# Presentation: 892276

## Developing International Collaborations for Primary Care Research -- The Example of the IFPCRN 

*John W. Beasley, MD*
- Department of Family Medicine, University of Wisconsin
- Chair, IFPCRN
- jbeasley@fammed.wisc.edu

## Developing International Collaborations

- Understand the progress that has been made in developing an international consortium of health care professionals interested in Primary Care Research Networks (PCRNs)
- Gain an overview of the types of primary care research being done in various countries around the world, both independently and in networks

## Developing International Collaborations

- Appreciate the potentials and problems of international networking.
- Share successes and problems in developing collaborations

## Slide 4

## Why Bother With  International Collaborations?	

- Compare our experience with that in other countries
- Maybe it’s not so bad here after all!

- “I have gone through checking what is happening in Family medicine research in other parts of Africa.  The other West African country of Sierra Leone is just coming out of a civil war;  Liberia of course is still in the fighting mode.”  Victor Inem, MD. (personal communication, 2003)

**Notes:**
Many of my colleagues – even here in the US, like to whine about “Oh, it’s awful here”. 

Well, our work is difficult everywhere, and it helps all of us to be able to put our own situations into perspective.

A colleague of our, Dr. Inem, from Nigeria wrote the words you see above.  It could be a LOT worse in the US and in Mexico!  We need to be thankful for what we have.  

## Why Bother With  International Collaborations?

- New areas and questions for research
- Foster international cooperation
- Support network development
- Stimulate scholarly activity
- Engage other disciplines in our work

## Why Bother With  International Collaborations?

- Develop a rich network of friends and associates around the globe.

## Why Bother With  International Collaborations?

- Unexpected (and wonderful!) results from bringing professionals together
- More on this later

## “What is the cost of NOT doing primary care research?”

## Primary Care improves health care in the US

- There is a direct relationship between the availability of primary care physicians and
- Lower cost
- Better healthcare indicators

- Baicker K, Chandra A., Medicare spending, the physician workforce, and beneficiaries’ quality of care.  Health Affairs – web exclusive. _[http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.184v1/DC1](http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.184v1/DC1)_
- Accessed 27 July, 2004

## (In this chart, they use the term “General Practitioner” to refer to all Primary Care Physicians.)

## (In this chart, they use the term “General Practitioner” to refer to all Primary Care Physicians.)

## Primary Care improves health care in Western Nations

- 10 Western Nations
- 1991 Study documenting that a strong primary health care system (and not a strong sub-specialist system) is associated with better health care indicators, lower costs and greater patient satisfaction.
- Canada, the Netherlands, Sweden score well, the US and West Germany score poorly (poor primary care system and poor indicators with higher costs).

- Starfield B.  Primary Care and Health:  A Cross-National Comparison. JAMA;1991:266. 2268-71

## Primary Care improves health care in Western Nations

- 18 wealthy “Organization for Economic Cooperation and Development” countries
- Positive correlation between strength of primary care system and lower
- All-cause mortality and “premature” mortality
- Disease specific mortality
- Asthma, CV, emphysema, pneumonia
- Independent of GDP per capita, alcohol and tobacco use.

- Macinko J, Starfield B, Shi L.  The contribution of primary care systems to health outcomes.  HSR:  Health Services Research  2003;38 (3)

## Family Physicians Improve Care in Countries with Limited Resources

- 2002 Study in Brazil
- Compared community with Family Physicians versus usual care by IM, Peds, OB-Gyn
- Showed decreases in:
- Perinatal mortality
- Child nutrition
- Reduced hepatitis A infection
- Delivery of preventive services

- Sant’Ana AM, Rosser WW, Talbot Y.  Five years of family health care in Sao Jose.  Family Practice 2002;19:410-415

## Need for Research in Primary Care

- The Network:  Towards Unity for Health
- Beasley JW, et al.  The Need for Research in Primary Care to Solve Global Health Problems.  Position Paper written for The Network:  Towards Unity for Health (Netherlands).  28 contributors from 17 countries.
- http://www.the-networktufh.org/publications_resources/positioncontent.asp?id=12&t=Position+Papers

## Need for Research in Primary Care

- Effective primary care is needed.
- Accurate and relevant data gathering and analysis are necessary for any discipline.
- Each discipline needs to develop its own scholarship.
- Clinical and other issues in primary care are different.
**Research IN, not just ABOUT primary care**

## Support for international primary care research activities 

- WONCA (Task force on research)
- IFPCRN
- The Brisbane Initiative for International Education for Leadership in Primary Care Research
- WHO
- interest in primary care ??
- The Network: Towards Unity For Health
- http://www.the-networktufh.org/home/index.asp
- AAFP
- The Linnaeus Collaboration (medical errors)
- http://www.npcrdc.man.ac.uk/ResearchDetail.cfm?ID=105

**Notes:**
Earlier we talked about the need for ongoing support, and the International Federation has the same support needs as do local and national networks.  The World Organization of Family Doctors, WONCA, provides listserver support for the International Federation.  

We have had contacts with WHO, but have not yet had success getting suport there, nor have we had any success to date with The Network (which is based in the Neatherlands).  The AAFP has offered limited support, but because of the help WONCA has given us, we have not yet had to call upon them.  We are also searching for other supporting partners.

Finally we also also working with a group called “The Brisbane Initiative” which seeks to make research training more available for family doctors in many different countries and to set up trans-national collaborations.

I would like slide 24, please

## What are the Potential Areas of Primary Care Research?

- “Primary care research is any research done in a primary care setting.”
- A Taxonomy for primary care research
- Basic
- Clinical
- Health services
- Health systems
- Educational

- Starfield B, A framework for primary care research.  J Fam Pract 1996;42:181-185.
- Mold JW, Green LA. Primary care research: revisiting its definition and rationale.  J Fam Pract 2000;49:206-208.

## Slide 20

## Slide 21

## Topic Areas for Primary Care Research

- Basic
- Research into methods (e.g. how PCRN’s work)
- How can we adapt standard measures to different cultures?
- What information can we gain from primary care?

- Lam C.L.K.  Reliability and construct validity of the Chinese (Hong Kong) SF-36 for patients in primary care.  H K Pract 2003; 25 (10): 468-475.
- Fleming, D., Pavlic, D.R. 1998: Information from primary care: its importance and value - A comparison of information from Slovenia and England and Wales, viewed from the 'Health 21' perspective. h_ttp://europa.eu.int/comm/health/ph_projects/1998/monitoring/fp_monitoring_1998_frep_05_en.pdf_  Accessed 17 January, 2004

**Notes:**
We can do basic research – that is, research into the methods that we will use in primary care research.  One example of this is a study done here in Wisconsin in the USA where we looked at the question of how to calculate the costs of developing and implementing research projects.  We have used the results of this study to explain why better support for primary care research infrastructure is needed.

## Slide 23

## Slide 24

## Topic Areas for Primary Care Research

- Clinical
- Research into clinical practice
- How can we improve communications between physicians and patients in Pakistan?
- What is the prevalence of violence in the home in South Africa?
- How can we improve asthma care in Australia and New Zealand?

- Qidwai  W,  Karim SI, Irfan FM. Communication Skills of Family Physicians in a Doctor‐Patient consultation. J Coll Physicians Surg Pak. 2003 Nov;13(11):674
- De Villiers, P.J.T. 1998: Home violence in South Africa. Surveillance during 1996 by SASPREN, a sentinel network of general/family practitioners. South African Family Practitioner Sept/Oct, 87-89.
- Glasgow, N.J., Ponsonby, A.L., Yates, R., Beilby, J., Dugdale, P. 2003: Proactive asthma care in childhood: general practice based randomised controlled trial. British Medical Journal 327, 659.

**Notes:**
When we think of primary care research we often think first of  clinical research. This research defines clinical problems and tests solutions such as improving physician-patient communication.  It can also explore such issues as antibiotics use for otitis media, interventions for family violence or any of a huge set of different clinical issues.  Clinical research includes studies of the natural history of disease the presentation of disease. As one specific example of primary care clinical research, Dr. Qidwai in Pakistan is exploring physician patient communication.  Our International Federation of Primary Care Research Networks has considered a study on the impact of HIV infections on primary care, but have not yet started that.

I will now talk about health services research.

## Slide 26

## Slide 27

## Topic Areas for Primary Care Research

- Health services
- Research into what arrangements of services  or policies best promote health
- How can we improve family assessment in Mexico?
- How can we make injections safer in Pakistan?

- Gomez-Clavelina, F.J., Irigoyen-Coria, A. 1995 : Two types of family assessment.  Family Process 34, 363-364.
- Usman, H.R., Akhtar, S., Rahbar, M.H., Hamid, S., Moattar, T., Luby, S.P. 2003: Injections in health care settings: a risk factor for acute hepatitis B virus infection in Karachi, Pakistan. Epidemiology and Infection 130, 293-300.

## Slide 29

## Slide 30

## Slide 31

## Slide 32

## Topic Areas for Primary Care Research

- Health systems
- Research into what kinds of systems and policies work best
- What is the impact of primary care on hospitalization rates in Kazakhstan?
- What is the effectiveness of programs to prevent mother to child HIV transmission in Nigeria?

- Cashin C, Zuess O, Nurbayev A, Khe N, Hafner G. Baiserke M. (2002a) The Impact of Primary Healthcare Development on Patterns of Hospitalization:  The Case of Integrated Management of Childhood Illness (IMCI) in Karaganda City, Kazakhstan.  Technical Report, ABT Associates, Karaganda, Kasakhstan.  2002
- Inem V, Adedokun AO, Ayankogbe OO.  Voluntary counseling and testing programme in the prevention of mother to child prevention of HIV in a practice based research network (PBRN) hospital in Lagos Nigeria.  Nigerian Medical Practitioner(2003) 43:6:135-138

## Slide 34

## Slide 35

## Topic Areas for Primary Care Research

- Education
- Research into what kinds of educational programs and policies work best to support primary care
- How can we best educate primary care clinicians for research in Mexico?
- How can we best educate undergraduates in Hong Kong??

- Olaya‐Vargas MA, Gómez‐Clavelina FJ, Brambila C, Rojo‐Padilla JA,  Vernon R. Consentimiento informado en usuarias de Métodos de Planificación Familiar en el ISSSTE, México. Archivos en Medicina Familiar 2000; 2(3): 81‐89.
- Dixon A.S., Lam C.L.K., Lam T.P.  Does a brief clerkship change Hong Kong
- medical students’ ideas about general practice? Medical Education 2000;
- 34:339-347.

## What  Questions Should be Studied Using an International Approach?

- There needs to be an energetic and committed PI and support by clinicians in various countries
- The question to be answered is of importance and interest to local clinicians.
- There is clear evidence of why an international approach is needed to answer the question.

- International Federation of Primary Care Research Networks Policy -- 2002

## Examples of International Collaborative Primary Care Research

- What is the best way to treat AOM?
- How do errors in primary care differ in different countries?

- Froom J CL, Grob P, Bartelds A, Bowers P, Bridges-Webb C, Grava-Gubins I, Green L, Leon J. Somaini B, Stroobant A, West R, and Yodfat Y. Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. BMJ 1990;300:582-586.
- Froom J CL, Green LA, deMelker RA, Grob P, Heeren T, van Balen F. A cross-national study of acute otitis media:  risk factors, severity and treatment at initial visit. Report from the International Primary Care Network and the Ambulatory Sentinel Practice Network (ASPN). Journal of the American Board of Family Practice. 2001;14:406-417.
- Makeham MA, Dovey SM, County M, Kidd MR. An international taxonomy for errors in general practice: a pilot study. Med J Aust. Jul 15 2002;177(2):68-72.

## Problems In International Collaborations

- Variation in data collection
- Duties and tariffs on instruments
- Fluctuation in exchange rates
- Financing costs of collaboration
- Sustaining personal relationships

- Green, L. A., G. E. Fryer, Jr., et al. (2004). "Opportunities, challenges, and lessons of international research in practice-based research networks: the case of an international study of acute otitis media." _Ann Fam Med_ **2**(5): 429-33.

## Slide 40

## Problems in International Collaboration

- Human Subjects Committees and ethical considerations
- Incredible variation

- Green, L. A., G. E. Fryer, Jr., et al. (2004). "Opportunities, challenges, and lessons of international research in practice-based research networks: the case of an international study of acute otitis media." _Ann Fam Med_ **2**(5): 429-33.

**Notes:**
Finally, there are issues with Human Subjects Protection Committees (often called Institutional Review Boards or “IRB’s” here in the US).  

When one international study was done on the reporting of medical errors, the reaction of the various Human Subject Committees ranged from “We don’t even need to review this.” in The Netherlands to “This study has risks which are too great and it should not be done.” from one IRB in Canada

When we attempt to enroll patients from many countries the process becomes exceedingly complex, and may involve the translation of consent documents into several languages (and cultures!) and many other issues.

I’m sure that you can think of more issues that we will have doing our work of international research.

However, I am now going to shift our focus to one type of research which, while limited in what it can accomplish, does get around some of these issues.

## Problems in International Collaboration

- Lack of funding
- Hard to get conferences together
- Many funding sources country specific
- Agreeing on the question
- What is seen as important is variable
- Differences in medical and societal culture
- Communication
- Language barriers
- Time differences
- Local “urgencies” come first
- “Something we can always do -- we never do.”

**Notes:**
I have discussed some of the potential areas for collaborative research and will now explore some more practical issues – and I will focus on those issues which impact on our ability to collaborate over national borders.

First, for all of us funding is hard to get – but it is even harder when we are doing studies that involve more than one region or country as many times funds are designated for national or local use. 

Second, what may be a pressing question for researchers in one country (such as the vertical transmission of HIV) may not be as pressing in another.  

And, third, there are of course language barriers – some may be as obvious as English and Spanish as in our case, but others play a role even when the language is the same.  For example, in the US the term “surgery” refers only to the action of performing surgery on a patient.  In the UK the same word also refers to the clinical office setting in which primary care is given.

Communication is also affected when we work across multiple time zones – it is not possible to do telephone conferencing, and it is hard even to get on-line communication in “real time”.  However, email has made very effective collaborations much easier.

Fourth, and very importantly, all of us have local issues which are much more pressing (e.g. patient care, faculty meetings) which may take precedence over international research activities – activities which are often unfunded.  It takes enthusiasm and a strong leadership to keep things going.

## IFPCRN	

- International Federation of Primary Care Research Networks
- Organized under WONCA
- Founded in Durban, South Africa, May 2001

**Notes:**
Let me now discuss briefly the International Federation of Primary Care Research Network – a group that owes a great debt to Francisco for his contributions to its development

I would like slide 19, please

## IFPCRN  Goals -- 2001

- The mutual support of research networks
- The exchange of ideas and methodologies
- Advocacy for the quality of research in primary care
- Capacity building
- Policy and advocacy initiatives
- Doing collaborative research

**Notes:**
As you can see, the International Federation has established a series of goals.  These include being an organization that can support research networks in many different countries and being a medium for the exchange of ideas and methodologies.

They include advocating for the quality of primary care research and building the capacity to conduct primary care research.

They include developing initiatives at the level of governments, international organizations, and non-governmental organizations that will support primary care research

And finally, they include doing collaborative research.

I would like slide 20 please

## IFPCRN Progress

- WONCA sponsorship
- Database of membership and networks
- Thanks to Mary Stone, UW DFM, USA
- Meetings at Wonca, NAPCRG
- Establishing regional structure and meetings
- Next at KOS, Wonca Europe
- http://www.woncaeurope2005.org/index1.htm

## IFPCRN Progress

- List server and Website
- Thanks to Professor Wes Fabb, Australia
- _[www.IFPCRN.org](http://www.ifpcrn.org/)_
- Linked via _[www](http://www.globalfamily/)_.GLOBALFAMILYDOCTOR.com
- Newsletter
- Editor: Francisco Gomez-Clavelina, M.D., Mexico
- One project published

## IFPCRN Membership

- Individuals and networks can join.
- Active network not required – just interest!
- Existing Federations (UK-FPCRN and US-FPBRN) do not have special status.

**Notes:**
Because we wanted to support network development, even in places where networks do not yet exist we opened out membership to individuals who are interested in network research as well as to actual, functioning networks. 

I would like Slide 21, please

## IFPCRNMembership, May 2004

- 133 Individual Members
- 44 PCRNs
- 41 Countries

## IFPCRN Membership Countries

- Australia
- Austria
- Belgium
- Bosnia and Herzegovina
- Brazil
- Canada
- China
- Columbia
- Ecuador
- Fiji Islands

- Greece
- Hungary
- Ireland
- Israel
- Lebanon
- Malaysia
- Mexico
- Netherlands
- New Zealand

**Notes:**
As you can see, even though we have been operational for only since the spring of 2001, we have 85 members from 21 countries.  

I would like slide 22, please

## IFPCRN Membership Countries

- Nigeria
- Pakistan
- Panama
- Philippines
- Portugal
- Romania
- Saudi Arabia
- Serbia and Montenegro
- Sierra Leone
- Singapore

- Slovenia
- South Africa
- South Korea
- Spain
- Thailand
- Turkey
- Ukraine
- United Arab Emirates
- U.K.
- U.S.

## Co-author Projects

- Simple – we ask some experts to contribute
- Simplifies human subjects issues
- Inexpensive and low time commitment
- Limited power – we can explore only a limited range of problems.
- Will not attract outside funding

**Notes:**
Before I go on to our own International Federation study I must mention with a bit of embarrassment that the study I am going to discuss meets only one of the criteria the International Federation came up with in Halifax – the second one.  However we did it anyway just so we could get started somewhere!

This type of research which is a one type of qualitative research, involves the use of key informants. 

It is simple – we just ask willing experts for their opinions related to the research question.

This research does not require each country – and perhaps not even the principal investigator – to go through an informed consent process.  This is because each of the participants is a co-investigator and is not really a subject.  

However, this type of research is also very limited in its power – we really cannot approach patients nor can we test interventions.

However, it can help us get some insights into what is happening in different countries and that may provide us with useful information.  For example, we could even do a multi-national study of informed consent issues in different cultures.  I think that would be a very interesting topic in itself.

## Our First Study	

- We wanted to know how active Family Physicians are in primary care research around the globe.
- We hope the results will be used to influence policy and encourage more funding and support for primary care research.

**Notes:**
For the IFPCRN’s first study we decided that we wanted some more knowledge about the role that Family Physicians play in research around the globe.  The reason for this is, as we all know, that many policy makers and funders of research do not realize that there is a need for research in Family Medicine. Furthermore, they may not realize that Family Physicians are involved in research and also to not realize that there is a need to provide funding for this important work.

## Methods	

- We selected co-authors – experts in Family Medicine – from 10 different countries.
- We asked each of them four open-ended questions.
- We asked them to comment not only on their own country, but also on their region.

**Notes:**
To do this research we contacted potential co-investigators, all of whom would be authors on the final paper, and asked if they would be interested.  For those who agreed, we asked them four open-ended questions.

And we asked them to give their answers, where possible, not only considering their own countries but also considering their general region. For example, Francisco gave information not only about Mexico, but also about other areas in Central and South America.

## Methods – The Questions

- What is the status of research in academic Family Medicine?_ _
- What is the status of practice-based research networks (PBRNs)?
- What are some examples of your research productivity?
- What are the prospects for Family Doctors contributing to research in the future?

**Notes:**
We asked the authors to describe the status of research among their academic family physicians and in their academic departments.

We asked them to describe any practice-based research networks that were active in their region.

We then wanted to assess some of the research productivity – and while knowing that it was really not possible to cover all the research being done, asked for representative examples of the work by Family Doctors in their area.

Finally, we wanted our collaborators to think about the future of research in our discipline in each of the regions

## A Real Multi-National Collaboration!

- John Beasley (US)
- Susan Dovey (New Zealand)
- Leon Geffen (South Africa)
- Cynthia Haq (US)
- Francisco Gomez-Clavelina (Mexico)
- Victor Inem (Nigeria)

- Cindy L.K. Lam (China, Hong Kong)
- Azhar Nugmanova (Kazakhstan)
- Waris Qidwai (Pakistan)
- Danica Rotar Pavlic (Slovenia)
- Chris van Weel (The Netherlands)

**Notes:**
As you can see, we had a real multi-national collaboration which did span the globe!  

We had 10 countries and regions represented.

[[ Francisco – note that I changed the order of slides here – 18 and 19 are reversed from the original set you got)

## What Were the Results of our Work?

- The Contribution of Family Doctors to Primary Care Research: A Global Perspective from the International Federation of Primary Care Research Networks (IFPCRN)

- John W. Beasley, MD, FAAFP; Susan M. Dovey, MPH, PhD; Leon Neville Geffen, MBChB, MCFP(SA); Francisco J Gómez-Clavelina, MD; Cynthia L. Haq, MD, FAAFP,  Victor Inem, MBBS, MPH, FMCGP, FWACP;  Cindy L.K. Lam, MBBS, MD, FRCGP, FHKAM;  Azhar Nugmanova, MD; Waris Qidwai, MBBS;  Danica Rotar Pavlic , MD, MSc;  Chris van Weel, MD, PhD, FRCG.
-        _Primary Health Care Research and Development_ 2004;5:307-316

**Notes:**
We have had one publication accepted.

## What Did We Learn?

- This method can provide interesting and useful results
- We were able to pull together multi-national information using email – this collaboration worked very well
- The collaboration did not require outside funding or a lot of time.

**Notes:**
But, of course, the reason for dong any study is to learn something and we can ask “what did we learn here?”  

First, we learned that this method works – although please remember the limitations I mentioned earlier.

Second, we learned that we could do this entirely by email and that this method worked well for what we were doing and gave sufficient information to complete the project.

## What Did We Learn?

- There is research going on in all of the five areas (basic, clinical, health services, health systems and educational) in all parts of the world.
- Progress is being made in developing formal education for future Family Physician research everywhere.

**Notes:**
We learned that there is a rich primary care research enterprise that addresses issues in all of the five major areas of research and that this work is global in nature.

We also learned that progress is being made everywhere in the education of future family physician researchers.

## What Did We Learn?

- There is much yet to do!
- We need to continue our work to build a research enterprise that will guide our practices and improve health care.
- This work will be increasingly important – and professionally rewarding to us.

**Notes:**
However, we also learned – and this is certainly not a surprise – that there is much work yet to be done.

Let us continue to work together – not to complete the task, for we will never do that – but to build a strong global enterprise of research in Family Medicine that will yield knowledge that will benefit our patients.

As our research enterprise matures, our work will be increasing recognized as making important contirbutions, and more professionally satisfying to us.

## Realities in developing countries

## DEVELOPING PRIMARY CARE RESEARCH NETWORKS IN PAKISTAN

**WARIS QIDWAI M.B.B.S.**** **
**M.C.P.S, F.C.P.S.,  (Pakistan)**
**Associate Professor, ****Aga Khan University, Karachi **
**Member, International Federation for Primary Care Research Network **

## PAKISTAN

**	****	**
**Is a developing country with per capita income of around US $ 500 only**
**< 1% OF GNP is spent on health**
**Is faced with quadruple burden of disease (Infections, Malnutrition, Chronic diseases, Injuries in addition to a high prevalence of Psychiatric disorders)**
**Qidwai**** **

## CHALLENGES IN STARTING RESEARCH NETWORK

**Physicians in the community have a tough time meeting their needs and are forced to concentrate on service provision**
**They face competition from quacks who provide care at a very low cost**
**Patients/legal system does not force physicians to conduct research or keep up to date **
**Qidwai**

## CHALLENGES IN STARTING RESEARCH NETWORK

**Need for resources in terms of manpower trained in research methodology, funds required for research, and lack of infrastructure including access to computers and internet**
**Lack of motivation for change among physicians**
**Qidwai**

## ROLE OF IFPCRN FOR PAKISTAN

**Help develop research networks at local level**
**Help develop collaboration with family physicians globally for collaborative research**
**Qidwai**

## ROLE OF IFPCRN FOR PAKISTAN

**Help develop expertise in research at local level (The Brisbane initiative)**
**Help develop a newsletter at the local level**
**Qidwai**

## Slide 67

## International Collaborations opportunities for progress

- Identify topic areas -- international issues
- global issues (tobacco, AIDS)
- issues related to health systems
- community oriented primary care
- best practices
- Other areas of research
- applying knowledge to practice
- cost effectiveness
- errors
- clinical care/effectiveness

**Notes:**
The International Federation has several areas which we intend to address through research and they include the areas I have noted on this slide.  One of the limiting factors in initiating this research, however, has been the need for one or more individuals to step forward and take charge of one of these projects as the principal investigator – this would be a very difficult task to organize such a project, get funding for it, and handle all the administrative details

I would like Slide 25, please

## International Collaborations  opportunities for progress

- Get new ideas for organizational development
- Develop better research methods
- Develop effective collaborations
- Advocate for primary care research
- Political bodies/governments
- International organizations (e.g. WHO)
- Help Family Doctors in countries with less resources

**Notes:**
We have, of course,  other areas in which we to make progress  and I have listed them on this slide.  Clearly, our International Federation has a lot of work to do!

I would like slide 26, please.

## IFPCRN Future Plans

- Workshops on PCRN development and methods
- Abu Dhabi, United Arab Emirates, 2006
- First IFPCRN Regional Meeting
- Kos, Greece, September 2005
- Better linkages to Brisbane Initiative
- Develop additional multinational projects!
**“****We’re looking for a few good PI’s”**

## Brisbane InitiativeInternational Education for Leadership in Primary Care Research

- Founded in Brisbane, Australia, 2002
- Under auspices of Wonca
- Chaired by Chris van Weel (Netherlands)
- Recognizes that even many developed countries lack resources for training future research leaders
- E.g. German, Italy

## Brisbane Initiative

- Fellowships and visiting traineeships
- Formal leadership training programs
- Develop educational resources
- Develop expert groups
- Create international “think tanks” for education for research

- http://www.globalfamilydoctor.com/publications/news/june%202004/health.htm

##  "The future role of Family Physicians in the changing health care delivery systems around the world: A perspective from the IFPCRN"

**Lead author: Waris Qidwai, M.B.B.S**
**	****	****Aga Khan University, Karachi, Pakistan**
**	****	****Member, IFPCRN**
**28 contributors from Australia, Austria, Brazil, Canada, Egypt, Greece, Hong Kong, Israel, Kazakhstan, Kenya, Korea, Lebanon, Nigeria, Pakistan, Portugal, Turkey, UK and USA**

## Questions

-  How is primary care delivered in your country?
- What are the problems?
- How is it  funded?
-  What is the role of Family Doctors in the delivery of primary care.
- How is their care integrated with care by others (quacks, traditional healers, sub-specialists)?

## Questions to Co-Authors

- How will the system and needs of the population change within the next 10 years?
- How can Family Physicians and organized Family Medicine help to meet these changing  needs?
- What challenges will this pose for Family Physicians and organized Family Medicine?
- How can these challenges best be met through system change, education and research?
- What resources will this require?

## Redefining The Research Network

- Producer of new knowledge
- Cultural change agent for primary care
- Meeting place for academics and practitioners
- Including other disciplines (e.g. Engineering)
- Focal point for research activities
- Learning Community
- Mold JW, Peterson KA. Primary Care Practice-Based Research Networks:  Working at the Interface between Research and Quality Improvement.  Ann Fam Med 2005;3:S12-20

## Redefining The Research Networks

- A community of scholars
- This may lead to unexpected benefits

## Unexpected Benefits

## Unexpected Benefits

## Building a global community of primary care scholars.