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Primary Care Conference 
19 Nov 2014 
Role of Research in Primary Care
Overview 
• Strategic context for health research 
• Overview of HRB 
• Primary care research in Ireland 
• Examples of primary care research linked 
to practice
Health Research Plans 
• HRG Action Plan for Health 
Research 2009-2013 
• HRB Strategic Business Plan 
2010 -2014 
• National Research 
Prioritisation Exercise 2012 
Set the strategic direction, goals, 
targets and actions to reap the health, 
social and economic benefits of our 
investment in health research
1. Patient-oriented research 
2. Population Health 
3. Health Services Research 
• Projects 
• Applied Programmes 
• Centres/networks 
• Short courses/workshops 
• Fellowships and Career 
Awards 
• Research Infrastructure 
• EU/International 
opportunities
HRB Strategy - Key Themes 
• Increase high quality, interdisciplinary 
health research 
• Enhance research partnerships, 
collaborations and networks 
• Focus on translation and application of 
knowledge 
• Enhance use of existing health and social 
data 
• Increase evidence-informed policy and 
practice
HRB Annual Income 1999-2012 
60.0 
50.0 
40.0 
30.0 
20.0 
10.0 
0.0 
1 2 3 4 5 6 7 8 9 10 
Total Income (€M) 
Year 
Capital (€M) 
Revenue (€M) 
1999 2001 2003 2005 2007 2008 2009 2010 2011 2012
HRB Portfolio analysis
Overview of HRB grant 
funding portfolio 
Projects & Programmes 
• Health Research Awards 
• Definitive Interventions 
• HRB/Medical Research Charity Group 
Awards 
Training/Career Development 
• Cochrane Training/Cochrane 
Fellowships 
• PhD Fellowships for Health and Social 
Care professionals (P/T and F/T) 
• Structured PhD Scholars -SPHERE 
• ICE Awards (post doc) 
• Research Leaders (Pop Health / HSR) 
• Clinician Scientists 
Centres and Research Networks 
• HRB Centre in Health and Diet 
Research 
• HRB Centre in Primary Care Research 
• All Ireland Institute in Hospice and 
Palliative Care – research network 
• Trials Methodology Network 
• Clinical Research Facilities (Dublin, 
Cork, Galway) 
• Clinical Trials Networks 
EU/International Opportunities 
• Horizon 2020 
• Wellcome Trust 
• US Ireland
Global and national context for 
primary care 
• Demographics – ageing population 
• More people living with chronic diseases 
• Shift in model from acute care to primary / 
community and self care 
• Shift from illness model to health and wellbeing 
• Emphasis on health promotion and behaviour 
change (lifestyle factors)
Case for primary care research 
• Need for an evidence base to support practice 
• Evidence to underpin clinical practice and healthcare 
policy must be obtained by R&D in primary care 
• Quality standards and protocols derive from research 
• Need research to inform policy on staffing, organisation 
or primary care 
• Process of conducting research important as the 
outcome 
• Involvement by primary care professionals in research 
leads to faster dissemination and adoption of research 
evidence
Issues for primary care research 
in Ireland* 
• Lack of infrastructure 
• Difficulties getting evidence implemented 
• Limited capacity of the primary care community 
to conduct research 
• Lack of any system for provision of payments to 
GPS to engage in research 
• Clinical academic career structure in primary 
care ‘unattractive’ 
* Mant Report 2006
HRB developments 
• Increased funding for health services, clinical research 
and patient research 
• Practical support through the TMRN (Trials Methodology 
Research Network) 
• Support for population or community based studies 
through the CRFs (Clinical Research Facilities) 
• Support for Primary care professionals through funding 
schemes, e.g. HPFs (note: few applications from GPs) 
• Investment in Centre for Primary Care Research (10 
years, €8 million) 
• Establishment of the Irish Primary Care Research 
Network
Themes in primary care research 
• Harnessing technology to improve primary care practice 
and health outcomes (e.g. access to primary care 
diagnostics) 
• Chronic disease management and multi-morbidity 
• Role of primary care in reducing inequalities in terms of 
access and health outcomes 
• Safer primary care (patient safety) 
• Evaluation of primary care reforms 
• Mental health and primary care 
• Workforce management in primary care 
• Role of primary care in health promotion and behaviour 
change
Examples of HRB funded 
primary care research projects 
• Framework for community involvement in decision making in primary 
care (Anne MacFarlane, Limerick) 
– Examined user involvement projects for quality, user experience and impact on 
service 
– Design a framework for the HSE to implement high quality user involvement 
projects 
• Developing and evaluating a complex intervention to influence quality 
and quantity of anti-microbial prescribing (Andrew Murphy, Galway) 
– Examining prescribing practices for urinary tract infections in Ireland and other 
countries 
– Evaluating interventions to reduce the amount of antibiotics prescribed 
• Towards early intervention for youth mental health (Walter Cullen, 
Limerick) 
– Developing an intervention to address barriers to ‘early intervention’ for mental and 
substance use disorders among young people
Mairead O'Driscoll, PhD Director, Research Strategy and Funding Directorate, Health Research Board
CPCR 
• Includes RCSI, TCD, NUIG and QUB 
• Focusing on 
– Safer medicines (safer prescribing, medicines management) 
– Safer diagnosis ( clinical decision support systems; generating and 
applying clinical prediction rules) 
– Evaluating intervention studies - in an elderly cohort, in a 
population of poorly controlled diabetes patients 
– More rational use of antibiotics 
– Managing multi-morbidity 
• Established the Irish Primary Care Network
iPCRN (Irish Primary Care 
Network) www.icprn.ie 
• Collaboration between the ICGP, the HRB Primary Care Research 
Centre (in RCSI) and WestRen (NUIG) 
• Aims to: 
o Establish a national network of GP practices whose purpose is to 
participate in clinical research for the benefit of their patients and 
o To enhance general practice through research training and activity 
• The iPCRN: 
o Facilitates GP's in maintaining The Medical Council's requirements 
for professional competence - particularly in in the areas of audit 
and research 
o Enables GP's to become more involved in planned research trial 
activities in the community 
o Enhances collaboration among network partners through access to 
literature, resources and training materials in research methodology 
o Provides General Practice with new applications/tools to audit and 
manage their patient care
Conclusions 
• Clear need for primary care research to improve service 
delivery 
• Key themes and questions for primary care research in 
Ireland 
• Need to encourage more primary care professionals 
(GPs, nurses, therapists, dentists) to engage in health 
services and clinical research 
• Need to work in multi and interdisciplinary partnerships 
for better research 
• Much improved environment for primary care research - 
support and infrastructure

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Mairead O'Driscoll, PhD Director, Research Strategy and Funding Directorate, Health Research Board

  • 1. Primary Care Conference 19 Nov 2014 Role of Research in Primary Care
  • 2. Overview • Strategic context for health research • Overview of HRB • Primary care research in Ireland • Examples of primary care research linked to practice
  • 3. Health Research Plans • HRG Action Plan for Health Research 2009-2013 • HRB Strategic Business Plan 2010 -2014 • National Research Prioritisation Exercise 2012 Set the strategic direction, goals, targets and actions to reap the health, social and economic benefits of our investment in health research
  • 4. 1. Patient-oriented research 2. Population Health 3. Health Services Research • Projects • Applied Programmes • Centres/networks • Short courses/workshops • Fellowships and Career Awards • Research Infrastructure • EU/International opportunities
  • 5. HRB Strategy - Key Themes • Increase high quality, interdisciplinary health research • Enhance research partnerships, collaborations and networks • Focus on translation and application of knowledge • Enhance use of existing health and social data • Increase evidence-informed policy and practice
  • 6. HRB Annual Income 1999-2012 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1 2 3 4 5 6 7 8 9 10 Total Income (€M) Year Capital (€M) Revenue (€M) 1999 2001 2003 2005 2007 2008 2009 2010 2011 2012
  • 8. Overview of HRB grant funding portfolio Projects & Programmes • Health Research Awards • Definitive Interventions • HRB/Medical Research Charity Group Awards Training/Career Development • Cochrane Training/Cochrane Fellowships • PhD Fellowships for Health and Social Care professionals (P/T and F/T) • Structured PhD Scholars -SPHERE • ICE Awards (post doc) • Research Leaders (Pop Health / HSR) • Clinician Scientists Centres and Research Networks • HRB Centre in Health and Diet Research • HRB Centre in Primary Care Research • All Ireland Institute in Hospice and Palliative Care – research network • Trials Methodology Network • Clinical Research Facilities (Dublin, Cork, Galway) • Clinical Trials Networks EU/International Opportunities • Horizon 2020 • Wellcome Trust • US Ireland
  • 9. Global and national context for primary care • Demographics – ageing population • More people living with chronic diseases • Shift in model from acute care to primary / community and self care • Shift from illness model to health and wellbeing • Emphasis on health promotion and behaviour change (lifestyle factors)
  • 10. Case for primary care research • Need for an evidence base to support practice • Evidence to underpin clinical practice and healthcare policy must be obtained by R&D in primary care • Quality standards and protocols derive from research • Need research to inform policy on staffing, organisation or primary care • Process of conducting research important as the outcome • Involvement by primary care professionals in research leads to faster dissemination and adoption of research evidence
  • 11. Issues for primary care research in Ireland* • Lack of infrastructure • Difficulties getting evidence implemented • Limited capacity of the primary care community to conduct research • Lack of any system for provision of payments to GPS to engage in research • Clinical academic career structure in primary care ‘unattractive’ * Mant Report 2006
  • 12. HRB developments • Increased funding for health services, clinical research and patient research • Practical support through the TMRN (Trials Methodology Research Network) • Support for population or community based studies through the CRFs (Clinical Research Facilities) • Support for Primary care professionals through funding schemes, e.g. HPFs (note: few applications from GPs) • Investment in Centre for Primary Care Research (10 years, €8 million) • Establishment of the Irish Primary Care Research Network
  • 13. Themes in primary care research • Harnessing technology to improve primary care practice and health outcomes (e.g. access to primary care diagnostics) • Chronic disease management and multi-morbidity • Role of primary care in reducing inequalities in terms of access and health outcomes • Safer primary care (patient safety) • Evaluation of primary care reforms • Mental health and primary care • Workforce management in primary care • Role of primary care in health promotion and behaviour change
  • 14. Examples of HRB funded primary care research projects • Framework for community involvement in decision making in primary care (Anne MacFarlane, Limerick) – Examined user involvement projects for quality, user experience and impact on service – Design a framework for the HSE to implement high quality user involvement projects • Developing and evaluating a complex intervention to influence quality and quantity of anti-microbial prescribing (Andrew Murphy, Galway) – Examining prescribing practices for urinary tract infections in Ireland and other countries – Evaluating interventions to reduce the amount of antibiotics prescribed • Towards early intervention for youth mental health (Walter Cullen, Limerick) – Developing an intervention to address barriers to ‘early intervention’ for mental and substance use disorders among young people
  • 16. CPCR • Includes RCSI, TCD, NUIG and QUB • Focusing on – Safer medicines (safer prescribing, medicines management) – Safer diagnosis ( clinical decision support systems; generating and applying clinical prediction rules) – Evaluating intervention studies - in an elderly cohort, in a population of poorly controlled diabetes patients – More rational use of antibiotics – Managing multi-morbidity • Established the Irish Primary Care Network
  • 17. iPCRN (Irish Primary Care Network) www.icprn.ie • Collaboration between the ICGP, the HRB Primary Care Research Centre (in RCSI) and WestRen (NUIG) • Aims to: o Establish a national network of GP practices whose purpose is to participate in clinical research for the benefit of their patients and o To enhance general practice through research training and activity • The iPCRN: o Facilitates GP's in maintaining The Medical Council's requirements for professional competence - particularly in in the areas of audit and research o Enables GP's to become more involved in planned research trial activities in the community o Enhances collaboration among network partners through access to literature, resources and training materials in research methodology o Provides General Practice with new applications/tools to audit and manage their patient care
  • 18. Conclusions • Clear need for primary care research to improve service delivery • Key themes and questions for primary care research in Ireland • Need to encourage more primary care professionals (GPs, nurses, therapists, dentists) to engage in health services and clinical research • Need to work in multi and interdisciplinary partnerships for better research • Much improved environment for primary care research - support and infrastructure