What is the relationship between research activity and quality of care in English general practice? A mixed methods study

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

6E.6

Presenter:

Peter Bower

Twitter:

@bowercpcman

Co-authors:

Jonathan Gibson, Cassandra Kenning, James Jamison, Jennifer Jones, Evangelos Kontopantelis, Matthew Sutton, Annette Boaz, Paul Little, Christian Mallen, Richard J McManus, Sophie Park, Juliet Usher-Smith, Bolanle Odebiyi, Peter Bower

Author institutions:

University of Manchester, University of Cambridge, University College London, London School of Hygiene & Tropical Medicine, University of Southampton, Keele University

Problem

There is evidence that healthcare organisations that take part in research demonstrate better performance. However, most evidence derives from hospital settings. We aimed to assess whether levels of research activity in general practice are associated with a range of organisational and patient-reported outcomes, and to explore possible mechanisms of impact

Approach

We used a mixed methods approach, informed by a logic model.

We accessed two datasets on research activity (NIHR Clinical Research Network data, and RCGP Research Ready Status) and a range of datasets on outcomes (including quality, patient experience, prescribing, staff retention, and hospital use).

We explored the relationships with cross-sectional analyses (exploring relationships between cumulative recruitment over a number of years and outcomes) as well as panel and instrumental variable analyses (exploring relationships between annual research activity and outcomes in subsequent years). Panel and instrumental variable analyses were better able to test causal links.

We also recruited general practices from across England and interviewed professionals and patients to understand their perspectives on research activity in general practice and its relationship with outcomes.

Findings

In cross-sectional analyses, research activity was associated with a number of outcomes, in line with the evidence in hospitals. The cross-sectional results were not highly dependent on a particular measure of research activity, but the associations were generally modest in magnitude.

However, using panel and instrumental variable techniques providing a more rigorous test of the link between research activity and outcomes did not provide strong support for a causal relationship.

Although staff and patients identified different mechanisms by which research might improve outcomes, respondents did not support any mechanism strongly. The most salient impact among professional respondents was that research activity provided relief from clinical pressures and supported their well-being and work satisfaction.

Consequences

Patients raised concerns that research activity might distract practices from clinical work, reducing access to care. We found no evidence of such impacts.

Levels of research activity in general practice are fairly modest in all but a small number of practices, and highly variable year-on-year. It remains possible that more significant increases in research activity will demonstrate larger impacts. There may be a tension between policy goals of increasing the number of practices engaged in research and increasing the scope of research activity in practices.

Given workforce pressures, the benefits of research activity on well-being could usefully be the focus of further research and development.

Submitted by:

Pete Bower

Funding acknowledgement:

This abstract reports independent research funded by the NIHR Policy Research Programme (ARAPAHO NIHR201428). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the DHSC