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Primary Care Research

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A practice-based research cohort of patients may have advantages over the traditional PBRN model

The North Carolina Primary Care Practice-based Research Network (PBRN) has developed a new model for conducting primary care research, which may offer advantages over the traditional PBRN model, according to a study supported in part by the Agency for Healthcare Research and Quality (HS13521). Primary care PBRNs are groups of practices that join to carry out practice-relevant research. However, traditional PBRNs have found it difficult to enroll sufficient racial and ethnic minorities. They also tend to focus more on physicians and physician services such as office function, quality of care, and health services research than on patients and health behavior. Finally, they tend to be costly, inefficient, and demanding of practitioners' time.

In 2001, the North Carolina PBRN began recruiting adult patients in 15 of its family practices to participate over several years in multiple PBRN research projects on chronic disease and related health care problems commonly addressed in primary care settings. This approach offers advantages over traditional PBRNs such as a patient rather than physician focus, a structure that places few demands on practices, ability to target racial and ethnic minorities, and better-defined patient populations. However, the cost of development and maintenance is significant, notes Philip D. Sloane, M.D., M.P.H., of the University of North Carolina.

The original group of recruited patients answered a questionnaire about demographics, risk factors, health status, and quality of life. Followup of enrolled patients has been maintained for 3 years. In 2004 and 2005, the cohort was refreshed by adding eight new practices. Of the 10,649 eligible patients approached in 2001, 5,575 consented to be included in the cohort. Blacks, Latinos, and older people were enrolled at rates paralleling the State's adult population. Over 3 years, cohort members were included in multiple studies and 77 percent of the original group remained active. The per-subject enrollment cost varied between $27 and $45. Annual program maintenance costs were about $35,000.

More details are in "Development of a practice-based cohort for primary care research," by Dr. Sloane, Leigh Callahan, Ph.D., Leila Kahwati, M.D., M.P.H., and C. Madeline Mitchell, M.U.R.P., in the January 2006 Family Medicine 38(1), pp. 50-58.

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