So many manuscripts, so little space! How does an associate editor choose what articles are sent for review?

Family Practice—‘The international journal for research in primary care’, is broadly based in content and aims to inform readers about innovative and quality research in primary care worldwide. The journal is published six times per year with advance online access. It has an editorial board consisting of researchers from different countries to ensure diverse expertise as well as geographical representation. The journal wants to ensure that the editorial board has a broad understanding of the differences in health practice and health systems globally so that they are able to decide what research it should publish which would be of interest to an international readership. It is also the strategic intention of the editorial board to see Family Practice grow as an international journal for researchers in primary care. Like any business, the publishers of Family Practice also want to expand its market share in international subscriptions and one way to achieve this is to solicit submission of more manuscripts from countries other than the UK. So how are we travelling in this direction? Table 1 shows the number of manuscripts received from different countries and their acceptance and rejection rates over the past 5 years. It is indeed encouraging to see the increase in manuscript submissions from the Asia–Pacific region, including Hong Kong and Korea, China, and European countries such as Poland, Spain, Germany and Belgium. Accordingly, one can be pleased that Family Practice is now definitely becoming more international. So, now that we have increased manuscript submissions from so many countries, how does the editorial board decide which articles to reject and which ones to send for review to ensure quality as well as interest to an international readership? As a member of the editorial board of Family Practice representing the Asia–Pacific region for >10 years, the last few as associate editor, I must consider this question when a new research paper comes to me for decision as to whether it is suitable for Family Practice and so whether it should be rejected immediately or sent to reviewers. This decision is not always straightforward and associate editors must use their own judgement and experience. Decisions based on scientific quality measures are relatively straightforward as there are generally agreed criteria for research methodology. However, the question of what type of research would be of interest to an international readership requires a more subjective decision. Useful questions for me to consider are: Is the content of sufficient interest to an international Family Practice readership? Is the topic of significant importance in influencing primary health care practice? Does the paper demonstrate novel methodology that can be shared among Family Practice researchers? Does the paper inform us about different primary health care systems? Should this paper go to a specialist journal where the content requires reviewers with specialist expertise? Should this paper go to a local journal where the results would have more relevance and influence for local health care delivery? So what types of research are of interest to an international readership? From my point of view, the research can have a number of characteristics. One such characteristic is novel methodology to address old or common problems. For example, Collings et al.1 in New Zealand trialled an ultra-brief guided self-help intervention to address subthreshold mental health syndromes in a primary care setting with promising results. In this current edition, Reid et al.2 in Canada conducted a randomized controlled trial and found that a brief minimal-contact intervention, combining a self-help booklet and telephone coaching, is an effective way to treat mild behavioural problems among young children. These are interventions we can either replicate or use to generate new questions in our own countries. Another area of interest is research examining how health care delivery can be improved for certain sections of the population who present frequently to the primary care system, such as children and the elderly. In this edition, Andersen et al.3 in Denmark report their cross-sectional study on how GPs assessed overweight children in the 5-year-old child health examination and highlight that one-third did not raise the issue of being overweight with their parents. This finding echoes that of other countries where management of childhood obesity remains a problem when parents and other family members are not engaged. Similarly, many countries share the same concerns regarding quality use of medicines among the elderly population, highlighted by Mira et al.,4 who showed that physician–patient communication failure led to medication errors in older polymedicated patients with multiple morbidities in Spain. The area of clinical care guideline development is relevant across different countries , in particular, the manner in which input is obtained from patients (consumers) and primary care health professionals, as guidelines are often developed by specialists. Two papers in this edition highlight research performed with international collaborations on guideline development. Lam et al.5 conducted focus groups in seven locations worldwide and reviewed the proposed new frontier of diagnoses of anxious depression and bodily stress syndrome in the International Classification of Diseases–Primary Health Care version 11 (ICD-11-PHC), providing practical feedback consensus about the time frame being too short for primary care professionals to reach the diagnosis of bodily stress syndrome. Similarly, semi-structured interviews were conducted by professionals from five countries led by Tonkin-Crine et al.6 to discuss what perspectives they need to have when attempting to implement interventions to introduce guidelines for the use of antibiotics in respiratory tract infections. The roles played by GPs and other primary care health professionals are highlighted in this piece of international research. The journal should also provide the opportunity for researchers to share useful and interesting information about their different health systems. Ways of managing with limited resources, different methods for organization and remuneration of primary care doctors and other health care workers, and systems of referral for specialist consultation and interaction with the hospital and aged care sectors will vary considerably between different countries. Not only are these differences of interest to readers when they consider the strengths and deficiencies of their own country’s primary care system, but there also may be elements that can be used to improve that system. Researchers may be interested to know what kind of research manuscripts would not be perceived as appropriate or of sufficient interest to an international Family Practice readership and would not be sent for review. Putting scientific quality measures aside, these are often studies that are being done in a local community and are of predominantly local significance, such as surveying the way their practitioners are performing in a specific clinical area or seeking to change local practice. This research may have impact on local communities and influence local education and training but will not be transferable to other health systems and is therefore better suited to a local journal. Some well-compiled papers are rejected and the authors are advised to seek publication elsewhere because the topic suits a specialized journal and requires reviewers with specialist expertise. In summary, publishing for an international readership in a broad generalist journal such as Family Practice requires balancing several considerations. Family Practice is published only six times a year and the editorial board has to make decisions to assess both quality and interest to an international primary care research readership. The editorial board seeks to broaden the base for contributions while ensuring that the journal provides information that is directly relevant to the improvement of primary health care delivery around the world. Outcome of submissions by country in any given year from 2007 to 2012 Bold numbers indicate the total manuscripts received for that year. Outcome of submissions by country in any given year from 2007 to 2012 Bold numbers indicate the total manuscripts received for that year.