Advancing knowledge translation in primary care
Advancing knowledge translation in primary care
Matthew Menear, MSc⇓ Kelly Grindrod, MSc Kathleen Clouston, PhD Peter Norton, MD CCFP FCFP France Légaré, MD PhD CCFP FCFP
Canadian Family Physician June 2012 vol. 58 no. 6 623-627
Across Canada, efforts are under way to strengthen primary health care (PHC), from the Divisions of Family Practice in British Columbia and family health teams in Ontario to family medicine groups in Quebec and collaborative family physician–nurse practitioner teams in Nova Scotia. Much work is needed though, as international comparisons suggest that Canada lags behind other developed nations in PHC performance and infrastructure.1,2 Canada’s historical lack of investment in PHC research, particularly in the domain of family medicine, has contributed to the current predicament.3 Compared with other health care disciplines, the past decade has seen a disproportionately low level of funding earmarked for family medicine research and few programs providing family physicians with advanced research training.3
In response, Canada’s premier health research agency, the Canadian Institutes of Health Research (CIHR), has recently committed to helping Canada become an international leader in the generation and translation of high-quality PHC research by 2020.4 In line with this commitment, CIHR hosted a Summer Institute on Primary Health Care Research for Canadian research trainees in June 2010. The Summer Institute’s theme was chosen by CIHR, which then nominated a leader to help organize the meeting. This leader, Dr Peter Norton, created a Steering Committee consisting of 4 other senior PHC researchers (Drs Earl Dunn, Moira Stewart, Rick Glazier, and Fred Tudiver) who together established the meeting’s objectives and design (Box 1). The result was a 4-day capacity-building initiative that brought together 30 trainees and 13 faculty leaders to focus on the next frontiers in PHC research. Trainees were graduate students, postdoctoral fellows, and clinician scientists (eg, family physicians, nurses, pharmacists), representing a range of disciplines and institutions. Faculty were distinguished researchers in the PHC field and led plenary sessions, directed animated group activities and discussions, and mentored trainees throughout the meeting. Plenary sessions were interactive and allowed trainees and faculty to address many conceptual, methodologic, ethical, and practical issues relevant to PHC research.
At the forefront during the Summer Institute was the importance of translating research knowledge to improve primary care practice. The CIHR has defined knowledge translation (KT) as a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.5
In essence, KT is about moving knowledge to action. In recent years, the “knowledge-to-action” process has been conceptualized by many authors, notably by Graham and colleagues5,6 who have developed a framework describing the dynamic process from knowledge creation to application (Figure 1).6 Knowledge creation has 3 phases: knowledge inquiry (the production of primary studies of variable quality), knowledge synthesis (the aggregation of existing knowledge, such as through systematic reviews and meta-analyses), and knowledge products and tools (which present knowledge clearly in user-friendly formats, such as clinical guidelines or patient decision aids). As knowledge moves through each stage it is refined and becomes potentially more useful to target knowledge users. This knowledge is then fed into an action cycle that describes activities to facilitate uptake into practice (eg, adapting knowledge to local contexts, evaluating outcomes).6
Figure 1. View larger version: In this page In a new window Figure 1. The knowledge-to-action framework
Reprinted from Graham et al6 with permission.
Box 1. 2010 Summer Institute objectives and design
Objectives
To explore key concepts and current issues in PHC research
To discuss key methodologies and methodologic gaps in PHC research
To discuss the implications of PHC research and knowledge translation on health policy and practice
To provide a high-quality interdisciplinary learning environment that offers trainees the opportunity to interact with students from diverse backgrounds and leaders in PHC research
Knowledge translation is critically important given the many gaps that exist between what we know and what is actually done in primary care.7 For example, considerable guidance exists for family physicians with respect to childhood immunizations, anticoagulation medication monitoring, post–myocardial infarction care, and diabetes and depression care, yet Canadian studies have shown variations in care and quality gaps in each of these areas.8–11
At the Summer Institute trainees and faculty discussed the challenges and opportunities of KT in primary care. In particular they reflected on the ways in which the primary care context differed from that of other health care sectors and how these differences could influence the “practice” of KT (helping stakeholders become aware of research knowledge and facilitating its use to support practice and health improvements12). Following the Summer Institute, 3 trainees (M.M., K.G., and K.C.) and 2 faculty members (P.N. and F.L.) decided to continue discussing KT practice in primary care contexts. Together, we also reflected on the value of advancing the “science” of KT in primary care (or KT research—studying the determinants of knowledge use and effective methods for promoting the uptake of knowledge12).
