eMJA: Van Der Weyden, General practice research in Australia: a timely reality check

Editorial

General practice research in Australia: a timely reality check

Do we need an independent body empowered to oversee general practice research?

MJA 2000; 173: 569-570

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General practice is the nub of Australia's healthcare. More than 90% of Australians visit a general practitioner each year: in 1997-98 alone, general practice consultations averaged 5.7 per citizen.¹ The cost of providing these services, when added to the associated costs of pathology tests, radiology investigations, pharmaceuticals and allied health services, consumed 14% of the total healthcare bill of $42 267 million in 1997-98 and represents 1.2% of our gross domestic product (GDP).¹

It is entirely reasonable to expect that an industry with this level of impact on GDP would be underpinned by a thriving research and development program. Unfortunately, this is but a pipe dream! In most First World countries, including Australia, general practice research has a low priority. Indeed, a recent report in The Lancet lamented that this research vacuum made general practice ". . . one of the most intellectually underdeveloped disciplines in medicine".² This underdevelopment stems from a lack of research culture, a heavy service commitment and the late arrival of academic GPs.

Despite their Cinderella status, most Australian general practice academic units have actively pursued research for over 25 years. But what are the outcomes? Unless research leads to publication, its quality is essentially unknown. Through exposure to public scrutiny, individual research can be independently assessed. If deemed rigorous and relevant, it joins the living literature and may change clinical practice; if deemed inadequate or irrelevant, it lies buried in the grave of the silent literature.

In this context, the report of Ward and colleagues³ in this issue of the Journal is a timely reality check. These investigators identified Australian general practice research published in the 20-year period 1980-1999 and compared selected characteristics of the research in the decades 1980-89 and 1990-99. The most noticeable difference was a nearly fivefold increase in publications in the second decade. The bulk of the research was published in two Australian journals (Australian Family Physician and The Medical Journal of Australia), but there were signs of an emerging international profile. Not surprisingly, the research was conducted mostly by affiliates of academic general practice units and nearly two-thirds of the authors were GPs. The second decade saw an encouraging twofold increase in randomised controlled trials, but they still accounted for less than 5% of publications. Finally, about half the research focused on topics of direct clinical relevance to general practice.

What are we to make of all this? It is evident that general practice research in Australia is growing in stature, but, compared with other medical disciplines, is still in its adolescence. The pleasing increase in publications reflects a combination of factors, including the progressive maturity of our academic departments with their growing infrastructure and research staff, and the dedicated funding of general practice through the General Practice Evaluation Program (GPEP). Since 1990, this program has injected $10.5 million into projects evaluating general practice and promoting research.⁴

However, despite the encouraging report card from Ward et al, Australian general practice research still has some way to go. This was clearly recognised by the General Practice Review Group in their recent report Changing the future through partnerships, which recommended encouraging a general practice research culture; strengthening the infrastructure of academic general practice; and promoting a multidisciplinary approach to research, involving both consumers and the Divisions of General Practice.⁵

These are laudable recommendations. But any successful partnership requires sensible collaboration and sensitive cooperation. With at least 13 organisations representing general practice in Australia procuring productive partnerships may be a tall order!⁶ Clearly, a prime priority for nurturing general practice research is to build upon the current strengths of academic units through infrastructure support and realistic research fellowships for both established GPs and those in training. With the many competing concerns of general practice, a sensible approach might be a national independent body empowered to oversee general practice research. Its first task would be to define general practice research and formulate descriptors for monitoring research activity.

In an address to the newly constituted National Health and Medical Research Council in 1937, W M Hughes, as then Federal Minister of Health, declared:

We ought to be content with nothing less than original research. Australia, priding herself on being a nation, ought not be satisfied to follow, to imitate, to duplicate. She must blaze a track for herself, seek to lead rather than follow: and this calls for the services of specialists of high repute to train, inspire, and guide research along the right lines.⁷

More than 60 years later this is the very challenge for Australian general practice.

Martin B Van Der Weyden
Editor, MJA

Hynes T. The financing of general practice. General practice in Australia: 2000. Canberra: Commonwealth Department of Health and Aged Care, May 2000: 235-269.
Horton R. Evidence and primary care [editorial]. Lancet 1999; 353: 609-610.
Ward A, Lopez D, Kamien M. General practice research in Australia, 1980-1999. Med J Aust 2000; 173: 608-611.
Hays R, Piterman L. Education and training for general practitioners. General practice in Australia: 2000. Canberra: Commonwealth Department of Health and Aged Care, May 2000: 347-382.
Department of Health and Family Services. General practice. Changing the future through partnerships. Report of the General Practice Strategy Review Group. Canberra: The Department, 1998.
Kamien M. Academic general practice: past, present and future -- a personal view. General practice in Australia: 2000. Canberra: Commonwealth Department of Health and Aged Care, May 2000: 519-526.
Compston JHL. The health of the people. Canberra: Roebuck, 1978: 76. (Roebuck Series No. 19.)

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