Primary Care Research Networks

The Institute of Medicine (IOM), in its 1996 report, Primary Care: America’s Health in a New Era noted the PBRNs “have been successful in the past and today offer the most promising infrastructural development the IOM study committee could find to support better science in primary care.” Consequently, one of its three research recommendations was “that the Department of Health and Human Services provide adequate and stable financial support to practice based primary care research networks.” Six primary care PBRNs have evolved over the last 35 years. They are constituted of practicing clinicians, who join together not for a single study, but to constitute a practice laboratory in which multiple studies are performed over time. Most networks, involve the participating clinicians in selecting and refining questions, in designing data collection methods, and in interpreting results.

In the United States a variety of networks have been created, including local ones linked to either a university or state academy chapter, regional networks, and national and bi-national networks. Over 60 local and regional networks have been started in recent years. Often these networks have collaborated to undertake large studies. Most PBRN activity is carried out with marginal compensation, although networks increasingly have been successful in obtaining federal NIH, CDC contract, and private foundation support.

From a research methods perspective, PBRNs have a number of strengths and weaknesses, some of which depend on the organizational characteristics of the network involved. We are fortunate that Dr. Larry Culpepper has developed practice based research networks (PBRNs) internationally over his career, and his doctoral thesis was devoted to the conduct of an investigation in 3 networks in North America, Netherlands, and the UK. He directs the primary care PBRN curriculum. This consists of a seminar in the Academic Seminar for fellows in which fellows learn about primary care PBRNs and are introduced to the particular a PBRNs they might seek to work with. We had two visiting professors who lead two different primary care PBRNs spend two days together discussing their work and engaging fellows in thorough discussion of conducting research in the PBRN environment.