Professor Scott A Murray is the St Columba’s Hospice Chair of Primary Palliative Care Research Group at The University of Edinburgh in Scotland, UK
We live in exciting times for palliative care in general and for palliative care in primary care and family medicine in particular. The World Health Assembly (WHO's resolution-making body) in May 2014 passed its . It called for palliative care to be integrated into health care in all settings, especially in the community, and countries will be answerable to this resolution in May20161.
Ten years ago Professor Geoff Mitchell, a speaker in today's NAPCRG 2015 plenary session, and I decided on his patio, one warm evening in Brisbane, Australia, that it was high time to re-emphasise the potential of palliative care in the community. That night the was born. ...continue reading →
Marianne Dees is a family physician and academic researcher at Radboud University Medical Centre in the Netherlands
Let's take a look at .
The case of Mr. Jones
Mr. Jones, aged 88, was referred to the hospital for the fourth time that year with dyspnoea. He was diagnosed with pneumonia. His medical history mentioned myocardial infarction, chronic heart failure, and a pacemaker. Two years earlier he had made a written will with a non-resuscitation and non-intensive care statement. The next day he became progressively dyspnoeic and developed kidney failure. He was transferred to the ICU ...continue reading →
is a Professor in the Department of Family Medicine at Dalhousie University, Nova Scotia.
Finally, a plenary session at NAPCRG on dying. For over twenty years I’ve come to this annual meeting as ‘the’ place to be nurtured as that oddest of breeds in medical research, a family doctor. Early in my academic life I thought I wanted to be a full time palliative care doctor. But over time I realized I loved long relationships with patients, sharing their experience with illness, helping them stay healthy and most compelling to me was being with them at life’s tough moments. What I call the transitions. New heart attacks, the diagnosis of multiple sclerosis, cancer diagnoses, depression, relationship challenges and so much more. Being a palliative care doc seemed only to work at the end of all of this. So, I moved back to being and loving family medicine. ...continue reading →
Carmen García-Peña is a Mexican family physician who is currently Head of the Research Division at the National Institute of Geriatrics. She is a keynote speaker at the forthcoming Annual
Family physicians are involved in countless daily activities ranging across a spectrum that may include treating patients with chronic or acute diseases, advising a mother with her first child, trying to coordinate care, providing emotional support, monitoring compliance of preventive programs, resolving administrative problems and, educating future family physicians. Many of these actions are based on clinical judgment, common sense, intuition, a framework that has been built up over the years of practice and, unfortunately, frequently, based on limited evidence and scientific research.
While that family medicine is a fundamental pillar of any health system, that family physicians and primary care systems improve the health of societies compared to other schemes and that they also increase and promote equity and solidarity, the scientific potential of the specialty has not yet been realized. ...continue reading →
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
Victor Montori and France Légaré raised interesting points about guidelines. Victor pointed out that, although most guidelines are issued by specialist groups, the authors opt out of clinical decision-making by suggesting that GPs can apply guidelines flexibly in the context of an individual patient’s circumstances. But, when you introduce quality measures, people hold you to those quality measures, and all flexibility is lost. France described the lure of standardization, which also concerned , who suggested we could handle this using a genome metaphor in accepting that, although we all have a standard double helix, it still allows for infinite variation.
is Senior Scientist at the Institute for Clinical Evaluative Sciences, Family Physician and Scientist at St. Michael’s Hospital, and Professor of Family and Community Medicine at the University of Toronto. He is currently serving as President of the North American Primary Care Research Group ()
I see patients in a setting where there is an inter-professional team, electronic medical records, patient reminders for cancer screening, physician payment through capitation incentives, and after-hours coverage. These changes have all occurred in the past few years and they have been very costly to the provincial health system.
Most primary care settings in the developed world have undergone similar changes, or want to have them. Like my setting, very few places are able to say whether these changes have made patient care better, improved health, or reduced costs. Sure, we all know of success stories: a plan that has reduced emergency department visits; a group that has improved immunization coverage. But are these successes sustained over time and when they are successful do they spread elsewhere? The evidence from somewhere else, produced about a decade ago, suggest that these types of changes produce better health and better equity at lower costs. But what about right now, where I practice? Sadly, not much is known.
is a physician specializing in diabetes care at the Mayo Clinic in Rochester, Minnesota. He conducts research in the Knowledge and Evaluation Research Unit at Mayo Clinic, and is a member of both the National Advisory Council for Healthcare Research and Quality to the U.S. Department of Health and Human Services and the steering committee of the International Patient Decision Aids Standards Collaboration. Dr Montori is a keynote speaker at the forthcoming
On Saturday November 22 2014, I will have the privilege to speak with the North American Primary Care Research Group plenary gathered in New York City, on Minimally Disruptive Medicine.
What will I try to accomplish? Beyond the stated objectives, I am hoping to promote among participants a new lens of looking at how we might organize and deliver care for patients with multiple chronic conditions. At the heart of my presentation will be the need to be careful and kind when caring for and about our patients, particularly those likely to be overwhelmed by multiple chronic conditions.
Careful care reminds us of our commitment to patients in terms of technically correct and safe care. For patients with multimorbidity, this means that we must understand how multimorbidity affects the efficacy and safety of routine interventions. Major uncertainty exists in this exercise, uncertainty that should lead us to only conditional recommendations, the kind that require us to engage patients in collaborative deliberation. This uncertainty gives clinicians permission to to care for each patient, rather than to attain targets.
is a primary care clinician and health services researcher, as well as Head of School of Primary Health Care, Director of the Southern Academic Primary Care Research Unit (SAPCRU) and Professor of General Practice Research at Monash University in Australia. He spent 6 years working in Ontario, Canada
A CMAJ editorial once, famously, described Canada as being the ‘’. “Pilotomania” is nowhere better seen than in Canada’s long running experimentation with models of delivering primary care. Given that experiments need some sort of professional interpretation, in 2007 the Canadian Health Services Research Foundation (as it was then) commissioned our team at the University of Ottawa (where I was working at the time) to review Canada’s primary care research capacity. Our report: , allowed us to unpack what turned out to be a fragile enterprise.
We were particularly struck by the challenges facing the primary care research workforce. Many researchers were isolated, especially those working outside nursing schools or Departments of Family Medicine. While islands of innovation existed, there was little sense of a sustainable system for primary care research and development.
Chris van Weel is
at Radboud University Nijmegen in The Netherlands; at the Australian National University in Canberra, Australia; and of
On a global scale, research in family medicine and primary health care appears to develop slowly and hesitantly, certainly in light of its contribution to education. This difficult state of affairs is mirrored in substantial international differences in research facilities: few countries can boast the visionary funding policies of Canada or Australia, or the inclusive research programming of universities in the Netherlands and the UK. The research grass often looks greener on the other side of a border, and this tends to trigger contemplation of what might have been – along with lamentations of deprived opportunities.
is a professor in the Departments of Community Health Sciences and Family Medicine at the , where he serves as Director of Research
It is a good time to be a primary care researcher in Canada. There has been unprecedented recent investment in Primary Care research in Canada. The Canadian Institutes for Health Research (CIHR) funded for 5 years starting in 2013. In addition the , (also funded by CIHR) is launching a pan-Canadian network focused on primary and integrated care. These big ticket investments are long overdue and very welcome. They have stimulated lots of excitement in the research community and will, through the inclusion of trainee funding in each grant, generate long term benefits for PC research.
The background to these initiatives is that primary care research in Canada has lagged behind other countries with similar ...continue reading →