Australia, like most other developed economies, is facing rising health care costs and an increased demand for health care services due to lifestyle factors, ageing and the changing burden of disease of our population. Primary health care with its place firmly in the community, is the backbone of all health care in Australia, a vital part of a unified health system, and as evidence demonstrates, an essential function of and support to the wider health system in rising to meet these contemporary challenges. To guide our national response to increasing health need and growing system costs it is critical that research is both driven by, and informs, primary health care policies and practice. This can only be achieved through robust Australian-based primary health care research, which reflects our policy priorities and responds to the needs of our community’s needs, using diverse research methods.
The global challenge of translating and implementing research into policy and practice has been acknowledged by the developing field of translational/ implementation research. This emerging field seeks to address the translation and implementation gap by using scientific methodologies that support the application of evidence-based research into policy and practice in order to benefit individuals and society (Brownson and Allen 2012) (Rubenstein and Pugh 2006); an approach endorsed by the McKeon review and further supported by international evidence,
“There is a need for increased funding support of research that is likely to significantly promote public and individual health, and translational research specifically aimed at implementing evidence.” (McKeon review p181)
APHCRI is playing an increasingly important role in addressing this gap in Australia through leading, funding and supporting priority-driven research into primary health care, with three key objectives to,
- Support priority-driven primary health care research
- Increase the capacity to undertake primary health care research
- Drive the implementation of research into primary health care policy and practice.
APHCRI’s research funding programs seek to fund research which addresses national health priorities in a way which allows more opportunity for research to be translated into policy and practice. This document describes several of the APHCRI-funded research projects and programmes which have had a direct policy/ practice outcome. It also outlines initiatives which have been taken as part of APHCRI’s strategic direction to establish and set up systems to improve the potential for the implementation of future funded research.
Building the future of primary health care research
APHCRI has undertaken a body of work with research stakeholders and users to consider how dedicated primary health care research may be funded, informed and delivered in Australia in the coming years, with a particular focus on how to improve the implementation of research. This has led to the following discussion paper and thought pieces,
The Centres of Research Excellence Program
The APHCRI funded Centre of Research Excellence (CRE) program funds research which seeks to enhance knowledge exchange between researchers and the wider primary health care sector to better enable effective implementation of research outcomes into policy and practice. Some examples of how this has been achieved include the Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC) which has contributed to the development of the National Health and Medical Research Council’s (NHMRC) Clinical Practice Guidelines for the Management of Overweight and Obesity for Adults, Adolescents and Children in Australia. This CRE’s research has also informed the development of the RACGP SNAP (Smoking, nutrition, alcohol, physical activity) guidelines on management of overweight and obesity in General Practice.
Similar impacts have been demonstrated by the Centre of Excellence for accessible and equitable primary health care service provision in rural and remote Australia. This CRE developed a new typology of settlement size and location that determines incentive payments for rural and remote medical practitioners, an issue identified by the Senate Community Affairs Committee Inquiry into the Factors Affecting the Supply of Health Services and Medical Professionals in Rural Areas (see link). The new “Monash model” focuses on developing improved measures of access to underpin workforce, service delivery and resource allocation programs in rural and remote areas.
Further outcomes from the APHCRI funded CRE programs can be found in the following research project reports,
- the Centre of Research Excellence in Primary Health Care Microsystems
- the Centre of Research Excellence in Indigenous Primary Health Care Intervention in Chronic Disease
- the Centre of Excellence for accessible and equitable primary health care service provision in rural and remote Australia
- Other completed research programs can be found here.
CRE research impact video clips
Many of the CREs have also had a regional/ local impact. In the following clips you can view some of the direct impacts of CRE funded research on both primary health care policy and practice. The CREs in the clips are still actively engaged in their research programs, so work is not yet complete. However, these clips provide an insight into the research project and process by explaining,
- What problem were the researchers trying to understand?
- What did the researchers do?
- What did the research find?
- What impact did the research findings have?
Short term research projects focusing on implementation
Tasmanian Sub-Acute project - An example of policy into action
A solid example of APHCRI’s performance in driving the implementation of research into PHC policy into practice is demonstrated through the Streamlined sub-acute pathways research in Tasmania project, funded by the Department of Health.
This project identified current pathways and barriers, gaps and system inefficiencies through data collection and analyses. Practical strategies to address these and improve sub-acute / post- hospital care were developed into a model for implementation that would deliver improved patient experiences and outcomes and more efficient service utilisation. Workshops, focus groups, interviews and surveys were used to supplement the quantitative analyses with the perspectives and needs of all the stakeholders involved.
The recommendation from this research and consultation with stakeholders was for an evidence-based, systematic approach to integrating rural hospitals and community nursing service into acute systems, using community nurse-led in-reach to get patients into appropriate sub-acute / post-hospital care. The nurse-led in-reach effort is targeted to older patients with defined chronic conditions whose length of stay in acute care exceeded 10 days.
This model, initially implemented at the Royal Hobart Hospital, has now been expanded to the two other major hospitals in Tasmania. Ongoing action learning circles to address problems as they arise and evaluation of effectiveness and efficiency are built into the model.
The preliminary data show that it is very cost-effective. Reductions were observed on acute hospital inpatient length of stay and total episode cost (acute and community components combined). The net benefit ranged between $553 and $5,109 per patient with the average estimated net benefit across all case types of $2,230 per patient and an average estimated 2.67 day reduction in length of stay.
This approach builds on current strengths and capacities and is therefore sustainable. It also addresses the degeneration experienced by long-stay acute care patients that hinders their subsequent recuperation and in doing so, delivers cost savings and more acute care beds.
Clinical leadership: supporting the uptake of evidence into practice
Clinical leadership is recognised as fundamental to driving service redesign in the health care sector and for improving patient outcomes. A trial Implementation Adviser role was developed by the APHCRI and the ACT Medicare Local, designed to support the uptake of evidence into practice and enhance capacity at the primary health care organisation-level to use research effectively to improve quality and outcomes. An evaluation of this approach can be found here.
Research to policy translation events
‘APHCRI Conversations’ is a regular program of presentations held at the Commonwealth Department of Health to facilitate exchange between researchers and academics working in the area of primary health care and Department policymakers. Topics are developed jointly with the Department of Health and involve a range of speakers who are experts in their field including researchers and academics from the CREs.
Working with communities and consumers
One of APHCRI’s core objectives is to develop and embed consumer and community participation at all stages and every level of primary health care research. Doing this well is not always easy but it is essential to ensure that research is relevant and meets the needs of all stakeholders.
In order to help researchers who receive APHCRI funding to meet this objective and to ensure their active involvement with consumers, patient groups and community members in a structured, comprehensive and measurable way, APHCRI has funded three workshops over the past two years. These workshops are run by the Consumer and Community Participation Program at The School of Population Health, University of Western Australia and the Telethon Institute of Child Health Research.
Attendees learn about the various ways and levels of consumer participation, how to address some of the barriers that hinder this participation such as the need to use language that is readily understood, how to find consumers willing to participate in the research cycle, and how to begin the process of involving them.
Over 60 researchers have attended these workshops, which have been greatly valued and highly evaluated. Many have said they will be more active in ensuring community engagement in the future while others have had their current approaches to consumer participation validated.
Some workshop participants have spoken about how attending the workshops has changed the way they will do research in the future.
Learning and sharing through research networks
The International Implementation Research Network in Primary Care (IIRNPC) is an international collaboration of primary health care researchers and stakeholders with a shared vision of advancing the field of implementation research and its specific application to bridging the gap between primary care research, policy, and practice in order to speed translation and transformation of care.
The IIRNPC‘s overall purpose is to create an international learning collaborative to enable primary health care to effectively fulfil its central functions in equitable and sustainable health systems through the sharing of research that informs policy and service development and improves the quality of health care.
Sharing through this network has led to a number of events and initiatives including the following:
Professor Nancy Edwards, University of Ottawa; Scientific Director, Institute of Population and Public Health, Canadian Institutes of Health Research. Using an implementation research framework, Prof Edwards’ presentation focuses on how considerations of contexts, systems and networks can advance research efforts in primary health care. Implementation research addresses what works, for whom, under what circumstances and how strategies can be scaled-up to improve equitable health outcomes.
APHCRI has hosted several international visitors to Australia to contribute to decision making in primary health care research and implementation, through learning and sharing from international experiences and perspectives. This has included,
- Dr Hernan Montenegro, Health Systems Advisor at World Health Organization
- Professor Walter Rosser from School of Medicine, Queen’s University, Canada
- Professor Rick Glazier Senior Core Scientist Program Lead the Institute For Clinical Evaluative Sciences (ICES), Ontario, Canada
Embassies Program; USA
The ‘Embassies Program’ held in Washington DC in 2014, was an initiative designed to: inform US health policy makers of the successes and challenges in other countries in implementing health care reforms; have host embassy leaders learn about health care innovation; and, identify international collaboration opportunities for translating innovations between countries.
‘Conversations’, hosted by three Embassies (Australia, The Netherlands, Denmark), were held between a national health leader from the host country and US policy makers and Senators, presenting an opportunity for US policy makers to learn from a number of countries, at an important moment in US health care reform. The conversations included an in-depth review of experiences of the three host nations in developing and innovating primary health care as the core function of their health care system. Click here to see more about the program.
As part of fulfilling its mandate to drive the implementation of research evidence and outcomes into primary health care services planning and delivery, APHCRI has established partnerships with international research centres in primary health care. APHCRI routinely offers International Visiting Fellowships for Australian early career researchers at the following centres,
- The Robert Graham Center (RGC), Washington DC
- Radboud University Medical Centre (Radboudumc), Nijmegen, The Netherlands
- The Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
National Network: KERTI
Effective researchers and research users (from policy makers to consumer representatives) understand that research is only part of the answer to complex health issues and continually seek to enhance their practice in knowledge exchange, translation and implementation.
The KERTI network is a supportive, informal national network of people with a shared vision of improving primary health care policy and practice through routine application of relevant research. The network name acknowledges the fundamental elements of research application—knowledge exchange (KE), research translation (RT), and implementation (I)—KERTI. The purpose of KERTI is to share learnings, identify mutual priorities, test innovation in the field and build the capacity of researchers as well as research users. Importantly, it seeks to cultivate a systems-wide knowledge exchange culture that values multi-level engagement between policy, management, practice, research and consumer perspectives. Central to this culture is an attitude that views research as a resource to be utilised.
The KERTI network held an inaugural meeting in 2014 aligned with the NHMRC Research Translation Symposium, its second meeting was held at the 2015 primary health care research conference. Future meetings are planned aligned to related national conferences/ symposia.
For more information on KERTI please contact the secretariat Julie McTaggart at firstname.lastname@example.org.
Capacity Building to further implementation
Research capacity relates to building skills in the research competencies required by individuals and teams to conduct research, this includes the system-level infrastructure (e.g. funding) and organisational (i.e. contextual) decision making which supports and determines what research will be conducted.
Understanding the research workforce and its future capabilities
The primary health care research workforce project was initiated by the APHCRI Research Advisory Board (RAB) in 2014. The project’s main objectives were to attain a better understanding of the current PHC research workforce composition, competencies and challenges, and to highlight gaps and future needs, including building skills and competencies to improve research implementation, to ensure that the PHC research needs in Australia are able to be adequately recognised and met.