New research collaboration focuses on advancing and strengthening primary care

Research has shown the strongest evidence for improving health outcomes in the population is by strengthening primary care.

Canadians see a primary care provider at multiple points in life from well-baby visits to end-of-life planning. A primary care provider could be a family physician, nurse, dietitian or other trained health professional, and the first called when people have a health concern.

The McMaster University Department of Family Medicine is launching the David Braley Primary Care Research Collaborative, a research collective focused on advancing and strengthening primary care in Canada and across the globe through proactive research programs relevant to the issues of today.

Research in primary care is critically important to improving health. When people have access to strong primary care, they can address a health concern before it leads to a trip to the hospital. So, not only does primary care keep people healthy, it saves health care dollars."

David Price, professor and chair of the Department of Family Medicine

Researchers, clinicians and staff in the department are engaged in practice-based research focused on building innovative systems of primary care. The team is working on initiatives to enhance the care that people receive, to improve access to health care particularly for people in greatest need and to change the way the next generation of physicians are trained.

Through the David Braley Primary Care Research Collaborative, the department will bring together researchers, clinicians, educators and partners to work on issues that will address the diverse needs of our community.

"By bringing people together, this collaborative will help to answer really important questions in primary care that will absolutely improve patient outcomes," said Paul O'Byrne, dean and vice-president of McMaster's Faculty of Health Sciences.

Capacity building and mentorship are key goals of the collaborative, says Dee Mangin, professor and associate chair of research for the department.

"Primary care clinicians ask questions every day," she said. "We are constantly wondering how to provide the most effective treatment for a patient given their life context, or how to better educate our future family physicians. The collaborative aims to empower clinicians, educators and researchers to turn these wonderings into research that will answer those questions for all of us."

The David Braley Primary Care Research Collaborative is launching with a $4 million investment, seeded by a $1 million donation from Hamilton businessman David Braley. This collaborative is the first of its kind in Canada, with the largest endowment supporting a research collaborative in primary care.

"David Braley has long been a supporter of primary care, and I would like to thank him for his generous support in establishing this collaborative", said McMaster University President David Farrar.

Already underway, the following research studies illustrate the work of the collaborative:

• CP@Clinic brings paramedics into subsidized housing on a regular basis to assess health risks and provide tailored education to low-income seniors. It has been shown to decrease 911 calls to the building by as much as 20%. The program is running in 35% of paramedic services across Ontario and is spreading across Canada.
  Principal investigator: Gina Agarwal, family physician, professor of family medicine
• TAPER is studying how to reduce the number of unnecessary medications a patient takes using a collaborative approach involving the patient, their family doctor, a pharmacist and an online tool to "pause and monitor" medications. Initial trials have shown promising results on patient quality of life, sleep, pain, treatment burden and cognitive ability.
  Principal investigator: Dee Mangin, family physician, professor and associate chair of research
• The prison health research program describes the health status and health care use of people who experience incarceration, to influence practice and policy to improve health outcomes. The goal is to prevent incarceration, improve health care in prisons, and support health and community reintegration for people at the time of prison release.
  Principal investigator: Fiona Kouyoumdjian, family physician, assistant professor of family medicine
• Indigenous Teaching Through Art (ITTA) is a program for faculty, clinicians and staff to increase their knowledge about Indigenous people in Canada through visual art and culture at the Woodland Cultural Centre in Brantford. The program is being evaluated by questionnaires, focus groups and interviews.
  Co-created and co-facilitated by: Amy Montour, family physician, assistant professor of family medicine, Oneida Nation, Six Nations of the Grand River; Lorrie Gallant, artist and storyteller, Cayuga Nation, Six Nations of the Grand River; Joyce Zazulak, family physician, professor of family medicine
• Health TAPESTRY brings trained volunteers into the homes of older adults to improve connection to interprofessional health care teams and community resources. The results have shown that participants in the program visited their primary care team more and were admitted to the hospital less. The program has just completed a scale up to six sites across Ontario.
  Principal Investigators: Doug Oliver (implementation lead), family physician, associate professor of family medicine, David Price (executive academic lead), family physician, professor and chair of family medicine, Dee Mangin (evaluation lead), family physician, professor and associate chair of research

The Department of Family Medicine includes the Divisions of Palliative Care and Emergency Medicine. The department operates three clinics in Hamilton: McMaster Family Practice, Stonechurch Family Health Centre and the Maternity Centre of Hamilton. The department's residency program includes seven sites across Ontario, training over 200 family medicine residents each year as well as a number of enhanced skills positions. The research enterprise manages over 10 million dollars in grant funding annually.