Primary care research in the era of translational medicine, challenges and successes

This is my last editorial, after serving as Editor in Chief of Family Practice for the past 6 years. Victoria Neale, Professor in the Department of Family Medicine and Public Health Sciences, Wayne State University, and one of our current Associate Editors will be taking over as Editor in Chief from 1 April. Victoria is a very experienced editor and is a graduate in Social Psychology and Public Health, but I’ll leave it to her to spell out her plans for the journal in due course. From my point of view, I take it as a sign of how much the editorial team at the journal has developed that we have a new editor-in-chief from the USA. Family Practice is the ‘international’ ‘academic’ journal of family medicine, and I’ve always kept that central to our editorial processes. When I took over in 2004, the first thing I did was to move the journal to online submission and develop a larger editorial team.1 In fact, since 2008, our editorial assistant Ms Vivienne Tsimbili has been based in Athens. In general, this has worked well and opened up the journal to a far more diverse range of submissions. There has also been a significant increase in the quality of published papers, matched by an increase in impact factor. In many respects, these changes to Family Practice have reflected the increasing use of information technology in our lives and have had significant impact on the way that we practice and conduct research. My area of research has moved significantly over the past 6 years from health outcomes research in dyspepsia to clinical research informatics and the role of information technologies in translational research (both using clinical data for research and decision support).2 We have recently obtained €7M from the European Commission for the TRANSFoRm project ‘Translational Medicine and Patient Safety in Europe’ (www.transformproject.eu). TRANSFoRm sets out to establish a means of integrating clinical information systems with research systems across Europe and to develop methods to integrate decision support for diagnosis into GPs health record systems.3 A significant part of this work will be to develop systems that can take knowledge, in the form of clinical prediction rules and use them to support diagnosis, not in the ‘clunky’ and time consuming way we have come to expect from our current electronic health record interfaces but quietly and seamlessly in the background. We know that GPs are as prone to error in diagnosis as in any form of human judgement; the challenge is to find ways of mitigating that fallibility.4–6 The project itself brings primary care researchers into the heart of advances in research methods and is in itself a manifestation of technological change. Organizing and running large international projects using e-mail, wiki, video conferencing over internet protocol, etc. is increasingly achievable.7 Universities will always be under financial pressure, and as academics, we need to ensure that we remain focussed on that fine line between the future and the present. I feel honoured to belong to a discipline that enables me to take both a generalist overview and to narrow down the focus on specific problems for research. The greatest challenge in family medicine is how we guide and support patients through bewildering array of multiple subspecialties, investigations and therapies. As specialist medicine has retreated into ever-smaller domains of expertise, it has been family medicine that has had to shoulder the burdens of speedy and more accurate diagnosis, long-term conditions and co-morbidity. The solution to this challenge is not for family medicine itself to subspecialize but to use innovation and technology to extend the role of the generalist, in much the same way that technologies make life easier to collaborate together in larger research projects. The use of decision assistive technologies, ‘smarter’ health record systems, personal health records and new ways of communicating with patients will be the future.8-10 In order to create that future, we need to continually hone and develop our skill-base as an academic discipline. Just as in the 1990s we saw many training in qualitative methods or epidemiology, we also need to consider training in informatics so that we can guide this developing field.11,12 So now you know part of what I’ll be doing post-Family Practice, co-ordinating a big European Union project and trying to increase my research skills by borrowing from another discipline. Following my move to King’s College London last year, I will also be head of general practice in a joint Department of Primary Care and Public Health Sciences. Although I will no longer be responsible for some sadly lengthy decision times (and Victoria has a plan to fix this problem), I will continue to contribute the journal cover image. Perhaps, this is fitting since the one thing I resisted changing when I first took over in 2004 was the cover!13 Funding: none. Ethical approval: none. Conflict of interest: none.