Voices from Left of the Dial: Reflections of Practice-based Researchers

The Journal of the American Board of Family Medicine

Nancy Rollins¹  Lyle J. Fagnan¹  Margaret A. Handley²  James Mold³ 

[1] Oregon Rural Practice-based Research Network (LJF, NR), Oregon Health & Science University, Portland;Department of Medicine and Center for Vulnerable Populations, University of California, San Francisco (MAH);Department of Family Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (JM)

关键词: Practice-based Research;    PBRN;    Community-based Research;    Primary Health Care;   

DOI  :  10.3122/jabfm.2010.04.090189

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: Practice-based research networks (PBRNs) provide an important approach to implementing primary care research at the community level, thus increasing the relevance and utility of research findings for routine primary care practices. PBRNs expend considerable time and energy in the recruitment, engagement, and retention of network clinicians and practices to establish this community-based primary care research laboratory. This study assessed factors motivating PBRN clinicians to participate and stay involved in practice-based research in their primary care office setting.

Methods: We invited practicing clinicians across the United States who are affiliated with a PBRN to share their stories regarding motivations to participate in practice-based research. Using qualitative methods, we categorized the stories into the main motivation for participation and the perceived impact of participation.

Results: We collected 37 stories from clinicians affiliated with 12 PBRNS located in 14 states. Motivations for participation in practice-based research included themes associated with personal satisfaction, improving local clinic-based care, and contributing to community- and system-level improvements. Sources of personal satisfaction corresponded to the 3 psychological needs postulated by Deci's and Ryan's Self-Determination Theory: competence, autonomy, and relatedness.

Conclusions: These stories from PBRN clinicians describe the values, motivations, and unique paths that clinicians took as they chose to participate and stay active in a PBRN. Their voices have the potential to influence others to participate in practice-based research.

• Practice-based Research
• PBRN
• Community-based Research
• Primary Health Care

Proponents of translational research have identified practice-based research (PBR) and practice-based research networks (PBRNs) as essential for answering questions relevant to primary care and for overcoming barriers to the implementation of existing evidence into community-based primary care practice.^1,2 A PBRN is defined as a group of separate practices that collaborate with each other and often with outside experts to conduct multiple research projects during an extended period of time while continuing to deliver care to patients.³ Family physicians in PBRNs have been contributing new knowledge to the discipline of family medicine for the past 3 decades. The Ambulatory Sentinel Practice Network (ASPN) began collecting data in 1982 and has published research on important subjects in primary care, such as headaches, spontaneous abortion, cough in children, and carpal tunnel syndrome.^4–7 In an attempt to understand the motivation of family physicians to participate in ASPN, researchers interviewed network family physicians about reasons for participation and found that the network studies created a bridge between practice and academia, made research possible while continuing to practice full time, and improved the quality of patient care.⁸

Family physician involvement in PBR has continued to grow since the early days of ASPN, and by 2004 the Agency for Health Care Research and Quality–supported PBRN Resource Center identified 111 active primary care networks in the United States.⁹ With the recent development of the National Institute of Health Roadmap Initiative and creation of the Clinical Translational Science Awards, opportunities for community-based family physicians to become involved in PBR has increased further.¹⁰

Critical to the success of PBRNs in meeting the challenges presented by the National Institute of Health Roadmap Initiative is a cadre of engaged family physicians doing research studies. To assist in the recruitment of community-based family physician researchers, the Practice-Based Research Working Group of the North American Primary Care Research Group's Committee for the Advancement of the Science of Family Medicine directed the authors to conduct the PBRN Clinicians Stories Project. The intent of the project is to tell the stories of family physicians who are currently involved in PBR and, through these stories, share their motivation to do research with other family physicians and the larger community of academic researchers and research funding agencies. Because PBRNs may devote considerable time and effort to the recruitment, engagement, and retention of their clinicians, we felt it was important to examine motivation for initial interest in PBR as well as factors more specific to ongoing participation. In this qualitative study, we assessed factors that motivate a diverse sample of PBRN clinicians to participate and stay involved in PBR in their primary care office setting. We have summarized the principal themes evaluated from these clinicians’ stories, which were collected between January 2007 and March 2008 from PBRN clinician-researchers practicing across a wide geographic range of the United States. For the discussion, we have used the Self-Determination Theory (SDT) model as a framework for summarizing our motivational themes. SDT is a general theory of human motivation based on the need to feel competent, autonomous, and related to others.^11,12 SDT has recently been applied to understanding the psychology of how clinicians make decisions regarding the delivery of preventive health services.^13,14

【 授权许可】

Unknown   

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