ML, Green LA, van Weel C: The need for research in primary care. Lancet 2003, 362(9392):1314–1319. 5. Al-Abdullateef SH: A survey of the attitude and practice of research among doctors in Riyadh Military Hospital primary care centers, Saudi Arabia. J Fam Community Med 2012, 19(1):38–42. 6. Jones C: Laboratories of primary care: Practice-based research networks in Canada. Canadian Fam Physician 2006, 2006(52):1045–1046. 7. Dwan KM, Magin PJ: The desire for research in general practice. Aust Fam Physician 2008, 37(10):871–873. 8. Pearce K, et al: How and Why to Study the Practice Content of a Practice- Based Research Network. Ann Fam Med 2004, 2(5):425–428. 9. Bakken S, Lantigua RA, Busacca LV, Bigger JT: Barriers, enablers, and incentives for research participation: a report from the Ambulatory Care Research Network (ACRN). J Am Board Fam Med 2009, 22(4):436–445. 10. Curtis P, Dickinson P, Steiner J, Lanphear B, Vu K: Building capacity for research in family medicine: is the blueprint faulty? Fam Med 2003, 35(2):124–130. 11. Giveon S, Kahan E, Kitai E: Factors associated with family physicians’ involvement in research in Israel. Acad Med 1997, 72(5):388–390. 12. Beasley JW, Starfield B, van Weel C, Rosser WW, Haq CL: Global health and primary care research. J Am Board Fam Med 2007, 20(6):518–526. 13. Hannaford P, Hunt J, Sullivan F, Wyke S: Shaping the future: a primary care Submit your next manuscript to BioMed Central research and development strategy for Scotland. Health Bull (Edinb) 1999, and take full advantage of: 57(5):295–299. 14. Del Mar C, Askew D: Building family/general practice research capacity. • Convenient online submission Ann Fam Med 2004, 2(Suppl 2):S35–S40. • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

Research consultation clinic: impetus towards facilitating primary care research

Asia Pacific Family Medicine , Volume 12 (1) – Sep 16, 2013

Loading next page...
 
/lp/springer-journals/research-consultation-clinic-impetus-towards-facilitating-primary-care-cuLjafl3XB
Publisher
Springer Journals
Copyright
Copyright © 2013 by Tan et al.; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1447-056X
DOI
10.1186/1447-056X-12-4
pmid
24041268
Publisher site
See Article on Publisher Site

Abstract

Background: In Singapore, SingHealth Polyclinics (SHP) is an accredited Family Medicine (FM) training centre which managed 1.8 million primary care patient-visits in 2012. To promote research in the institution, research consultation clinics (RCC) are being introduced in 2010 to enable free face-to-face consultation between experienced and novice researchers on specific research topics. Each RCC session allows about an hour or more for the SHP staff, medical undergraduates and general practitioners to seek advice and clarification on key research areas, ranging from research question refinement, study design and execution, data analysis, result presentation to publication. The consultants comprise of two FM researchers with postgraduate research qualification. Aim: This article aims to review the implementation of RCC from 2010 to 2012 and its impact on research activities and outcome indicators in the same period of time. Methods: The study comprised of two segments. Part I was a three-year retrospective review of the RCC administrative record. The total number of RCC sessions, hours utilised, participants’ profiles, the number of research studies initiated by them and their research presentations at local and overseas scientific meetings/conferences were computed. Part 2 was an anonymous web-based questionnaire survey fielded to RCC participants to collect their feedback on the RCC service and their self-reported initiation and completion of research study after the RCC consultation. Results: The RCC sessions increased from 17 to 40 sessions, resulting in increment of 2 to 14 research presentations and from 2 to 6 initiations of new research studies per annum from 2010–2012. The response rate to the questionnaire survey was 70.3%, with the majority of multi-disciplinary respondents rated the RCC service to be accessible, adequate and were satisfied with its quality. Study design, data management and study execution were ranked as important areas of research for consultation. 79% of them had started a research project and 36% had completed their studies. Conclusions: The RCC is a feasible model to catalyse multi-disciplinary research in primary care institutions. Further study is needed to evaluate its relevance when research advances and novice researchers become experienced investigators to take on more complex projects. Keywords: Research, Consultation, Primary care * Correspondence: tan.ngiap.chuan@singhealth.com.sg Research Department, SingHealth Polyclinics Head Office, 167 Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore 150167, Singapore DUKE-NUS Graduate Medical School, 8 College Rd, Singapore 169857, Singapore © 2013 Tan et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 2 of 7 http://www.apfmj.com/content/12/1/4 Background and in the respective master degree programmes for A strong primary healthcare system is vital to improve community nurses and pharmacists who take on ad- the health of the general population and reduce the vanced professional training. healthcare burden to the nation [1,2]. Research in pri- Aside from training, mentorship appears to be pivotal mary care aims largely to seek better understanding of in moulding primary care practitioners into researchers. disease management in relation to the individuals, fam- Curtis P et al. reported that amongst Family Medicine ilies and the community, and to evaluate the effective- (FM) graduates who received the American National Re- ness and efficiency of healthcare practices and health search Service Awards, they were less successful in policies [3]. Beyond general practice and family medi- terms of research and publication output compared to cine, primary care research is multi-disciplinary, cove- fellow recipients such as internists and paediatricians ring community nursing and pharmacy, sociology, health [10]. The authors attributed the differences to a lack of service and policy research. As primary care supports protected time and sustained research mentorship for the base of the population pyramid and amidst a rapidly the family physicians. Likewise, in Israel, FM residents expanding global population, there is an urgency to scale trained under pro-research mentors were likely to be up primary care research to seek medical evidence to more intensely involved in research when they became prevent, cure, and care for diseases; to translate these family physicians [11]. evidences into regular clinical practice and to formu- A strong and increased level of commitment from pri- late policies to ensure universal equity of care [4]. mary care organisations is needed to provide support and However, primary care research faces challenges, even resources and to reduce barriers for family physicians to in resource-rich countries, due to limitations of research carry out research [12]. Hannaford P et al. showed that a capacity in general practice, inadequate research infra- modest investment of resources and support will create structure in primary care and poor provision of support substantial increases in both the quality and quantity of to individual general practitioners to conduct research. primary care research [13]. They recommended that this Saad H. Al-Abdullateef in a survey of general practi- investment should be targeted at both existing primary tioners in selected primary care centres in Saudi Arabia care professionals working in service settings in primary showed that while a majority expressed interest (66%) care and those in the academic departments in the univer- and planned to carry out research (74.2%), they cited sities [13]. Various funding models for primary care re- insufficient time (83.5%) and lack of support (58.8%) as search have since been developed and implemented in key barriers to research [5]. various countries, centred largely on channelling govern- Practice-based research networks (PBRNs) are groups ment funding via FM departments in universities in of practices networked together to undertake research Australia & the Netherlands, or via the Royal College of relevant to general practice and the local community's General Practitioners in Britain [14-16]. However how needs [6,7]. These PBRNs, often involving collaborations effective and efficient are these funding models in promo- between practitioners and academicians, can expand the ting primary care research and enhance research-related capacity and bandwidth of primary care physicians [8]. training for the general practitioners are seldom measured, Nonetheless, these PBRNs are largely medical, whist and its translation into actual research endeavours are nurses and other researchers tend to form their respec- rarely evaluated. A new model to expedite primary care tive research networks. Furthermore, a survey of a New research in terms of effective individual coaching and effi- York based PBRNs revealed that only 25% of the physi- cient application is urgently needed to empower the pri- cians had formal research training and 21% of them had mary care practitioners. clinical research certification [9]. Lack of time or com- Primary care research faces similar challenges in peting demands for time was the top ranked barrier Singapore, where infrastructure constraints and healthcare resources were hithertho barriers to its development [17]. (92%) in the survey, and 80% of the clinicians reported that their lack of appropriate training was a barrier [9]. However in recent years, despite the lack of dedicated Thus, participation in PBRNs may not adequately ad- research funding for primary care researchers from the local official research agencies, rapid development of aca- dress the specific research needs nor provide training for the individual primary care researchers; neither does it demic medicine in the local public healthcare institutions add impetus towards multi-disciplinary research in pri- resulted in unprecedented support for primary care re- search from primary healthcare organisations, such as mary care. Nevertheless, there are ample research related training SingHealth Polyclinics (SHP). The latter comprises a clus- opportunities that are available from the local academic ter of nine public primary care clinics or polyclinics in institutions to equip primary care professionals with Singapore, which is also a recognised FM training centre basic research skills. Basic research training is incorpo- accredited by the American College of General Medical rated in medical undergraduate education curriculum, Education. Whilst governance, policy and finance are Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 3 of 7 http://www.apfmj.com/content/12/1/4 centrally administered in SHP, the polyclinics operate at FM researchers within the institution with post-graduate various sites to serve the local communities in the south- qualifications in research. ern and eastern parts of Singapore using a common and Periodic evaluation of the service provided by RCC integrated electronic medical records system. Thus in from the participants is vital to ensure that this model of terms of primary care research, the institution can be research support remains relevant and its service caters regarded as a de-facto practice-based multi-disciplinary adequately to their needs. This study aims to determine research network. the level of satisfaction amongst the RCC participants in Novice researchers from SHP can seek seed funding terms of their perception of the accessibility of the ser- from SHP to support their approved research projects vice, adequacy of the duration of the consultation, effec- whilst established researchers are encouraged to vie for tiveness of the consultancy, the key research areas in competitive research grants from national research agen- which they seek consultation, and the outcomes of the cies. Whilst financial support to kick-start research for RCC consultation. these researchers is no longer a barrier, approval for seed funding is based on the evaluation of research proposals’ Methods scientific merits and logistic considerations. Hence novice The evaluation of the RCC service comprises of two seg- researchers find it propitious to consult experienced re- ments. The first part was a retrospective review of the searchers for guidance in order to optimise their success RCC records from 2010–2012 to determine the short- rates in their seed funding or other grant applications. term accomplishments of past participants in terms of With the endorsement from senior management in SHP, their research study initiation and subsequent oral or pos- research consultation clinics (RCC) are established in May ter presentation at academic meetings and/or scientific 2010 to support budding FM researchers in the institution. conferences. “New study” is defined as study initiated Dedicated resources are channelled centrally from institu- within the respective calendar year with reference to its tion annual operating budget to set up the RCC service. date of approval from the institutional review board. The This caters to the opportunistic cost for the consultants, research presentations refer to investigators’ presentations as well as the participants to meet at the RCC for free of their research findings at local or overseas scientific face-to-face consultations during clinic operating hours. It meetings or conferences which are approved by SHP. Both also provides for the seed funding for researchers to sup- outcomes were traced from the respective databases in the port the execution of their project. SHP Department of Research. Each RCC session allows at least an hour for any indi- The second segment was a questionnaire survey of the vidual or group of multi-disciplinary SHP staff to seek same cohort of participants. Each participant was invited advice and clarification on any issues pertaining to their to undertake a web-based questionnaire survey regar- research endeavours. During the consultation sessions, dless of the frequency of RCC participation. The sam- the topics covered include the various domains in re- pling frame comprised of participants who had utilised search, ranging from exploring research idea, definition the RCC service at least once and who had provided of research question, research method, project design, their email contact. The records show a list of 75 RCC application for ethics committee review, logistic plan- participants between January 2010 and December 2012, ning, data analysis and interpretation to results presenta- of which email addresses were provided by 64 of them. tion and publication. The participants can arrange for The questionnaire collected data on the participant’s multiple consultations to clarify queries for their same study or repeat consultation for another study. 1. demographic profile such as age, gender, education The RCC sessions are taken up by SHP multi- status, staff category disciplinary staff, including doctors, nurses and phar- 2. views on accessibility of the service, macists who plan to commence research as part of their 3. quality of the consultancy, professional development or are pursuing advanced 4. ranking of key research domains for which they training programmes which incorporate research as sought consultation part of the curriculum. The service is also open to ex- 5. outcome measures of RCC in terms of initiation and ternal primary care researchers, including private ge- completion of their respective research projects neral practitioners, and medical students from the two local medical colleges, under the over-arching objective The questionnaire survey was anonymous to ensure of enhancing primary care research development and truthful responses from the participants. The investiga- foster research collaborations between different pri- tors notified the participants of the survey via their email mary healthcare providers in Singapore. This necessi- addresses. Second and third round of notices were deli- tates the increase of consultants from one to two to vered to the participants’ email addresses to serve as re- manage the expanded RCC capacity. The consultants are minders to participate in the survey on the second and Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 4 of 7 http://www.apfmj.com/content/12/1/4 third week respectively after the commencement of the the key areas of research for which participants sought first survey. consultation at RCC (Figure 2). Almost 8 out of 10 The survey was designed using the web-based Qualtrics (79%) participants had started a research project after platform to field the questionnaire. The participants would RCC consultation and 36% (14/39) of them had com- read the study’s objectives and other research-related in- pleted their studies (Figure 3). formation according to the Participant Information Sheet Some investigators have already started their study and prior to answering the questionnaire. Due to anonymity of sought consultation at RCC in the midst of their study the questionnaire and the minimal risk nature of the execution. This accounted for the difference between study, approval was obtained from the Institutional Review those who indicated that they had initiated their research Board (CIRB reference no: 2013/253/E ) to waive the writ- (79%) and those who have completed or in the process of ten consent of the participant. The data from the com- carrying out their studies (36% + 49% or 85%). pleted questionnaire were imported into MS Excel for computation and analysis. Discussion The study shows that the establishment of RCC can be a Results catalyst to facilitate research in primary healthcare institu- The number of RCC sessions and hours increased from tion. It is a system approach to empower novice re- 17 sessions (17 hours) in 2010, 47 sessions (48.5 hours) searchers to embark on research. The RCC serves as a in 2011, to 40 sessions (46 hours) in 2012. The number platform for researcher-centric coaching, which caters to of new research projects or conference presentations their individual or team’s specific needs when they plan or resulting directly from the investigators’ participations in are in the midst of executing research. Most of the partici- the RCC also increased from 2010 to 2012 (Figure 1). pants have undertaken basic research training at local aca- For the questionnaire survey, 64 email addresses from demic institutions. However these generic structured a list of 75 participants were found to be unique and training programs may not provide answers to specific currently valid. 45 of them responded to the survey, con- questions or solutions to problems encountered by the stituting a response rate of 70.3% (45/64). 39 of them individual or team members during the planning or execu- completed the entire questionnaire, which formed the tion stages. The RCC bridges this gap, with the consul- denominator for the computation of the results. tants functioning as mentors to guide these researchers. Majority of participants were medical staff of SHP Once these researchers gain hands-on experience and (56%), predominantly females (67%), aged 21–40 years confidence after these beginners’ trials or studies, it sets (58%) and with post-graduate qualifications (49%). Table 1 the stage for them to pursue advanced research training shows the demographic profile of participants in the ques- program and to take on more complex studies. tionnaire survey. The key elements for a successful set-up include sup- Most participants considered the RCC as accessible and port from senior management to provide the appropriate adequate in time provision. All of them were satisfied with resources, ensuring that the service is accessible and the quality of consultancy at RCC (Table 2). Study design, convenient. Adequate time allocation and quality of the data management and study execution were ranked as consultancy are essential elements for successful service Number of Research Projects 6 initiated by Non-RCC participants No. of oral/poster Number of Research Projects presentations and initiated by RCC participants no. of research projects initiated by SHP investigators Non-RCC participants who presented 6 RCC participants who presented 2010 2011 2012 Year Figure 1 New research projects initiated in SHP and research presentation by SHP staff. Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 5 of 7 http://www.apfmj.com/content/12/1/4 Table 1 Demographic profile of RCC participants Retrospective review of department record Questionnaire survey Demographic characteristics Number (n) Total = 64 % Number (n) Total = 45 % Domain of work SHP Staff 43 67 33 73 Non-SHP Staff (e.g. GP, Medical students) 21 33 12 27 Gender Male 23 36 15 33 Female 41 64 30 67 Age group (Year) 21-40 37 58 26 58 41-60 26 41 18 40 61 and above 1 2 1 2 Education status Undergraduate 12 19 6 13 Degree holder 21 33 17 38 Post graduate 31 48 22 49 Profession Medical (Medical students and GP inclusive) 39 61 25 56 Nursing and pharmacy 25 39 20 44 delivery to the participants. Based on their rankings, the RCC consultation. Further research will be required most participants value the consultation in critical areas to understand their other unmet needs and identify of research, such as study design, execution and data other barriers that could have hindered their initiation. management. These components will appeal to novice There is also a lag time between research consultation researchers who are commencing their early phases and the initiation of new studies due to logistic reasons of research planning and execution. Nonetheless, es- such as application for ethics approval and lack of re- tablished researchers can also use the RCC service, as search funding. peer reviews by consultants serve to polish up their The evaluation of the research support service needs presentations and publications. to be implemented on a regular basis to stay relevant to This study is the first in the healthcare institution and the evolving research developments in SHP. As novice provides a timely evaluation of the needs of the staff researchers become more experienced and take on more members, who are planning or have already embarked complex research studies, the service will need to expand. on research for the past three years. However, about one To enhance the RCC service, additional expertise is re- in five participants have yet to initiate their study after quired to augment the small pool of family physicians Table 2 Accessibility, quality and perceived value of consultancy at RCC Accessibility to RCC Views of participants n = 39 Total disagree/disagree n/(%) Totally agree/agree n/(%) I can easily book a RCC appointment. 4 (10) 35 (90) I feel that the RCC, currently held on two afternoons per week are adequate. 7 (18) 32 (82) The venue at a centralised location in HQ is convenient. 1 (3) 38 (97) The one-hour time slot per RCC session is adequate. 8 (21) 31 (79) Quality and perceived value of consultancy at RCC Views of participants n = 39 Agree n/(%) Totally agree n/(%) The consultant at RCC is qualified to provide the consultation. 21 (54) 18 (46) The consultation provides the information that I need for my research project. 23 (59) 16 (41) The consultation helps in my research. 22 (56) 17 (44) I appreciate that RCC service is currently free of charge. 12 (31) 27 (69) Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 6 of 7 http://www.apfmj.com/content/12/1/4 Rank 1 Rank 2 Rank 3 No. of participants who 15 selected the respective areaof research 16 8 Define research Study design Study Data Results Publications question execution management presentation Figure 2 Participants’ ranking of top three key areas of research for their consultation at RCC. cum consultants, including biostatistician, epidemio- participants’ contacts are periodically updated, which logist and bioinformatics professional. A biostatistical may ameliorate the response rate of subsequent surveys. consultation clinic, facilitated by a biostatistician, has In addition, absolute and opportunistic cost of providing been set up in SHP to complement the RCC in Septem- the resources in operating the RCC, including time and ber 2012. Further study will be carried out to determine manpower, will be computed in future surveys, as the its effectiveness in providing biostatistical support to basis of cost effectiveness analysis. the researchers. Gathering qualitative feedback from the consultants on the RCC service will close the evaluation Conclusions loop in future study. The establishment of research consultation clinic in a One limitation of the survey is the failure of the inves- primary healthcare institution helps to support and facili- tigators to reach out to all the RCC participants. These tate research amongst its staff. Accessibility, convenience, include individuals who had left the organisation or adequacy and quality of the consultancy are key elements medical students who had already graduated, resulting for its successful implementation. It can be measured by in change of their email addresses. Administrative sup- process outcomes such as the number of new research port will need to be enhanced to ensure that the projects initiated and publications in journals. Yes No Did not start 15% (6) 21% (8) Did not start No % of RCC 49% (19) participants No 79% (31) Yes 36% (14) Yes Initiation of research project Completion of research project Figure 3 Outcomes of consultation at RCC. Tan et al. Asia Pacific Family Medicine 2013, 12:4 Page 7 of 7 http://www.apfmj.com/content/12/1/4 Competing interests 15. van Weel C, Rosser WW: Improving health care globally. A critical review The authors declare that they have no competing interests. of the necessity of family medicine research and recommendations to build research capacity. Ann Fam Med 2004, 2(Suppl 2):S5–S16. 16. Campbell SM, Roland MO, Bentley E, Dowell J, Hassal K, Pooley JE, et al: Authors’ contributions Research capacity in UK primary care. Br J Gen Pract 1999, 49:967–970. TNC contributed in the conception and design of the study, the content 17. Tan NC, Goh LG: Primary Care Research – A Blueprint for Action for of the survey questions, analysis of data publication and manuscript drafting. Singapore. APJPH 2001, 43(1):49–53. KPT contributed in the content of the survey questions, survey distribution and the review of manuscript. TYT participated creating the web base doi:10.1186/1447-056X-12-4 survey, collection and processing of data and the review of manuscript. Cite this article as: Tan et al.: Research consultation clinic: impetus All authors read and approved the final manuscript. towards facilitating primary care research. Asia Pacific Family Medicine 2013 12:4. Authors’ information KPT is the manager of department of research, SingHealth Polyclinics. TYT is the executive of department of research, SingHealth Polyclinics. TNC is the director of department of research, SingHealth Polyclinics. He is also a family physician (senior consultant) at SingHealth Polyclinics (Pasir Ris), an adjunct assistant professor of Duke-NUS Graduate Medical School. Acknowledgements We would like to thank Qualtrics which provided us free online platform to carry out data collection and analysis. Received: 7 June 2013 Accepted: 13 September 2013 Published: 16 September 2013 References 1. Macinko J, Starfield B, Shi L: The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Serv Res 2003, 38(3):831–865. 2. Starfield B, Shi L, Macinko J: Contribution of primary care to health systems and health. Milbank Q 2005, 83:457–502. 7. 3. Green LA: The research domain of family medicine. Ann Fam Med 2004, 2(Suppl 2):S23–S29. 4. De Maeseneer JM, van Driel ML, Green LA, van Weel C: The need for research in primary care. Lancet 2003, 362(9392):1314–1319. 5. Al-Abdullateef SH: A survey of the attitude and practice of research among doctors in Riyadh Military Hospital primary care centers, Saudi Arabia. J Fam Community Med 2012, 19(1):38–42. 6. Jones C: Laboratories of primary care: Practice-based research networks in Canada. Canadian Fam Physician 2006, 2006(52):1045–1046. 7. Dwan KM, Magin PJ: The desire for research in general practice. Aust Fam Physician 2008, 37(10):871–873. 8. Pearce K, et al: How and Why to Study the Practice Content of a Practice- Based Research Network. Ann Fam Med 2004, 2(5):425–428. 9. Bakken S, Lantigua RA, Busacca LV, Bigger JT: Barriers, enablers, and incentives for research participation: a report from the Ambulatory Care Research Network (ACRN). J Am Board Fam Med 2009, 22(4):436–445. 10. Curtis P, Dickinson P, Steiner J, Lanphear B, Vu K: Building capacity for research in family medicine: is the blueprint faulty? Fam Med 2003, 35(2):124–130. 11. Giveon S, Kahan E, Kitai E: Factors associated with family physicians’ involvement in research in Israel. Acad Med 1997, 72(5):388–390. 12. Beasley JW, Starfield B, van Weel C, Rosser WW, Haq CL: Global health and primary care research. J Am Board Fam Med 2007, 20(6):518–526. 13. Hannaford P, Hunt J, Sullivan F, Wyke S: Shaping the future: a primary care Submit your next manuscript to BioMed Central research and development strategy for Scotland. Health Bull (Edinb) 1999, and take full advantage of: 57(5):295–299. 14. Del Mar C, Askew D: Building family/general practice research capacity. • Convenient online submission Ann Fam Med 2004, 2(Suppl 2):S35–S40. • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit

Journal

Asia Pacific Family MedicineSpringer Journals

Published: Sep 16, 2013

References