- Email: [email protected]
Primary care diabetes research: Making an impact on society
p r i m a r y c a r e d i a b e t e s 2 ( 2 0 0 8 ) 1–2
available at www.sciencedirect.com
journal homepage: http://www.intl.elsevierhealth.com/journals/pcd/
Editorial
Primary care diabetes research: Making an impact on society
This issue of Primary Care Diabetes contains an important article on priorities for diabetes primary care in Europe [1]. On the basis of information gathered from the literature and on expertise obtained from experts, the article by Van Eygen et al. very much meets the aims of this journal and Primary Care Diabetes Europe in improving the care for people with diabetes mellitus within the Primary Care setting. From their consultation process, the authors were able to identify essential elements of high-quality diabetes care: prevention, patient empowerment, care provided by an interdisciplinary team, quality monitoring and the need for better information and communication technology. Given the diversity of healthcare systems in Europe and the status of Primary Care within those systems, the level and speed of implementation of these priorities across Europe will depend on existing structures, will need a reform of the healthcare system in most countries, and will require investments in terms of finances, human resources and technology. Overall, existing systems and usual traditions will need to change in order to accomplish the goal of improving the care of people with diabetes. During the consultation process, important gaps in our knowledge and in the evidence available were identified by the authors [1]. Among them are the lack of reliable data on the cost-effectiveness of prevention in diabetes care, on the benefits of screening programs for diabetes, on the effectiveness and efficiency of patient education programs and the lack of knowledge about key measures to monitor the quality of care provided. Building on and expanding these results, the European Forum for Primary Care gathered recently in Vienna to systematically collect and discuss experiences or practices in European countries and to identify in more detail those which are either favourable or unfavourable for the situation of people with diabetes [2]. The group was first able to summarize that the care of people with diabetes is organized differently across Europe. The level of organization varies widely and apparently depends on both the development of the healthcare system and the magnitude of professional involvement.
Not surprisingly, official data on the prevalence of diabetes vary widely too, because sources of data and the methods of data collection differ. Regardless of the level of care achieved, diabetes is believed to be underdiagnosed; therefore, the prevalence and its expected dramatic increase might even be underestimated. The quality of care provided and adherence to guidelines are basically unknown and seem to be unsatisfactory. Overall, countries that have a monitoring system and that are registering people with diabetes have a better picture than countries without such a register. Some positive developments were identified by the European Forum for Primary Care (Position paper 2007–2008, unpublished). There is a trend in many European countries to introduce disease management programs or at least some structured programs for the care of people with diabetes, to offer specific guidelines for primary care produced by General Practitioners, a trend towards patient empowerment and a trend to recognize General Practitioners as valuable coordinators of structured-care programs. However, the lack of reliable epidemiological data on diabetes for reasons of comparison, of data on outcome measures for the quality of care provided and, in general, the lack of high-quality research at the primary care level in many countries is astonishing. As a consequence, the group recommends the standardization of sources of data for calculation of prevalence and incidence of diabetes in order to make them comparable across European countries; initiatives to improve the quality of care such as guidelines and structured programs, or the identification of common goals at the national level should be developed by an interdisciplinary team including all parties involved for better acceptance and adherence. Interventions and research in general at the primary care level should be encouraged and supported universally to improve the evidence and knowledge base for decisions in Public Health. Overall, these recommendations again call for a change of current systems, established structures and routine practices. Why are these evidence based initiatives adequate publication of their outcome in this journal important? Ideally, to achieve the ultimate goal of biomedical research, the health
1751-9918/$ – see front matter © 2008 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.pcd.2007.12.002
2
p r i m a r y c a r e d i a b e t e s 2 ( 2 0 0 8 ) 1–2
of the population should be improved, in this case that of people with diabetes. This requires both the generation of new knowledge and its efficient transfer into practice—which means translation, application and implementation of scientific discoveries—in order to promote a change for the better in the practices of health professionals, in patient behaviour or society as a whole [2]. Primary care clearly requires more research activities in general [3] but to accomplish that, simply publishing results from clinical trials or of basic or clinical studies in scientific journals (regardless of Impact Factor) is not enough. In order to bridge the increasing gap between research data obtained and practice reality, the conclusions and consequences of research results have to be implemented at the population level [4,5]. This proves to be difficult and usually requires system changes and healthcare reforms. Along that path, and with a commitment to a shared vision, traditional barriers for change and gaps have to be identified, goals have to be established and a new model has to be proposed and developed. Following this stepwise process of translating evidence into reality, both society and professionals have agreed as a first step upon the goal of improving the quality of care of people with diabetes. As an essential second step, we have seen that more research is needed to identify gaps or to assess programs or outcomes. The third step to date is almost completely unknown: a shared vision of a new model for the care of people with diabetes at the community level. Once implemented, such a development would have a huge impact on patients and society. Widespread discussion of such a new model among colleagues is a prerequisite for that and its publication is of relevance to society as measured by a new instrument, proposed to be the ‘Societal Impact Factor’ [5]. Applied health research,
in particular primary care research, is ideally suited not only to acquire scientific knowledge as such, but also to develop and assess the usefulness and implementation of scientific achievements within the foreseeable future. The paper by Van Eygen et al. in this issue of Primary Care Diabetes in particular is a step in that direction and has the potential for societal impact.
references
[1] Van Eygen et al., Priorities for diabetes primary care in Europe, PCD xxx, this issue. [2] M. Maier, Men’s health and gender medicine: scientific impact or societal impact? J. Mens Health Gender 3 (2006) 330–331. [3] J.M. De Maeseneer, M.L. van Driel, L.A. Green, C. van Weel, The need for research in primary care, Lancet 362 (2003) 1314–1319. [4] R. Smith, Measuring the social impact of research, Br. Med. J. 323 (2001) 528. [5] Royal Netherlands Academy of Arts and Sciences Amsterdam, The societal impact of applied health research: towards a quality assessment system, 2002, Available at http://www.knaw.nl/publicaties/pdf/20021098.pdf.
Manfred Maier Department of General Practice and Family Medicine, Centre of Public Health, Medical University Vienna, ¨ Wahringerstrasse 13a, A-1090 Wien, Austria E-mail address: [email protected] 13 December 2007 Published on line 14 January 2008
available at www.sciencedirect.com
journal homepage: http://www.intl.elsevierhealth.com/journals/pcd/
Editorial
Primary care diabetes research: Making an impact on society
This issue of Primary Care Diabetes contains an important article on priorities for diabetes primary care in Europe [1]. On the basis of information gathered from the literature and on expertise obtained from experts, the article by Van Eygen et al. very much meets the aims of this journal and Primary Care Diabetes Europe in improving the care for people with diabetes mellitus within the Primary Care setting. From their consultation process, the authors were able to identify essential elements of high-quality diabetes care: prevention, patient empowerment, care provided by an interdisciplinary team, quality monitoring and the need for better information and communication technology. Given the diversity of healthcare systems in Europe and the status of Primary Care within those systems, the level and speed of implementation of these priorities across Europe will depend on existing structures, will need a reform of the healthcare system in most countries, and will require investments in terms of finances, human resources and technology. Overall, existing systems and usual traditions will need to change in order to accomplish the goal of improving the care of people with diabetes. During the consultation process, important gaps in our knowledge and in the evidence available were identified by the authors [1]. Among them are the lack of reliable data on the cost-effectiveness of prevention in diabetes care, on the benefits of screening programs for diabetes, on the effectiveness and efficiency of patient education programs and the lack of knowledge about key measures to monitor the quality of care provided. Building on and expanding these results, the European Forum for Primary Care gathered recently in Vienna to systematically collect and discuss experiences or practices in European countries and to identify in more detail those which are either favourable or unfavourable for the situation of people with diabetes [2]. The group was first able to summarize that the care of people with diabetes is organized differently across Europe. The level of organization varies widely and apparently depends on both the development of the healthcare system and the magnitude of professional involvement.
Not surprisingly, official data on the prevalence of diabetes vary widely too, because sources of data and the methods of data collection differ. Regardless of the level of care achieved, diabetes is believed to be underdiagnosed; therefore, the prevalence and its expected dramatic increase might even be underestimated. The quality of care provided and adherence to guidelines are basically unknown and seem to be unsatisfactory. Overall, countries that have a monitoring system and that are registering people with diabetes have a better picture than countries without such a register. Some positive developments were identified by the European Forum for Primary Care (Position paper 2007–2008, unpublished). There is a trend in many European countries to introduce disease management programs or at least some structured programs for the care of people with diabetes, to offer specific guidelines for primary care produced by General Practitioners, a trend towards patient empowerment and a trend to recognize General Practitioners as valuable coordinators of structured-care programs. However, the lack of reliable epidemiological data on diabetes for reasons of comparison, of data on outcome measures for the quality of care provided and, in general, the lack of high-quality research at the primary care level in many countries is astonishing. As a consequence, the group recommends the standardization of sources of data for calculation of prevalence and incidence of diabetes in order to make them comparable across European countries; initiatives to improve the quality of care such as guidelines and structured programs, or the identification of common goals at the national level should be developed by an interdisciplinary team including all parties involved for better acceptance and adherence. Interventions and research in general at the primary care level should be encouraged and supported universally to improve the evidence and knowledge base for decisions in Public Health. Overall, these recommendations again call for a change of current systems, established structures and routine practices. Why are these evidence based initiatives adequate publication of their outcome in this journal important? Ideally, to achieve the ultimate goal of biomedical research, the health
1751-9918/$ – see front matter © 2008 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.pcd.2007.12.002
2
p r i m a r y c a r e d i a b e t e s 2 ( 2 0 0 8 ) 1–2
of the population should be improved, in this case that of people with diabetes. This requires both the generation of new knowledge and its efficient transfer into practice—which means translation, application and implementation of scientific discoveries—in order to promote a change for the better in the practices of health professionals, in patient behaviour or society as a whole [2]. Primary care clearly requires more research activities in general [3] but to accomplish that, simply publishing results from clinical trials or of basic or clinical studies in scientific journals (regardless of Impact Factor) is not enough. In order to bridge the increasing gap between research data obtained and practice reality, the conclusions and consequences of research results have to be implemented at the population level [4,5]. This proves to be difficult and usually requires system changes and healthcare reforms. Along that path, and with a commitment to a shared vision, traditional barriers for change and gaps have to be identified, goals have to be established and a new model has to be proposed and developed. Following this stepwise process of translating evidence into reality, both society and professionals have agreed as a first step upon the goal of improving the quality of care of people with diabetes. As an essential second step, we have seen that more research is needed to identify gaps or to assess programs or outcomes. The third step to date is almost completely unknown: a shared vision of a new model for the care of people with diabetes at the community level. Once implemented, such a development would have a huge impact on patients and society. Widespread discussion of such a new model among colleagues is a prerequisite for that and its publication is of relevance to society as measured by a new instrument, proposed to be the ‘Societal Impact Factor’ [5]. Applied health research,
in particular primary care research, is ideally suited not only to acquire scientific knowledge as such, but also to develop and assess the usefulness and implementation of scientific achievements within the foreseeable future. The paper by Van Eygen et al. in this issue of Primary Care Diabetes in particular is a step in that direction and has the potential for societal impact.
references
[1] Van Eygen et al., Priorities for diabetes primary care in Europe, PCD xxx, this issue. [2] M. Maier, Men’s health and gender medicine: scientific impact or societal impact? J. Mens Health Gender 3 (2006) 330–331. [3] J.M. De Maeseneer, M.L. van Driel, L.A. Green, C. van Weel, The need for research in primary care, Lancet 362 (2003) 1314–1319. [4] R. Smith, Measuring the social impact of research, Br. Med. J. 323 (2001) 528. [5] Royal Netherlands Academy of Arts and Sciences Amsterdam, The societal impact of applied health research: towards a quality assessment system, 2002, Available at http://www.knaw.nl/publicaties/pdf/20021098.pdf.
Manfred Maier Department of General Practice and Family Medicine, Centre of Public Health, Medical University Vienna, ¨ Wahringerstrasse 13a, A-1090 Wien, Austria E-mail address: [email protected] 13 December 2007 Published on line 14 January 2008