The keys to advancing research in family medicine

Research is an important component of academic medicine, but many family medicine departments have struggled with barriers ranging from departmental culture to the lack of resources needed to advance the field.

It doesn't have to be that way, according to a paper published in the journal Family Medicine. Researchers report key factors that can boost the creation of knowledge, including leadership commitment to research and building a team approach to research that is relevant to family medicine.

"Primary care is the largest delivery platform in the United States, but we spend so few resources on determining how to improve it, how to make the delivery efficient, effective and equitable," said Dr. Winston Liaw, clinical associate professor at the University of Houston College of Medicine and chairman of the Department of Health Systems and Population Health Sciences. "A lot of the evidence we use to make decisions about primary care comes from research done in specialty clinics or highly specialized medical centers, which is a different patient population than those who come to primary care clinics."

Liaw led the research, which identified eight family medicine departments from across the country that regularly produce authoritative and relevant research, and conducted interviews to determine why these so-called "bright spots" succeeded.

"Bright spot departments had leaders that value research and committed resources to support it," the researchers wrote. "The chairs did not need to be researchers, but needed to understand the research process, potential sources of revenue and infrastructure. They viewed challenges and crises within the department and institution as opportunities to conduct research."

In addition to Liaw, coauthors included Aimee Eden, a researcher with the American Board of Family Medicine; Megan Coffman, health policy director at the Robert Graham Center; Meera Nagaraj, an undergraduate student at Davidson College; and Dr. Andrew Bazemore, director of the Robert Graham Center.

The UH College of Medicine will focus on training primary care physicians to address a shortage in Houston and across Texas, while improving access to health care in underserved urban and rural communities.

Research will be part of that mission, Liaw said. "Doing research in primary care is important to improving the health of people who come to primary care centers, which is a large percentage of our population."

He knows that won't happen automatically. Earlier research has shown that 80 percent of family medicine faculty spend a half day or less per week on research and, on average, publish less than once per year. But the findings reported in Family Medicine suggest a path to get there, as researchers identified several keys:

• Leadership that is committed to research
• Research built around teams of researchers, with interdisciplinary teams facilitated by partnerships that allow the family practice department to tackle complex problems, supported by mentorship and resources
• The convergence of researchers and clinicians to ensure the research is relevant to family medicine
• A departmental culture of trust

The findings suggest collaborations between the College of Medicine and other health-focused colleges and departments at UH—from psychology and the fundamental sciences to the colleges of optometry and pharmacy—will be an important part of the solution.

But Liaw said the researchers also discovered that primary care clinicians can provide important ideas and observations to further the research of colleagues.

"That's important for students, to know that even if they're not a researcher, their questions can be very important," he said.