Priorities for primary care respiratory research published
A global prioritisation exercise has identified the current respiratory research needs of primary care healthcare professionals worldwide
A paper published in npj primary care respiratory medicine has identified and prioritised the current respiratory research needs of primary care health professionals worldwide. The areas of focus include common chronic respiratory diseases (such as asthma, chronic obstructive pulmonary disease (COPD)) and other respiratory conditions (including infections and lung cancer).
Chronic respiratory diseases cause an estimated 7.7 million deaths worldwide every year. Primary care around the world has an important role in preventing, diagnosing and managing these diseases within their diverse healthcare settings.
Consensus is needed around research priorities to identify evidence gaps, and the corresponding evidence-based guidelines, quality standards and training to support primary care practice worldwide. The published prioritisation exercise aims to help guide researchers, funders, and policymakers, with the ultimate goal of improving clinical guidelines and patient care globally.
Clinicians from 27 high-, middle- and low-income countries were asked their opinions on the most common respiratory conditions they encountered in their clinical practice as well as what they thought were the most clinically important. They were also asked to suggest research questions relevant to the conditions they identified. The questions were grouped into prevention, diagnosis, management, self-management and prognosis related to the key conditions.
An e-Delphi prioritisation exercise was carried out between May 2019 and August 2020 in which 112 practicing healthcare professionals suggested research questions. A panel of 27 academic experts refined the questions, which were then prioritised over three rounds of ranking.
Participants came from a wide range of backgrounds, roles, experiences and global regions: all the main continents were represented. There was a balance of high-income and low- and middle-income countries represented, and nearly two-thirds of participants came from low- and middle-income settings.
Asthma was identified as the most frequently encountered respiratory condition, as well as being perceived as the most clinically important by healthcare professionals. In contrast, the greatest number of research questions submitted were based on COPD management, followed by asthma self-management, and asthma management and prognosis.
Six cross-cutting themes relevant to primary care clinicians were identified from the questionnaire:
- A need for education and accessible guidelines tailored for the primary care context
- Gaps in evidence for preventing, diagnosing and treating respiratory conditions in primary care
- A focus on locally relevant evidence to inform decisions
- A focus on locally relevant and practical solutions for primary care, and particularly in low-resource settings
- A need to improve patient empowerment to manage their own conditions, and
- The growing importance of a wider multidisciplinary healthcare team
The findings reflect the wide range of problems encountered in primary care, from prevention through to management of complexity, and emphasise the need for influencing behaviour change among both patients and clinicians.
The themes and research questions that have arisen from this study will now be a guide for researchers and funders when planning research and allocating resources. The hope is that research inspired by this exercise will be relevant to primary healthcare professionals which will improve the chance of it being implemented effectively, contributing to the respiratory health of patients globally.
Researchers from the Asthma UK Centre for Applied Research contributed to the prioritisation exercise along with colleagues from the International Primary Care Respiratory Group (IPCRG) and the NIHR Global Health Research Unit on Respiratory Health. Professor Hilary Pinnock, general practitioner, Professor of Primary Care Respiratory Medicine, and Centre Lead for Optimising management of asthma attacks, was involved in the exercise. She said:
This prioritisation exercise is very welcome! It has the potential to influence the research agenda so that studies will be funded that will provide professionals with relevant evidence on the diagnosis and management of the respiratory conditions that are such an important part of our day-to-day work in primary care. It is particularly encouraging that professionals globally prioritise research that supports patients to take greater control in the management of their conditions.
Read the paper
Abdel-Aal, A., Lisspers, K., Williams, S. et al. Prioritising primary care respiratory research needs: results from the 2020 International Primary Care Respiratory Group (IPCRG) global e-Delphi exercise. npj Prim. Care Respir. Med. 32, 6 (2022). https://doi.org/10.1038/s41533-021-00266-4