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What is the future of general practice academics interested in research on multimorbidity?

By Aline Ramond-Roquin and Martin Fortin
In a recent provocative blogpost [1] hosted by the Canadian Medical Association Journal, the associate editor Domhnall MacAuley initiated an interesting discussion on the challenges general practice research currently faces. We would like to extend the reflection and to discuss some issues relevant for multimorbidity research.
First, we somewhat disagree on the fact that academic general practitioners have “become less and less embedded in daily patient care”. Many of them still deliver “personal, primary and continuing care”. The traditional model of single-handed practitioners offering “twenty four hour access to patients” is quite obsolete, but this reflects the evolution of general practice rather than a specific characteristic of academics.
Indeed, general practitioners can no longer single-handedly fill the increasingly complex needs of their patients. Patients living with multimorbidity, who are now considered the rule in primary care, need interdisciplinary care. The current evolution towards increasing interdisciplinary work has generated specific research questions which require lowering some traditional barriers in the academic setting and developing interdisciplinary research, to appropriately address them. In this regard, having non-doctor primary care researchers in academic departments of general practice should neither be reduced to a question of “cost-effectiveness”, nor be considered as a threat for general practice research, as suggested in the CMAJ blogpost. Rather, collaborations within interdisciplinary teams are definitely an advantage to undertake research in complex fields such as multimorbidity. In these teams, general practitioners with significant clinical activity have a crucial and irreplaceable role.
Finally, meaningful research for people living with multimorbidity is often based on complex designs, such as multi-level epidemiological studies or pragmatic trials. We therefore strongly argue for scientific journals not neglecting research grounded in the real world of practice. They should not only focus on “sample size” and “international generalizability”, but should also be concerned by clinical relevance and potential for implementation and transferability in different contexts. Producing and publishing practice-based evidence is required to practice evidence-based medicine relevant to the context, with the potential to eventually improve the life of our patients.
[1] http://cmajblogs.com/thinking-the-unthinkable-about-general-practice-research/

One comment

  • 1
    Catherine Regan
    February 23, 2016 - 4:38 am | Permalink

    some interesting comments. Knowing our local regional university I tend to agree with the original blog in terms of where research needs to head to be viable. I am a GP and did my PhD in the area of frailty (I’ve also had a “portfolio career” but in turns of continuity am still seeing mainly patients I have seen for the last 20-30 years) Because I was also working at a senior level in post graduate GP training I spent a considerable amount of time teaching multimorbidity (and aged care). In that position I didn’t have the time, resources or connections to be involved in much formal research and I would have to say that GP academics are not always very collegial in reaching across these boundaries, even now. I expend time thinking how to implement research findings in practice(but these are rarely applicable to different contexts) and trying to critique polices that do not seem to be evidence-based. At the educational level my goal is to engage and enthuse registrars in this area which has to be done even before there are research answers. Multidisciplinary research is interesting (and I was once an allied health professional myself) but the reality of multi-disciplinary care in the real world is very varied. I think I have decided that the only role I can perform these days is to keep up to date and try to translate research into practice. I therefore appreciated your final points. If GP academics move (realistically) more into the ivory tower then there should be consideration of the issue of knowledge translation.

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