Completing the feedback loop: research, audit and evaluation in family medicine

J A Dickinson 狄堅信

Most Family Physicians are not interested in research: they regard it as largely irrelevant to their activities. And they are right. Most medical research is distant from their needs and may take years to become relevant, if ever. The front line needs information that is immediately useful to improve practice.

But improving the quality of practice is difficult. By the very nature of family practice, we are affected and limited by the system in which we work. Our population, the local epidemiology, our training, health care organisation and the funding arrangements make practice in each country different from others. Therefore, although the basic biological factors in our patients are the same as in other places, many aspects of what we do are different from other countries, and even from hospital clinics. Thus although we can learn from other specialties, and from family practice in other countries, much cannot be directly applied here. Consequently, we require research and evaluation in the Hong Kong front line.

A substantial amount of research has been done in Hong Kong general practice, and many Family Physicians have participated in research projects: through answering questionnaires or undertaking data gathering for projects in their practice. Several local practitioners have undertaken projects or written theses, for various diploma and master’s courses either locally or around the world. Even more have undertaken evaluation and audit projects. First-timers find that they take more energy than expected, and are pleased to finish. Once completed, many of these reports have been put into a drawer and not seen again. Thus there are many valuable projects examining Hong Kong practice that few know about.

However, the feedback loop is only completed when others know about the outcome: whether positive or negative, so we can all learn from the results. An audit of diabetes control, of prescribing for hypertension or of antibiotics is not only useful for the person doing it, but also for others in similar situations, who can learn from it too. This makes the whole effort more worthwhile. Thus, one of the least emphasised components in research and audit projects is one of the most important: dissemination to all those who could use the information. For Hong Kong Family Medicine research, this means you: practitioners in our community.

Ideally outcomes should be published in a journal read by doctors who are concerned by the issue, and discussed with that audience in scientific meetings. Despite journals such as this one, which regularly publish articles about such work, compared to other specialties the process does not work well in Family Medicine, for understandable reasons.

Many doctors feel dubious about writing up their project. After all, writing is a skill that takes effort to acquire, even for those who are writing in their native language. Therefore to assist those who have something to communicate, but are uncertain about writing it, a workshop on writing papers will be most valuable. For such a workshop to become successful, participants need to have an idea, and preferably a draft beforehand, so that the workshop is focused on specific needs.

Communication of results at conferences is another skill, which also needs to be learned. Fortunately it is not too difficult. Scientific conferences mostly provide either ten-minute slots for presentation, or posters. Both of these are deliberately limited, to ensure that presenters focus on the main point, so as not to waste effort of either themselves or their audiences. A good meeting is thus fascinating because every fifteen minutes a new topic and new presenter come up. Posters are even better: viewers can pass quickly and focus on those with a relevant message, then talk in detail with the author if desired.

Most practitioners are not researchers, nor do you need to be, but you may well be interested in the outcomes of research and audit activities, to learn how you might improve your own practice. Many Hong Kong doctors attended the WONCA conference that Hong Kong hosted in 1995, though not many presented their own work. That conference showed the value of doing and learning about research in our field. Since then, there have been few opportunities in Hong Kong to demonstrate and feed results back to frontline doctors: completing the first stage of the feedback loop. Hong Kong should have more of these conferences and all Hong Kong practitioners like yourselves should participate to share and exchange useful information and results.