7th Annual Divisions of General Practice Network Forum
3-6 November, Perth
Ellen McIntyre, Libby Kalucy (paper & workshop presenter), Barbara Beacham (workshop & poster presenter), Carmen Navarro, Ann-Louise Hordacre, Miriam Keane, Sheri Millar, Fiona Thomas,
PHC RIS
 Over one thousand people attending the recent 7 th Annual Divisions of General Practice Network Forum in Perth were stimulated and challenged throughout the Forum that covered primary health care policy, Divisions performance, quality and evidence based care, access to primary health care, and prevention and early intervention.
Keynote speaker Professor Barbara Starfield ( John Hopkins University, USA) presented convincing evidence of the health-promoting influence of primary health care, which she defined as primary care applied on a population level. Primary health care reduces inequity in health, with the largest effects in disadvantaged areas. Professor Starfield called for more research into the relationships between primary, specialty and public health, as an increased supply of specialists was not generally associated with improvements in population health. She considered that the so-called 'epidemic' of chronic disease distracts attention from the real issue of providing a patient oriented approach to health problems over time. (Further details can be found in her publication Contribution of Primary Care to Health Systems and Health, Millbank Quarterly, 2005; 83:457-502)
The Divisions of General Practice Network's Primary Health Care Position Statement promoting community health and wellbeing through Divisions of General practice and primary health care teams was launched on day two of the Forum. Members of the guest panel, comprising RACGP (Michael Kidd), RDAA (Ross Maxwell), AMA (Bernard Pearn-Rowe), and ADGP (Rob Walters) led a vigorous debate around issues of leadership in multidisciplinary teams, fund-holding and workforce management.
David Learmonth, (First Assistant Secretary, Primary Care Division) spoke positively of the Divisions as change management agents, able to deliver on national primary care initiatives through supporting grass roots general practice as well as responding to local health needs of their community.
Common themes throughout the forum were the need to demonstrate outcome and value as well as activity as Divisions grow and consolidate their function and roles; the diversity of work being done within Divisions, Divisions as important facilitators of communication and cooperation amongst health care providers, and the recognition of networking as an important means of sharing information.
For further details, please visit: http://www.adgp.com.au
Cultivating capacity: 3rd Annual NSW Primary Health Care Research & Evaluation Conference
1-2 December 2005, Sydney
Belinda Lowcay & Barbara Beacham, PHC RIS
 Not surprisingly, the topic of research funding arose at a recent research forum: The 3 rd Annual NSW Primary Health Care Research & Evaluation Conference. Professor Sally Redman, CEO of the SAX Institute (formerly Institute for Health Research), pointed out that the NHMRC distributes approximately $500 million per year, yet PHCRED is funded only $8 million per year.
Despite increased numbers of applications from the primary health care sector there is increasingly less NHMRC funding channelled into general practice and primary health care research. This is because, essentially, the NHMRC is a biomedical funder. There is no population or public health stream despite recent changes to the structure of the NHMRC.
Professor Redman encouraged researchers to focus on high yield research and significant questions, but to ground them in real world needs and qualitative methods. Professor Redman also suggested that researchers should lobby for stable funding (rather than project funding) and for research infrastructure such as shared databases, cohorts, and practice networks.
The role of control groups
Dr Keith McInnes, Visiting Fellow at the University of Sydney , highlighted the important role of control groups in research.
He described how 70 USA clinics providing outpatient HIV services participated in an 18-month intensive quality improvement program in which they came together for 1-3 days at a time to learn from each other and to learn how to apply quality improvement techniques in their clinics. A controlled pre-post evaluation was then conducted.
When reviewing the results for the outpatients attending clinics in the intervention group, there were large improvements on some of the health indicators. However, when comparing the intervention group outpatients to the control group outpatients there were no significant differences in the changes to indicators. Overall, there was no impact on improvement to HIV care: the control group outpatients achieved the same overall positive improvements to their health indicators.
Dr McInnes highlighted that without the control group this HIV study may have looked good: it seemed the quality improvement measures were achieving positive results.
He also cautioned that the Plan Do Study Act (PDSA) cycle may not be the appropriate tool for achieving systems change. He believes it is better for smaller issues, quicker results, and small changes rather than cohesive, incremental steps that lead to wider change.
Knowledge brokering
24-25 October 2005, Halifax, Canada
Libby Kalucy, PHC RIS
 Knowledge brokering is about investing in building relationships between the users and creators of research, to achieve knowledge transfer and exchange. It complements the essential 'push' mechanisms from researchers, and 'pull' mechanisms from research users. Knowledge transfer and exchange requires capacity to be built in both of these areas, as well as in the skills of building relationships at an organisational level.
In the last few years knowledge brokering (KB) has reached the point where 900 people are interested in the network run by the Canadian Health Services Research Foundation (CHSRF). The KB function needs to be recognised, rewarded, acknowledged and evaluated, according to Irving Gold, Director of Knowledge Transfer and Exchange, speaking at the national knowledge brokering meeting in Halifax in October run by the CHSRF.
Evaluation is a high priority to provide evidence to justify committing substantial resources to knowledge brokering activities. Six demonstration projects currently in progress in Canada will contribute greatly to better understanding and evaluation of the knowledge brokering function. All sites have the same overall program goals:
To stimulate the implementation of structures, processes or people in health services organisations with the purpose of linking researchers with decision-makers and facilitating their interactions.
To increase the appropriate use of high quality research evidence in the decision-making process of demonstration site organisations.
For more information see http://www.chsrf.ca/brokering/evaluation_program_e.php
One of the purposes of the knowledge brokering network in Canada is to generate and share the 'tools of the trade' which include resources, strategies, self assessment tools, contracts, and job descriptions. The national meeting in Halifax was a major opportunity for such activities. Delegates suggested some practical incentives for engagement between people from different policy, practice and research sectors:
- health care organisations providing funding to cash-strapped universities to obtain the sort of research they want and need
- health care organisations recognising they can offer universities valuable non-financial resources such as sites for research, and access to research subjects
- the Canadian Institutes of Health Research changing the format for curricula vitae of researchers to include professional activity as well as research and teaching
- researchers improving their chances of engaging practitioners by demonstrating that the proposed activity is likely to, or proven to, improve patient care.
Practical resources to support knowledge brokering
Delegates became more familiar with two tools at the professional development day in Halifax . CHSRF developed Is research working for you? as a self assessment tool and discussion guide for health services management and policy organisations, to help them evaluate their capacity to use research results as well as more common forms of evidence, when making management and policy decisions. CHSRF suggests this tool will help knowledge brokers to understand the communities they serve, by facilitating dialogue, identifying needs and tailoring internal or external support and capacity development to meet the needs. The tool is available free from the CHSRF on application.
Eileen Waddington, an experienced social welfare researcher and consultant, demonstrated to delegates a tool developed by the Social Care Institute for Excellence in the UK. (http://www.scie.org.uk) The tool has several versions to assess partnerships or teamwork, based on ingredients of successful partnership such as recognising and accepting the need for partnership; developing clarity and realism of purpose; ensuring commitment and ownership; developing and maintaining trust; creating robust and clear working arrangements; and monitoring, measuring and learning. For more information on these tools go to http://www.partnershipassessment.com
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