Several countries have undertaken major health system transformations in the past decade, often including experiments with primary care to try to improve their outcomes. These system transformations hold lessons for other countries to share. Examples include the United Kingdom and The Netherlands which are reducing primary care patient panel size and moving more to group practice models. Australia recently created primary health care organisations with geographies of accountability, borrowing from the United Kingdom and Denmark and is also creating 'superclinics' with broader primary health care team capacities. The Dutch are receiving new payments to support chronic care management through practice consortia.
However one of the most critical issues impeding improvements in health today is the enormous inconsistency between those interventions which we know can optimise population health and health care delivery and those which are actually implemented in everyday practice (Green et al 2009[i]). Further, it is well documented that only a fraction of primary care research is translated to policy and practice (Woolf 2008[ii], Green et al 2009). Implementation research seeks to address this gap by using scientific methodologies that support the movement of evidence-based research into policy and practice in order to benefit individuals and society (Brownson et al 2012[iii], Rubenstein and Pugh 2006[iv]).
No single set of methods define implementation research however there are approaches to research that are more suited to a focus on implementation and which support the critical principles of relevancy and engagement with stakeholders.
Multiple stakeholders are involved in the development and implementation of new approaches to heath care including: patients/users of health care, community leaders, policymakers, primary health care professionals, scientists and experts in the field of implementation science. These stakeholders each represent vital, unique expertise in the design process and application of innovations in health care. Their interaction will ultimately determine the success of health care reform/improvement.
[i] Green LW, Ottoson JM, Garcia C, Hiatt R. Diffusion theory and knowledge dissemination, utilization and integration. Annual Review of Public Health 2009; 30: 151-174
[ii] Woolf SH, The Meaning of Translational Research and Why It Matters. JAMA. 2008;299(2):211-213. doi:10.1001/jama.2007.26.
[iii] Brownson RC, Allen P, Duggan K, Stamatakis KA, Erwin PC. Fostering More-Effective Public Health by Identifying Administrative Evidence-Based Practices: A Review of the Literature. AJPM 2012; 2012;43(3):309-319