Published by CheckUp
ONE wonders whether there is method in the madness of defunding general practice by suggesting co-payments, Medicare rebate freezes and, more recently, conducting complete reviews on how the management of chronic diseases in general practice is meant to be remunerated.
One justificative phrase I’ve come across multiple times is ‘there’s no evidence for this… there’s no evidence for that, therefore we’re going to defund xyz’.
Of course, the limited evidence base is system-induced as only 2% of total NHMRC grants over the past few decades were awarded to general practice and primary care researchers. The figure for 2015 was closer to 1%.
It’s hardly surprising then that only one member of the NHMRC council has a general practice or primary care background.
Additionally, with the future of the Primary Health Care Research and Information Service and the Australian Primary Health Care Research Institute (APHCRI) uncertain, Australia’s capacity to undertake research in general practice and primary care is at risk. You don’t need a randomised controlled trial to conclude this approach does not make any sense. So what has happened?
Traditionally, medical research has largely been conducted in the tertiary hospital sector. However, as most illnesses are now managed in general practice, one wonders whether evidence generated in a high-tech, expensive tertiary care centre can be ‘copied and pasted’ into the low-tech, efficient general practice setting.
We should ask whether efficacy demonstrated in tertiary care trials is equivalent to effectiveness in complex real-world comorbidities and the social, economic and cultural dimensions in general practice.
May I suggest the answer to the question here is ‘no’ ?
Again, is anybody surprised then that 85% of the total research effort is thought to be wasted?
Isn’t it obvious that we need to talk about the validity of research? Isn’t it clear that evidence for general practice needs to be generated and studied in general practice?
Yet, there is also the obvious evidence-policy divide.
How else to explain that by defunding APHCRI, the national support service for Practice-Based Research Networks (PBRNs) will also cease operations — removing the hub of Australia’s network of 23 highly successful PBRNs.
General practice research requires infrastructure support to build its capacity to increase the evidence base for quality primary healthcare. Much of the evidence GPs need can only be obtained from research involving GPs and patients.
PBRNs are invaluable for general practice research. They are the equivalent of basic science laboratories for rigorous high-quality research and valid outcomes that do translate into the day-to-day clinical practice of GPs.If one is looking for evidence-based answers, shouldn’t one fund the effective structures that produce the valid research that informs the evidence base?
Subsequently, it would not only be logical for the government to continue to fund APHCRI and to increase NHMRC funding for general practice research, it would also be common sense.
My question here is, will there be any evidence of that?