Birden Hudson H
Northern Rivers University Department of Rural Health, Lismore, New South Wales, Australia.
Rural Remote Health. 2007 Jul-Sep;7(3):776. Epub 2007 Aug 14.
This article reviews the Researcher Development Program (RDP) component of the Australian Government's Primary Health Care Research, Evaluation, and Development (PHC RED) strategy, examining critical aspects of program performance and suggesting strategies that might increase the involvement of rural GPs in research.
Primary health care research capacity can only be built by providing sustainable, dedicated funding and a dedicated redistribution of workload from practice to research. The PHC RED funds and program supports only provide incentives to redirect existing capacity within primary health care from patient care to research for the time during which incentives are in place, generally as a part-time funded position for less than one-year's duration. The one-year time constraint is the most serious impediment to the success of the program. There is no formal provision for the continuing status of clinician/researchers. Continuation depends on the capacity of the mentor agencies, academic departments of general practice or university departments of rural health, to continue to support them, and on the time they can make available from their practice. Existing measures of program success, published research and new knowledge incorporated into practice settings, are too ambitious for researchers given a one-year time frame, working part time. Clinician/researchers have a demonstrated willingness to devote time to developing and answering a research question, but often lack the time and administrative support to get through the processes required, including ethics application and writing for publication.
A better way to capture success of the RDP program might be through a multi-objective composite set of measures of research performance that captures different types of outputs, with weighting factors assigned to different measures of research output. Development of peer-review panels to replace or augment annual reporting to assess the progress of PHC RED programs might also serve both to measure success and to promote collaborative ventures. Small scale research projects are more conducive to practising GPs than randomised controlled trials or large scale observational studies. Smaller projects can still lead to important discoveries and improvements to the healthcare system. Examples include guideline development, descriptive studies, and small-number analytical epidemiological studies. In order to engage the rural primary care community in redirecting clinical time to research, the needs of clinicians must be met, as well as those of funders, academic mentors and collaborators. Structures and systems that can be developed through PHC RED, including research networks, will determine whether efforts to increase research in primary-care settings succeed and are sustainable. Sustainable networks need sustainable funding.
本文回顾了澳大利亚政府初级卫生保健研究、评估与发展（PHC RED）战略中的研究人员发展计划（RDP）部分，审视了该计划执行情况的关键方面，并提出了可能会增加乡村全科医生参与研究的策略。
初级卫生保健研究能力只能通过提供可持续的专项资金以及将工作负荷从临床工作重新分配到研究工作上来建立。PHC RED基金和计划支持仅仅提供激励措施，以便在激励措施实施期间，将初级卫生保健机构内现有的能力从患者护理转向研究工作，通常是作为一个为期不到一年的兼职资助职位。一年的时间限制是该计划取得成功的最严重障碍。对于临床医生/研究人员的持续身份没有正式规定。其延续取决于指导机构、全科医学学术部门或农村卫生大学部门继续支持他们的能力，以及他们从临床工作中抽出时间的能力。鉴于研究人员是兼职工作且时间期限为一年，现有的衡量计划成功的标准，即已发表的研究成果以及纳入实践环境的新知识，对他们来说过于雄心勃勃。临床医生/研究人员已表现出愿意投入时间来提出并回答一个研究问题，但往往缺乏时间和行政支持来完成所需的流程，包括伦理申请和论文发表写作。
衡量RDP计划成功与否的更好方法可能是通过一套多目标综合的研究绩效衡量标准，该标准涵盖不同类型的产出，并为不同的研究产出衡量标准分配权重因素。建立同行评审小组以取代或补充年度报告来评估PHC RED计划的进展，这也可能既有助于衡量成功又能促进合作项目。小规模研究项目比随机对照试验或大规模观察性研究对执业全科医生更有利。较小的项目仍然可以带来重要发现并改善医疗保健系统。例子包括指南制定、描述性研究以及小样本分析性流行病学研究。为了让农村初级保健社区将临床时间转向研究工作，必须满足临床医生以及资助者、学术导师和合作者的需求。通过PHC RED可以建立的结构和系统，包括研究网络，将决定增加初级保健环境中研究工作的努力能否成功以及是否可持续。可持续的网络需要可持续的资金。
