Practice-Based Research Deserves Strong Role, FPs Tell NIH

By Jane Stoever

Practice-based research stands on its own as a separate body of work, family physician researchers advise the NIH in “Practice-Based Research — ‘Blue Highways’ on the NIH Roadmap,” an article in the Jan. 24/31 issue of The Journal of the American Medical Association, or JAMA.

The NIH Roadmap for Medical Research was developed to guide medical research in the 21st century. The project aims to identify gaps in biomedical research that the NIH must address. According to the agency, the roadmap “identifies the most compelling opportunities in three main areas: new pathways to discovery, research teams of the future and re-engineering the clinical research enterprise.”

The JAMA article, which opens with a line from Blue Highways: A Journey Into America by William Least Heat-Moon — “On the old highway maps of America, the main routes were red and the back roads blue” — provides recommendations to the NIH about the nature of the research pipeline. (Read an extract of the article online for free; full-text access is available to non-JAMA subscribers for a fee.)

The blue highways Least Heat-Moon spoke of still run through communities that are centers of business and agriculture, say three FP researchers led by John Westfall, M.D., M.P.H., associate professor of family medicine and associate dean for rural health at the University of Colorado at Denver and Health Sciences Center, in the article. The blue highways connect those communities “to the roaring interstate system,” they add, noting that the NIH roadmap “may benefit from ‘blue highway’ research that connects the major academic science laboratories to the physicians and patients in primary care offices across the United States.”

“Myriad detours, speed traps, roadblocks and potholes limit the movement of treatments from bench to practice,” say the authors. They note that the NIH Roadmap has three key elements: basic science research, human clinical research and clinical practice. The authors call for a fourth element, practice-based research, and say it must precede the application of human clinical research results in clinical practice.

“The role for (practice-based research) networks envisioned by the Roadmap initiative is largely a recruitment vehicle for clinical trials,” say the authors. “The benefit of practice-based research goes beyond the simple notion of access to large numbers of patients.”

Co-author James Mold, M.D., M.P.H., head of the research advocacy group of the AAFP Commission on Science and professor and research director in the family and preventive medicine department at the University of Oklahoma Health Sciences Center, Oklahoma City, gave examples of prime topics for practice-based research in a recent interview.

“There’s almost no funded research at present that addresses how primary care physicians should evaluate or manage symptoms like night sweats or muscle cramps or physical findings like loss of ankle reflexes in old people,” said Mold. “We need research on these symptoms, and it would logically be done in practice settings. There’s no way ‘how to deal with night sweats’ is ever going to start in the basic laboratory and move down the path to practice. Sometimes research has to be informed by practice.”

In conclusion, the authors of the article warn, “Without the blue highways of practice-based research, an important concern is that the NIH Roadmap will focus its research in academic tertiary and quaternary care centers. … The two-way interface between basic science laboratory and clinical practice must be reimagined and strengthened. … ‘Practice-based research’ should enter the mainstream medical research vocabulary and become a strong component of the NIH Roadmap and the CTSA (Clinical and Translational Science Awards) program.”
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