Fristående ledare publicerad i the Lancet i september 2014

Denna fristående ledare skrivern av Richard Horton publicerades i the Lancet 20 september 2014:
1082 Vol 384 September 20, 2014
Offline: How to save primary care research
Some years ago, I attended a meeting of WONCA in
the cold, remote wastelands of Canada. WONCA is the
World Organization of National Colleges, Academies, and
Academic Associations of General Practitioners/Family
Physicians. The objective of the 3–day conference was to
produce a research strategy for primary care. But instead of
a positive discussion about important research questions
to be asked and inventive ways one might choose to
answer them, it became a festival of complaint about the
victimisation of general practitioners—how they were
ignored and marginalised, powerless and poor, misjudged
and misunderstood. After 72 h trapped in this snowbound
enclave, a reasonable person might have decided never
to open the dark and depressing closet of primary care
research ever again. But then Lars Lindholm called.
Instead of grumbling, Lars brought together the
Universities of Umeå, Linköping, and Göteborg in 2009
to create Sweden’s first National Research School in
General Practice. The goal of the School, funded by the
Swedish Research Council, was to upgrade the quality of
research in general practice by recruiting a new generation
of brilliantly trained researchers. The School wanted to
change the culture of general practice research in Sweden
by establishing a creative and sustainable environment
for study. Multidisciplinary and interdisciplinary research
would be encouraged. And research students would not
be exposed only to Swedish general practice research. They
would be given opportunities to work side-by-side research
mentors overseas at international centres of excellence.
Since 2010, 50 PhD students have joined the School.
Ten more are joining this month. Half will complete a “predoc”.
The research students are not all doctors. There are
six nurses, three physiotherapists, three psychologists, and
two occupational therapists. Although the programme
began with only three medical schools, now Örebro,
Uppsala, Lund, and (to a lesser extent) Karolinska take
part too. Advanced courses are provided in quantitative
and qualitative methods, screening and prevention, and
implementation science. The “pre-doc” is not like a student
elective; it is a 2–3-month research attachment designed
with a specific project in mind. The 2014 “pre-docs”
worked in Chicago, Melbourne, Sydney, Pretoria,
Las Vegas, Nijmegen, Edinburgh, and Southampton.
Further attachments are planned in Phoenix and
Auckland. The School has delivered at least three unique
opportunities for its students. First, research collaborations
overseas, with exposure to new attitudes, techniques, and
facilities. Second, access to senior scientists outside their
own university and field of study. Third, personal tuition
on writing research and getting published. The School has
already defeated one of the worst afflictions in science—
unproductive competition (or “harassing each other”,
as Lars Lindholm put it). Pro-Deans Lars Dahlin (Lund
University) spoke of the importance of cooperation at a
time when national health systems were becoming increasingly
fragmented; Patrik Danielson (Umeå University)
emphasised the School’s aim to produce national research
leaders; and Eric Hanse (Göteborg University) stressed the
value of internationalisation.
The proof of these fine ambitions is, of course, in the
research itself. 13 students have defended their doctoral
theses successfully so far. Last week in Gothenburg, the
School came together to showcase the findings of its newest
students—overdiagnosis of abdominal aortic aneurysm, the
role of religious belief in medical care, nutrition in Swedish
nursing homes, among many other projects. The School
could evolve in several directions. If stretched, funding
from the Swedish Research Council will last until 2017.
The immediate challenge is therefore to secure long-term
financial security. But beyond survival, one can also envisage
the School becoming a national accountability mechanism
for Swedish primary care, building the means to monitor
and review progress and setbacks in health-care delivery
outside the hospital. The Swedish National Research School
has also inspired others. Several scientific disciplines in
Sweden plan to adopt the same idea of a national research
school. In 2013, the Norwegian Research Council funded a
Norwegian Research School in General Practice, modelled
on that of its Swedish neighbour.
Under the banner of
“Building Bridges to Lift a Specialty”, this Swedish initiative
deserves to be studied and copied widely as a means to
strengthen primary care research. At long last, it’s time to
put complaining behind us.
Richard Horton