Ten most notable family medicine research studies in Canada

Composition of the committee

Representatives from the SOR and the Health Policy and Government Relations (HPGR) department of the CFPC developed a framework for inclusion and identified an initial short list of articles. Members of the SOR Council and research directors from the 17 Canadian departments of family medicine reviewed the preliminary list and suggested additional studies.

Report

The top 10 most noteworthy family medicine research studies are presented in this article and illustrate the unique contribution that Canadian family medicine research brings to health care in Canada. They have helped advance the quality of health care and improve care delivery, beneficially influencing health care practices, health care policy, and patient experiences. These Canadian studies in family medicine have contributed to improving the delivery of family medicine in Canada and throughout the world.

1. A primary care pragmatic cluster randomized trial of the use of home blood pressure monitoring on blood pressure levels in hypertensive patients with above target blood pressure.³ In this award-winning paper by Dr Marshall Godwin and colleagues, it was demonstrated that home blood pressure (BP) monitoring did not improve BP compared with usual care at 12 months’ follow-up, but that it might improve BP monitoring in men. Further studies are needed.

2. Does episiotomy prevent perineal trauma and pelvic floor relaxation? First North American trial of episiotomy.⁴ Dr Michael Klein questioned the use of episiotomy in childbirth, which was being widely used, because he suspected that it caused many of the problems it was supposed to prevent. He and his colleagues carried out the first North American trial of episiotomy in childbirth. The work of Dr Klein and colleagues is often credited for the dramatic reduction in the use of episiotomy.

3. The impact of patient-centred care on outcomes.⁵ Published in 2000 by a team of family medicine researchers at Western University, this study was one of the first to demonstrate that the patient-centred clinical method improved health outcomes. Since the publication of this study, patient-centredness has become a foundation of the practice of family medicine.

4. The Kahnawake Schools Diabetes Prevention Project: intervention, evaluation, and baseline results of a diabetes primary prevention program with a Native community in Canada.⁶ Published in 1997 by Dr Ann Macaulay and colleagues, this study demonstrated the feasibility of implementing a community-based diabetes prevention program in an aboriginal community through the use of participatory research.

5. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP).⁷ This very large, well designed study, which involved 39 communities in 2 Canadian provinces, demonstrated how, at the community level with the support of family doctors, a simple BP test in older adults could be taken in a setting like a pharmacy by trained volunteers and could decrease death and hospitalization from heart disease.

6. The impact of not having a primary care physician among people with chronic conditions.⁸ Carried out by researchers at the Institute for Clinical Evaluative Sciences, this 2008 study shows how important having a family doctor can be in avoiding emergency department visits, reducing health care costs, and reducing demands on the health care system.

7. Building a pan-Canadian primary care sentinel surveillance network: initial development and moving forward.⁹ This study demonstrated the feasibility of the development of a pan-Canadian primary care research network that would help researchers collect longitudinal data from practices across Canada to assess the primary care epidemiology and management of 5 chronic diseases: hypertension, diabetes, depression, chronic obstructive pulmonary disease, and osteoarthritis.

8. Principles for the justification of public health intervention.¹⁰ This study by Dr Ross Upshur focuses on the intersection of primary care and public health, particularly with respect to the interrelationship between ethics and evidence. These principles are colloquially and widely referred to as the Upshur principles.

9. Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care.¹¹ Ontario has been on the leading edge of primary care reform with its family health teams, aiming to demonstrate how teams of caregivers can improve performance and health outcomes in primary care. This rigorously designed study demonstrated the effectiveness of an intervention delivered by nurse facilitators in improving preventive care procedures in primary care settings.

10. Prevalence of multimorbidity among adults seen in family practice.¹² This study was the first in Canada to examine multimorbidity in the adult population receiving primary care from family physicians. It demonstrates the complexity of problems common in the Canadian population that confront family physicians daily.

Limitations

The studies selected for this retrospective were based in large part on a framework for inclusion that would support advocacy in government and policy areas. Suggested topic areas, geographic parameters, and time frames restricted the choices, eliminating some studies that might have been equally notable. In addition, the included studies were chosen in a fairly arbitrary fashion, and there might be equally or more important studies that have been missed.