The Department of Family Medicine, The Sackler School of Medicine
University of Tel Aviv, Israel
First and foremost I am a family physician and for the last thirty years have served a very varied population of patients in a town outside Tel Aviv.
In addition I run a specialization programme in Family Medicine. My research interests are wide and include more than a hundred publications of both qualitative and quantitative research. For the last ten years I have been a Principle investigator for a NIH funded cohort study which is examining the relationship between diabetes and dementia. I am looking forward to share my research experience and meet with you all in Halle!
Medical specialties are characterized by a definable body of knowledge applicable to patient care, a scientific foundation and new knowledge generation. Family medicine has defined an emerging body of knowledge, specifically relevant to primary care, and research capacity has grown incrementally since the founding of the specialty.
Not all research conducted on primary care problems constitutes primary care research, but all research done in primary care is primary care research. That is, it is not the nature of the problem studied that makes it primary care research but, rather, the context and the way in which the research is conducted. Since primary care is the point of first contact for all problems, it follows that these problems are potentially and properly the subject of primary care research.
Our EHR systems are becoming more interconnected each year meaning that we can both identify patients for different trials and follow them at relatively low cost. This allows for effective randomization and easier identification of confounders. With increasing research capacity I see a time where significant national funding will come to primary care in order to answer the question that face us every day. This will benefit both the patients and the payer of services. We are in a unique position to undertake patient-reported chronic disease outcomes, translational research, and research on drug side effects that have previously been underreported.
Using the electronic health record, the clinical experience of both patient and physician is virtually indistinguishable whether or not the patient is randomized, primarily because the outcome data are obtained from routine clinical data or from short web based questionnaires. Such an approach can be used for head to head studies of common drugs, rare diseases and lifestyle intervention.
As opposed to standard clinical research, once the data base has been set up and the IRB approval given there is a very low marginal cost for enlarging each trial.
A trial showing no difference in treatment efficacy for two different drugs such as topical antibiotics, steroids or common oral medication could help reduced the number of medications and save money. The same trial demonstrating a difference will guide us to better medical outcomes.
I will talk about why we need to do primary care clinical research and what we need to study, but for most of the talk I will share my experience of clinical research in primary care in the hope that some of you will join me in a clinical research journey!
Family Medicine research is the essential link in the chain that brings medical science from the bench to the bedside and beyond: into our homes and communities.
To be true to our calling we must integrate clinical research with the tender loving care that we offer our patients. After all if we offer tender loving care without asking the difficult clinical questions we are only doing half the job. The sleeping beauty is of course the Electronic Medical Record.