Primary care practice-based research comes of age

Physician-researchers are struggling with data management, privacy and funding issues to find the answers they seek.

By Victoria Stagg Elliott, AMNews staff. July 4, 2005.

Lance Reynoso, MD, a family physician at St. Mary's Hospital in Grand Junction, Colo., has lots of questions.

He knows, for example, what the hemoglobin A1c number should be for his patients with diabetes. But he isn't sure that using it as a target is always worthwhile.

He also knows how to interpret lab results but wonders about the best way to communicate the information to his patients and convince them to take necessary action.

"I don't care if scientists have found out how many mitochondria divide in a hair," he said. "There are so many unanswered questions when patients come in that we have to look at."

These kinds of uncertainties are what motivated Dr. Reynoso to be involved in the Colorado Research Network or CaReNet. This group is a local, practice-based research network and one of a growing number of such entities, which enlist primary care physicians to turn real-world practice experiences into a lab that can lead to real world solutions.

The concept of PBRNs emerged in the past 30 years and picked up steam in the last decade. At least 111 networks were operating at the end of 2003, an increase from just 28 in 1994.

With the bump in numbers has come more credibility. These networks increasingly are being viewed as vital sources of scientific data. But most experts feel that they are now also dealing with lots of growing pains.

For this reason, the Agency for Healthcare Research and Quality published a supplement in the May/June Annals of Family Medicine featuring multiple papers exploring future challenges. This collection is the first of what the agency hopes will be a series of educational efforts examining the development of these kinds of research networks -- whether funded by the agency or not.