Francesco Carelli
Professor FM in Milan and Rome
EURACT Council, Executive Board

Although there have been many declarations describing the importance of primary care  accepted through the  world, the reason for the importance of research in primary care is not as well recognised.

In many countries primary care is still felt as the non – academic discipline, which should mainly concentrate on the provision of health care and should leave the academic career aside.

There are two main reasons why it is necessary to develop research in primary care. 

Reason 1: the specific contribution of primary care to the development of medical research itself.

In family medicine one deals with illness and disease that are not seen in other medical specialties. Family doctors treat under their own responsibility more than 90% of presented health problems, many of which never come to the attention of the clinical specialist.  The problems we are presenting are usually the ones that are not encountered during research: the majority of these patients would be excluded from randomised clinical trials because of their multimorbidity and age. The contact is usually with diseases at early stages of development: this means that the primary care setting must be integral part of clinical research.

Because we do not have research on primary care pathology, there is a tendency to use secondary research as a substitute which is not always adequate. When clinical evidence of relevant conditions is available from other sectors of health care, it is essential to study the effects of selection bias through referral and research in primary care so to establish the effectiveness of treatment under primary care conditions.

It is necessary to understand how primary care makes an essential contribute to the outcome of care, as this opens the possibility of further improving care. There is also the need to study primary care in the context of local, regional and national health care settings in order to see the effects of the health care system on disease management and outcomes so to create adequate conditions.  International collaborative research is extremely important since it is able to provide us with adequate information.  

Although primary care does not have its specific research methods, it is often the vehicle that has introduced some new innovative research methods in medical research.  This happened especially recently, when qualitative research developed dramatically with the introduction of focus groups and other qualitative methods.

Reason 2: the contribution of research to primary care development

By the development of its own research strategy, primary care recognises itself as a scientific discipline equal to others.  This is the final step in academic recognition of the discipline and adds greatly to its importance and prestige. By demonstrating that we are able to produce good research projects, family medicine adds greatly to its recognition. A lot of these objectives cannot be achieved without international co-operation.  There are four reasons for a more explicit international exchange and comparison of primary care research: 1) to transfer experience and expertise; 2) development of research methodology and technique; 3) exchange of implementation research; 4) joint research on the contextual aspects of medical care.

Although there is good organisation in many countries to support research in primary care, we lack a top – down approach, because we have not been successful in accessing policymakers and in ensuring adequate funds for primary care research at an international level and in developing an overall research agenda for primary care at the more global level.

In Index Medicus, primary care is allocated in a summary category (“medical general “ ) rather than under its own specialty. This has two detrimental consequences: 

1)the uptake of family medicine research journals is restricted as they have no “ general “ mission but a very specific

2)family medicine research output is systematically underrated in bibliographical analyses, regardless of increasing production of high quality scientific articles.

In attempt to help solving these problems, we need a research strategy to be promoted in every medical school, also with (inter)national medical research programmes and research networking, including journals, fora, conferences, blog.